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Case Clinic:
Von Willebrand Disease

Munich Re’s medical experts respond to challenging underwriting scenarios

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    March 2024

    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: Von Willebrand Disease

    The Munich Re medical team investigated the insurability of a person for life/critical illness (CI) insurance with Type 2A Von Willebrand Disease. The case included a history of severe nose bleeds, five ER visits in the past 12 months for the same, and mild iron deficiency. The team asked, “Should bleeding be better controlled before an offer can be made?”

    Munich Re medical's response

    What exactly is Von Willebrand Disease (VWD)?

    • An inherited bleeding disorder resulting from either decreased levels of Von Willebrand Factor in the blood or normal levels of Von Willebrand Factor that do not work properly. The end result is a difficulty forming and maintaining blood clots, resulting in prolonged bleeding. Symptoms can include easy bruising, gum and nose bleeding, and excessive bleeding during menses, delivery, and surgeries.
    • There are three different types: Type 1 (mild - 85% of cases), Type 2 (moderate - 13-15% of cases, with subsets 2A, 2B, 2M, 2N), and Type 3 (severe - 2% of cases). 

    How common is this condition, and what are some mortality and morbidity concerns?

    • VWD is the most common bleeding disorder, affecting 1% of the general population. It is nearly always inherited and equally split between men and women
    • Mortality increases with disease severity. Mild disease poses minimal, if any, additional risk. As severity increases, injury and surgical complications increase, as does the risk of life-threatening complications such as intracranial bleeding and intra-abdominal bleeding
    • Morbidity risk is life-threatening hemorrhage complicated by heart attack, stroke, or coma (for Type 3 VWD only). 
    • It is important to look at Von Willebrand Disease by both the diagnosed Type (1, 2, or 3), as well as the pattern and severity of symptoms.

    Final recommendation

    Munich Re determined that a diagnosis of Type 2A Von Willebrand Disease with a benign clinical course (main symptom nose bleeding, no overnight hospitalization, mild anemia only) represents a mild-moderate mortality risk. A postpone would not be required, and a small rated offer for life could be made. With no increased morbidity risk, CI could be offered standard. 
    Contact the author
    Laura Parker
    Laura Parker
    Senior Underwriting Specialist
    Munich Re, Canada (Life)
    Email
    LParker@munichre.ca
    Tim Meagher
    Dr. Tim Meagher
    Vice President & Medical Director
    Munich Re, Canada (Life)
    Email
    tmeagher@munichre.ca
    Gina Guzman
    Dr. Gina Guzman
    Vice President & Chief Medical Director
    Munich Re Life US
    Email
    gguzman@munichre.com
    Bradley Heltemes
    Dr. Bradley Heltemes
    Vice President & Medical Director of R&D
    Munich Re Life US
    Email
    bheltemes@munichre.com
    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.