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Difficulty: MediumSources of Underwriting Information

A specialized risk evaluator at a life insurance carrier is cross-referencing a newly submitted application with external data sources. The applicant indicated no history of cardiovascular disease on the medical questionnaire. However, the Medical Information Bureau (MIB) database reveals a code for a recent heart-related treatment. To comply with industry regulations, how must the evaluator proceed to resolve this conflicting information?

  1. Order an Attending Physician's Statement (APS) to independently verify the applicant's clinical history, as adverse decisions cannot be based solely on MIB reports.Answer
  2. B
    Void the application immediately, since the applicant's health statements are considered warranties that guarantee absolute historical accuracy.
  3. C
    Instruct the producer to unilaterally amend the medical questionnaire on the original application to match the MIB records.
  4. D
    Categorize the applicant's dishonesty as a physical hazard and issue a formal denial letter based exclusively on the MIB data.

Answer

The insurer must order an Attending Physician's Statement (APS) to independently verify the medical history because adverse underwriting decisions cannot be based exclusively on MIB findings.
The correct action is to obtain an Attending Physician's Statement (APS). The MIB serves to alert insurers to potential discrepancies, but industry rules mandate that MIB findings cannot be the sole basis for declining a risk or charging a higher premium. The insurer must independently verify the medical history.

Step-by-Step Solution

1
Identify the regulatory restriction regarding Medical Information Bureau (MIB) reports.
MIB data cannot be used as the sole basis for an adverse underwriting decision.
MIB rules require independent verification to protect consumers from potential coding or database errors.
2
Determine the appropriate source to verify the medical discrepancy.
An Attending Physician's Statement (APS) is required.
The APS provides primary source clinical data directly from the treating physician, satisfying the requirement for independent investigation.
3
Evaluate the incorrect regulatory assumptions in the other choices.
Voiding for a warranty breach, unilaterally altering the application, and misclassifying the hazard are all regulatory violations.
Applicant statements are representations, only applicants can authorize changes, dishonesty is a moral hazard, and MIB data cannot be the sole reason for denial.

Key Concept

The Medical Information Bureau (MIB) is an alert system for underwriters, but its reports cannot be used as the sole basis to decline an applicant or increase premiums; independent verification (like an APS) is mandatory.
Estimated Time:1m 15s
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Sources of Underwriting Information

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