In life insurance underwriting, moderate alcohol use can lead to abnormal carbohydrate-deficient transferrin (CDT) test results, potentially impacting clients’ ratings. Advisors who understand the intricacies of CDT testing can guide clients through these challenges and position cases for more favorable outcomes.

CDT testing in underwriting

CDT is a biochemical marker used to detect recent moderate to heavy alcohol use through blood samples. Elevated CDT levels are often seen in individuals consuming 50–80 grams of alcohol over two weeks, which equates to about 4 to 6 glasses of wine or beer. 

In life insurance underwriting, results will be shown as normal or abnormal, and carriers usually won’t share the specific data ranges they look at. However, the medical field generally considers CDT levels above 2% abnormal. 

Typically, CDT testing is a reflex test requested by the carrier if there are other indicators of heavy alcohol use like high HDL or liver enzyme levels (GGT, AST, ALT) or documented heavy drinking in a physician's notes. 

Abnormal results may lead to standard ratings, table ratings, or even denial, depending on the client’s overall health profile. Understanding CDT tests and their underwriting implications can help advisors prepare clients and identify potential issues before testing.

Implications of elevated CDT results

Underwriting decisions can range widely for clients with abnormal CDT levels. Even if a client re-tests and receives normal results, the initial positive test remains part of the record, viewable by other carriers through MIB coding. Advisors must be prepared to present a holistic health profile to mitigate CDT results, especially when advocating for clients with otherwise good health.

Causes of elevated CDT beyond alcohol use

Abnormal CDT levels don’t always mean heavy alcohol consumption. Other factors, like liver disease, specific medications (anti-convulsants, ACE inhibitors), iron abnormalities, hepatitis C, and hormonal changes during menopause, may elevate CDT. These factors, combined with moderate alcohol use, can push CDT levels into abnormal ranges. Advisors should discuss these possible causes with clients to set realistic expectations before insurance lab testing.

Preparing clients for CDT testing

Proper preparation before a life insurance medical exam is critical to helping clients achieve the best underwriting outcomes. Here are some tips if alcohol usage is a concern: 

• Avoid alcohol: Advise mild drinkers to avoid alcohol for at least 48 hours before testing. Moderate drinkers should abstain from drinking for two weeks.
• Have transparent conversations: Encourage clients to be transparent about their alcohol intake and any conditions or medications that could impact test results as part of a proactive approach to underwriting.

Positioning abnormal results with carriers

When clients have elevated CDT levels, focus on their entire health profile. If a client shows no other signs of chronic alcohol use or maintains otherwise good health, advisors should advocate for more favorable ratings. Some carriers may be more flexible with moderate drinkers with a low-risk profile, while other carriers may not look at CDT testing at all–understanding carrier guidelines and their stances on CDT results can go a long way in helping a client secure coverage.

How Modern Life supports advisors 

Modern Life’s specialized underwriting knowledge and partnerships help advisors navigate CDT-related challenges. 

Modern Life recently handled a challenging case for a high-profile client with coronary artery disease (CAD). During underwriting, the lab work revealed an unexpected abnormal result for CDT. However, further investigation showed no corroborating evidence of heavy alcohol consumption in the client’s lab results or in the attending physician statements (APSs).

Leveraging our strong carrier relationships and an innovative underwriting program, we were able to address the carrier’s concerns and provide clarity on the client’s health profile. This collaborative effort ultimately resulted in the client securing a standard rating—ensuring appropriate coverage while overcoming significant hurdles.

Key takeaways

• CDT testing is a reflex test based on other health indicators.
• Prepare clients proactively before testing and discuss medications or health factors that may elevate CDT.
• Advocate for clients by focusing on their full health profile, not just CDT results.
• Leverage Modern Life’s underwriting expertise and strong carrier relationships.

For support navigating complex cases, connect with Modern Life. Our expertise can help position your clients for success, even with challenging underwriting hurdles.