I have a client who has many health problems, but recognises the significant need for protection. Due to his Crohn's disease, type 1 diabetes and heart condition, I have found it impossible to get cover from any of the major providers. Cost is not an issue, but what other options do I have?
Paul Sandilands, Pulse
This is a difficult case. The applicant seeking life cover has three known illnesses. None is necessarily an underwriting impossibility, but the combination creates difficulties.
The availability of cover will depend on obtaining detailed information on each condition.
Crohn's disease is not in itself life threatening, but it is without cure. It relates to digestion. Patients can have problems absorbing nutrients and treatment in relation to other problematic conditions.
Steroids can stabilise the condition. There can be long periods of remission, without problems. Conversely, it may be necessary to treat frequent recurrences with surgery, sometimes involving the removal of the colon.
The development of cancer can occur and underwriters will be looking for any prognosis of this possibility.
Underwriters will be looking for control of the diabetes, whether dealing with type 1 or 2 - is the patient looking after him or herself?
Smoking is often associated with a lack of control and will certainly tip the chances of obtaining cover against the applicant. Underwriters will also attach importance to control of the heart condition - are the diabetes, cholesterol, weight and blood pressure under control?
If the heart condition has been treated with a stent or bypass, underwriters will be looking for resumption of a normal way of life and normal levels of activity such as the return to work.
One thing is certain in this case: it is not for the standard market. It will be necessary to go to a life insurance specialist.
Philip Brown, Partnership
Providing life assurance quotes for people with existing medical conditions is a complex business.
Crohn's disease is an inflammatory bowel condition that follows a chronic recurrent course with periods of remission.
The illness can be medically and/or surgically treated depending on severity. Crohn's will attract a moderate rating depending on the date of the last episode.
For type 1 diabetes, the rating will depend on a series of factors, such as the age at onset and the duration of the disease, the degree of control, the existence of other co-morbid conditions (high blood pressure and smoking) and any complications, such as heart disease or kidney problems to name a few.
The heart condition could be anything from a relatively minor condition (such as a benign heart murmur) to angina, a history of heart attack, a structural defect, enlargement or heart failure. So in this case, the rating will depend on the exact nature of the condition, the severity, treatment and prognosis. The likelihood of obtaining cover is driven by the control of conditions. In the case of diabetes, if the control is poor and other conditions or complications exist, this itself could result in a decline decision for life assurance.
The same can be said for the heart condition. Again, it really depends on the nature and severity of the specific heart condition.
These three conditions, in combination with one another, are almost certain to make securing life assurance for this client extremely challenging.
Matt Morris, LifeSearch
This is a client with a very poor medical history, so protection cover will be very difficult to find. Unfortunately, due to having multiple serious conditions, the client's options are limited.
But there is still hope. If an insurer would not take the client, there are some specialist companies that may be able to offer this person a limited amount of life insurance.
Most standard insurance providers have a maximum ‘loading' they are willing to accept after they carry out their assessments of the applicant's health. If the applicant doesn't meet these criteria, they will be declined. This is where the specialist companies step in.
However, the client would need to provide extensive medical details, including the information of what medications he is on, the dates of any relapses and what treatment, if any, he is currently undergoing.
Also, the type of heart condition the client has suffered could make a big difference to whether he can find insurance.
Simply excluding the relevant conditions from a protection policy, such as critical illness, does not necessarily reduce the insurer's risk by all that much because having one condition - for example, diabetes - can lead to other forms of serious illness later.
However, with the constant advancement in medicine and new drugs, many conditions can be adequately controlled - at least over the medium term.
So people with serious conditions will no doubt continue to become more insurable over the coming years, just as we have seen HIV-positive people being able to get life cover recently.
