In general, a stroke refers to the death of brain tissue, due to lack of oxygenated blood reaching a particular area of the brain. They can either be characterized as a mini stroke — TIA (Transient Ischemic Attack) or full stroke — CVA (Cerebrovascular Accident). Strokes are one of the leading causes of death and disability in adults today.
A TIA, is a brief, temporary ischemic attack (less than 24 hours), that resolves itself without permanent damage to the brain or residual neurologic impairment. Most TIAs are due to a small temporary blockage of a cerebral or carotid artery that impairs neurological activity for a short period of time. Symptoms include temporary numbness, dizziness, weakness, blurry vision or dizziness, speech abnormalities and fainting. Because of the fleeting nature of TIAs, the Dr.’s diagnosis is usually made from history alone, rather than by physical exam or lab testing. Often it’s reported to the doctor by someone that observed the event and can recall the symptoms.
A CVA, in contrast, occurs when one or more blood vessels in the brain are blocked or rupture, and often lead to permanent damage. Lack of blood flow (ischemia) is the major cause of strokes, and atherosclerosis (plaque in the arteries) is the leading cause of cerebral ischemia. High blood pressure, smoking, diabetes, peripheral vascular disease (PVD) and heart disease are all major risk factors for strokes. Testing for CVAs will include CT scans, MRIs, carotid ultrasounds or Doppler testing and echocardiograms or stress tests. CVAs have similar symptoms as TIAs and can result in long lasting neurological impairments, memory loss, and paralysis.
The primary questions to be asked of a proposed insured that presents with a history of stroke are:
- Age of diagnosis?... and was it diagnosed as a TIA or CVA?
- Was this the first occurrence?...if not, when were prior instances?
- Any history of CAD, PVD, diabetes, hypertension, or smoking?
- Has there been follow up testing and have results been negative?
- Is there a known cause of the stroke?
- Is there any residual neurologic or cognitive impairment?
Strokes have a tendency to recur and, because of that, will often have a postponement period of 3 to 12 months. If there are no further incidents, underwriting improves as time from the stroke occurrence increases. Age of the person at the time of the occurrence or diagnosis is also a factor. TIAs are underwritten more favorably than CVAs, and we can often get offers of T2-3 and up. CVAs are more difficult to underwrite, but offers of Table 4-6 are not uncommon. The Pinney Stroke Questionnaire will help you gather the information needed for us to give you an idea of how your case will be rated.Download the Questionnaire