From an insurance perspective the implications on the underwriting process largely depend on the und...
From an insurance perspective the implications on the underwriting process largely depend on the underlying cause. In the first instance most conditions will be assessed on the basis of a GP report together with a structural heart disease questionnaire and copies of any hospital reports.
However, the condition that would be declined at application stage would be the transposition of great vessels. When the medical information has been received from the doctor, the underwriter needs to establish what investigations, if any, have previously been carried out, the type of surgery performed, and whether there are any ongoing symptoms or further investigations envisaged. Some of the ongoing symptoms that may be experienced are hypertension and ECG and heart abnormalities.
In some instances the underwriter will not be able to consider cover until at least six months has lapsed since the surgical procedure.
Below is an underwriting guide to what terms may be available for applicants with congenital heart disease, with surgical correction performed:
• Patent ductus arteriosus - if the condition has been corrected and is more than six months post surgery, then ordinary rates for all benefits will be considered as long as a full recovery has been made with no residual symptoms.
• Atrial septal defect - if the client has disclosed that a surgical repair was performed in childhood and that there is no residual problems and no follow up is required, then ordinary rates may be considered for life and income protection (IP) from the application form without the need for further medical information. For critical illness (CI) cover, further medical evidence would be required and if terms are available, heart valve and structural surgery is likely to be excluded.
• Fallot's tetralogy - 12 months post-surgery (total corrective surgery only) with no residuals, for life and CI cover, a range of plus 50% to declinature, but this largely depends upon the client's age at application. For IP this would be a declinature from the application.
• Coarctation of the aorta - cover could only be considered for lives above age 20, and who have been regularly followed up in adult life at a specialist clinic. For life and IP cover it would normally depend upon the type of surgery performed and at what age, together with any associated complications. For CI cover this would be a declinature from the application.
Where there is a history of congenital heart disease it may be useful for the IFA to contact the insurance provider's underwriting team, as it helps to discuss a particular case in-depth before submitting the application form to see whether cover can be considered.
