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Dr. Michael Fulks MDJul 14, 2020 11:03:00 AM1 min read

Globulin: A Warning Underwriters Cannot Ignore

How do you find a very expensive early mortality risk, most of which is the result of undiagnosed — but often widespread — malignancy? Many conditions have laboratory test findings at underwriting if you know where to look.

A great example of a test providing warning is serum globulin. Globulin testing measures total antibody (immunoglobulins) level with diffuse elevations often signaling the presence of a widespread solid cancer. Specific immunoglobulin elevations may suggest a hematologic malignancy such as multiple myeloma. Globulin testing is often done on insurance lab tests, but the telltale results are ignored or missed.

Oftentimes other lab findings or applicant history are not suggestive of disease, so globulin results are not addressed. Plus, an elevation of total globulin cannot be linked to one specific cancer or condition which might be rated. As a result, postponement for further clinical evaluation is required based only on globulin levels, which can be difficult to tell an agent and applicant.

But, applicants with the highest 0.5 percent of values (>3.8 gram/dL) have 4X increased mortality risk; would you ever want that potential risk without an evaluation? Unlike many tests, globulin values and relative risks are similar across age and gender so that a universal alert or postpone-for-evaluation cut-off values can be used.

This is low-hanging fruit for insurers. Learn more from our Journal of Insurance Medicine article, Serum Globulin Predicts All-Cause Mortality for Life Insurance Applicants, which includes risk and distribution for various globulin levels, and the extra risk also associated with very low levels.

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About the Author

Michael Fulks, MD, Consulting Medical Director, is board-certified in internal and insurance medicine. After leaving practice, he served as a medical director, creating or editing several underwriting manuals and preferred programs. For the past 13 years, Dr. Fulks has consulted for CRL, participating in its mortality research on individual tests and all laboratory test results, BP and build in combination. He is also involved in the development and implementation of automated screening tools for non-laboratory data.