Insuring the Parents of Children with Special Needs

According to the most recent survey conducted by the U.S. Department of Health and Human Services, 13.9 % of children in the U.S have special health care needs. These needs vary and can include a range of conditions including chronic physical, developmental, behavioral, or emotional challenges.  The special needs of these children typically require health and related services for an indeterminate and, often, an extensive period of time.

Underwriting parents of special needs children can be a bit more complex than traditional underwriting.  The two areas of complexity are the situational medical issues the parents themselves sometimes face and the unique aspects of financially underwriting a much longer term need.

Medically speaking, parents of special needs children face a myriad of taxing issues that can manifest as situational anxiety and/or depression due to the stress and strains that are placed on them.  Parents often seek medical attention to help them cope with these issues; this includes traditional psychotherapies along with taking medications to help them manage these situational diagnoses.  While seeking medical attention is the correct step to take, it can often lead to adverse consequences when securing life insurance to fund a Special Needs Trust (SNT).

“I work almost exclusively with special needs families,” said Mitch Weisbrot, CLU, a Special Care Planner with MassMutual, “and I estimate that 25% of the parents utilize medication to maintain emotional balance, which helps prevent stress-related illnesses.  They shouldn’t be punished by underwriters for doing everything possible to live long, healthy lives.”

Many of these same parents also face additional financial challenges that can affect both their current and future planning goals. In traditional life underwriting, the need for personal coverage is typically a multiple of income or net worth.   However, parents who have children with disabilities are trying to provide a lifetime of multifaceted and expensive care for individuals who will never be self-sufficient.   The insurance proceeds are not intended to drastically improve a person’s living arrangement, but rather to maintain their current standard of living.

When dealing with a special needs child, there are many future costs which need to be considered. These costs can include, but are not limited to, care management, medical equipment, medication, social enrichment, legal fees, and professional support.   The expenses related to an individual’s holistic care might increase at a greater rate than inflation, and additional needs might come to light over time. For example, a child with muscular dystrophy will see a significant increase of associated costs. By age 10, the child may lose the ability to walk and by their teenage years, that child may lose all mobility. The result is a child needing very little expenditures on equipment as a toddler, to a large sum of money to be spent as they age.

The biggest challenge here is not only trying to predict the timeliness of the parent’s death, but also the life expectancy of the child, two inherent factors which lead to a prediction of the future needs and costs to support the child. For instance, as noted in the above example, a child with muscular dystrophy may only live into their mid-twenties, whereas someone with Down syndrome can live well past fifty. Therefore it is necessary for an underwriter to understand the unique circumstances of these families in order to underwrite these cases outside of the typical guidelines.

Life insurance is the most common financial tool that is used to fund a third party special needs trust.  For many families, making modest premium payments for life insurance may be the only way they can leave a large sum of money for the benefit of their special needs family member.  The amount of coverage and the cost of coverage for clients are based on an insurance company’s financial and medical underwriting standards, so knowing how to strategically approach the underwriting process can make a significant difference in the type, amount, and cost of coverage that is obtained for each client.

There is both an art and a science component to underwriting a life insurance policy.  All too often life insurance carriers are primarily focused on the “science” side. They follow the underwriting guidelines provided in their manuals without any regard for the unique factors that affect the case.  Unfortunately this can lead to unfavorable underwriting offers and subsequently higher premiums for an already-stretched client. However, if an advisor understands the “art” component–divided into 6 areas below–he or she can increase the odds of a better outcome for the client.

1. Knowing the underwriters at the carrier is critical. Underwriters are just like you and me. They have life experiences and unique personalities that affect their outlook on things. At some insurance companies, underwriters are given discretion to be creative at times and work outside the prescribed guidelines if they feel a case warrants it.  If you know which underwriter is more compassionate or which underwriter is the parent or relative of a special needs child, this can make all the difference.

2. Presentation counts. Make      a good impression by including a cover letter to clearly describe the      desired outcome. Make sure to outline the medical issues and how you      believe they should be viewed. Address medical or financial issues upfront      and provide a clear explanation of all the positive factors that should      mitigate these risks. Putting this information in a cover letter helps      prevent the underwriter from forming a bad first impression.

3. Know your client. The more you know about your client, the      better you are able to defend that client. Asking the right questions will      provide valuable information to use when negotiating the best offer. What      do you know about his or her involvement in the community?  Have they missed any time at work due to      anxiety or depression?  What      activities does he or she participate in? Does he or she have a happy family      life? What type of special needs does the child have?  How will it progress and what resources      will be needed?   Will the child relocate      to a different state (e.g., Alabama to California) to be with local      relatives should the parents die? The more information you can find out      about your client, the more likely you are to build a story that will help      an underwriter feel more comfortable assessing the risk.

4. Don’t argue. Negotiate. A      few years ago, the argument approach was very successful; however, as      reinsurance started discovering an increase of unwarranted exceptions,      audits to the frontline insurance carrier became more prevalent. As a      result, carriers need to better document why they are deviating from their      guidelines and making a more aggressive offer than they normally would.      Thus, you need to negotiate your way to a better offer. Also, make sure to      understand and point out what the standard mortality is for your client’s      age, and negotiate to a conclusion that your client’s underlying medical      condition does not significantly increase his or her mortality from the      standard population.

5. Read the medical records. It is not unusual for medical      records to contain incorrect or incomplete information. Doctors write information      for themselves; they do not consider that someone else may read or      interpret their notes down the road. Although most agents and advisors are not given direct access to      their clients’ medical records, clients and/or new business expeditors      should review all medical records prior to underwriting submission to make      sure the information is consistent, logical, and pertaining to the correct      patient.

6. Deliver. Trials are the best method for      placing today’s big cases. Limit your trial to the top few companies that      are most likely to accept your case based on      their manual and the carrier that prices best, should you get the desired      offer. Once you get what you want, place the case. Underwriters see      thousands of trials a year and most do not get placed. If you stand out as      a person who places your trials, the underwriter is likely to spend more      time on the case to find credits and argue with his medical staff (on your      behalf) to get you the offer you need.

In closing, when it comes to underwriting the unique circumstances faced by the parents of special needs children, it is critical to know how to navigate the underwriting process to secure the best offer and the best type of coverage to meet your client’s planning goals

By Barry L. Goldberg for Agent eNews.  Barry is a Principal with and President of Independent Life Brokerage.

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