Case Clinic:
Heart Diverticulum
Munich Re’s medical experts respond to challenging underwriting scenarios
meeting
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    This series presents individual medical cases that feature challenging conditions, uncommon diseases, or an unusual presentation of symptoms. Below, we summarize a case, explain our research and analysis, and suggest an underwriting recommendation. Munich Re’s team of global medical directors routinely conducts rigorous analyses of the latest medical advances so that primary insurers and society alike can benefit from evidence-informed risk assessments. It is our hope that exploring compelling cases will foster a greater understanding of medical research and awareness of new medical innovations and emerging risks while ultimately expanding insurability.

    Case: Small incidental left ventricular diverticulum

    A carrier approached Munich Re regarding the insurability of a 56-year-old male with a challenging heart history seeking $10,000,000 in coverage. We were asked “The proposed insured appears to be stable. Significant cardiac workup has been mostly negative with the exception of a small incidental left ventricular diverticulum described as muscular and not fibrous. It looks to have been stable for at least three years. We do not know what the rate or concern of rupture is or what treatment is available. Is this insurable?”

    Copies of the cardiac imaging were not provided but the client included a nice summary of his clinical records which included summaries of prior cardiac test results.

    Munich Re medical's response

    • Serous cystic neoplasms (SCNs) or serous cystadenomas are non-mucinous lesions with characteristic findings on imaging. They are multi-cystic with a honeycomb appearance, sometimes described as a “bunch of grapes.” Most commonly seen in women over 60 years old, these lesions have a negligible risk for malignancy.
    • Pancreatic cystic neoplasms are being detected more frequently and are mostly found incidentally due to the widespread use of abdominal imaging such as CT scans or MRIs. 
    • These cystic neoplasms of the pancreas are further subcategorized as either “mucin-producing cysts” (which may have malignant potential) or “non-mucin-producing cysts.”
    • Mucin-producing cysts, such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, may have malignant potential and must be monitored carefully.
    • Serous cystadenomas are in the non-mucin-producing cyst category and are considered benign with no malignant potential. 

    Final recommendation

    The Munich Re team recognized that serous cystadenomas can often be identified by their characteristic imaging features. For asymptomatic people with classic imaging features of a serous cystadenoma, no further work-up is advised. Non-mucinous producing cysts, such as a serous cystadenoma, have no malignant potential and can be accepted at standard risk class for mortality risk. Morbidity risk can be covered with an exclusion.
    The information provided herein is for general information purposes only and should not be relied upon as professional advice. Munich Re, and its employees, directors, officers, and representatives do not warrant, represent or guarantee the accuracy, completeness, or currency of any of the information provided herein and accept no liability whatsoever arising in any way from the use of or reliance on such information, including liability for direct, indirect, special, incidental or consequential damages. © 2024 Munich American Reassurance Company. All rights reserved.
    Contact the author
    Gina Guzman
    Dr. Gina Guzman
    Vice President & Chief Medical Officer
    Munich Re Life US
    Tim Meagher
    Dr. Tim Meagher
    Vice President & Medical Director
    Munich Re, Canada (Life)
    Bradley Heltemes
    Dr. Bradley Heltemes
    Vice President & Medical Director of R&D
    Munich Re Life US
    John F. White III
    Dr. John F. White III
    2nd VP & Medical Director
    Munich Re Life US

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