Clinical Laboratory and
Biometrics Measures Used to Assess Risk
THERE WAS OVER $20.8 TRILLION OF LIFE INSURANCE in force in the United States in 2015 (
American Council of Life Insurers, 2016). Many of these policies were issued by insurance carriers whose medical
directors, actuaries, and underwriters are experienced in evaluating, underwriting, and managing risk.
Risk is determined by the overall current and likely future
health of the prospective applicant and is translated into what
the insurance carrier will charge in premiums to accept the
applicant’s overall risk. Most life, disability, and long-term care
insurance companies will focus on medical history, family history,
biometrics, and a critical assessment of the applicant’s clinical
laboratory. Additional tests like EKG, stress testing, cognitive
function testing, and others will often be ordered based on age
or past medical history.
This article will explore the past, present, and future of clinical
laboratory and biometric testing as they apply to life, disability,
and long-term care insurance underwriting.
Clinical Laboratory and Underwriting—A History
Insurance policies were generally issued with little or no enhanced
clinical laboratory testing up until the AIDS/HIV epidemic in the
early 1980s. Until then, insurance carriers often had their agents
or brokers send the home office a urine specimen to be quickly
analyzed via dipstick. With the advent of HIV, though, insurance
companies’ mortality, morbidity, and claims risk increased greatly,
and standard practice changed to test an applicant’s blood for the
HIV virus in addition to routine urine testing. Because blood
was now being tested, insurance companies’ medical directors,
actuaries, and underwriters looked for a group of tests in addition
to HIV that correlated with increased morbidity and mortality
in the general population seeking life, disability, and long-term
care insurance—and preferably at low cost. The basic laboratory
panel currently used by most insurance carriers is listed in Table
1. Blood and urine is most often drawn in the field (i.e., the appli-
cant’s home) to make it easier and more convenient for applicants.
Based on age and the clinical results, additional reflex tests may
be ordered. Reflex tests are tests that are automatically ordered
based on the predetermined levels of another test. The most often
utilized reflex tests are found in Table 2.
Standard Insurance Laboratory/Biometrics Panel
Test (Blood) Test (Urine)
• Glucose • UpH
• BUN • UPROT
• Creatinine • UCREAT
• ALP • UGLUC
• Bilirubin • UPROT/CREAT
• AST • ULEUK
• ALT • UHEMO
• GGT • Cotinine
• Total Protein
• Globulin Biometrics
• Cholesterol • BP Syst.
• HDL Cholesterol • BP Dias.
• LDL (Calculated) • Pulse
• TC/HDL Ratio • Height
• LDL/HDL Ratio • Weight
• Triglycerides • BMI