Rehabilitation has been a core part of income protection for some time, but what does it actually entail? In the case of strokes, not very much, as Peter Madigan discovers
Rehabilitation has been much-discussed in recent years. Many providers suggest that it could be the single most valuable added benefit available, while others are convinced that it has been hyped up, and ultimately delivers little in the way of tangible results.
Although the vast majority of income protection (IP) claims are for stress and musculo-skeletal complaints, strokes are becoming more prevalent in younger people, and claims are beginning to reflect this. According to charity Different Strokes, 10,000 people under the age of 55 suffer a stroke every year in the UK, with one in 10 of these being under 30. With more people of working age affected than ever before, employers are increasingly looking for rehabilitation services on their IP and CI policies to get staff back to work as quickly as possible.
Stroke claims are surprisingly straightforward. "In some ways they are less complicated than stress claims, as they are a clearly definable disability, not like a spinal complaint, for instance, which may have a number of influences behind it," says Dr Michael O'Donnell, chief medical officer at UnumProvident. "The problem with strokes is that they are enormously variable in their severity, ranging from a transient ischaemic attack, otherwise known as a mini-stroke, to a full blown cerebral haemorrhage, so there is no standard rehabilitation - it must be done on a case-by-case basis," he adds.
The bulk of the recovery from a stroke takes place in the first three months, with the immediate rehabilitation taking place in a specialist stroke ward. State provision thereafter leaves much to be desired.
"Often after stroke there is a residual problem with speech, but the waiting list for NHS speech therapy is six months long. That's six months where a person might not be able to work because of their impaired speech. Adding rehabilitation services to a plan only amounts to an extra 20 pence on a premium," says Richard Thomas, managing director of Red Arc Assured.
There has been some debate as to whether rehabilitation for stroke victims is even effective. In 1992, a paper entitled 'Effectiveness Bulletin' from the University of Leeds examined 17 major studies and failed to reach a conclusion as to whether rehabilitation from stroke even works.
"There's no doubt that rehabilitation in hospital in the immediate aftermath of a stroke is effective. But every stroke is different and there will be cases where rehabilitation will not be able to do much," says Joe Corner, director of communications at the Stroke Association.
"Rather than questioning the effectiveness of rehabilitation, we are more concerned that insurance policies will not provide the comprehensive cover that stroke victims need. The NHS rehabilitation services are still the best since they are in for the long haul and will see you through," adds Corner.
Time limits
The possibility of a patient using up all their rehabilitation allowance before they are fully rehabilitated is indeed a fear, but one that insurers dismiss. "There is no set limit on entitlement to rehabilitation, since every case is different," says O'Donnell. "Some patients will react very quickly to treatment and some will not. There will also be instances when patients are not responding to physiotherapy and when we assess that situation and consider ending the therapy since it is having no effect. There are no clear cut entitlements," he adds.
It is crucial that rehabilitation is carried out by stroke specialists however. "If a patient is receiving therapy it should always be from a dedicated stroke therapist. Giving patients the wrong treatment can result in muscle atrophy and have a detrimental effect," says Corner.
This should not be a major consideration for protection providers, however, since they have no involvement in the immediate care for a person after they have suffered a stroke. A crucial distinction exists between the intense work that begins just hours after a stroke and the services offered by insurers.
"Medical rehabilitation is left to the NHS and we have nothing to do with that, but when the immediate medical needs are dealt with often a person will need further help to get them back to work. It is this occupational rehab that insurers deal in," says O'Donnell.
With the focus very much on returning to work it is easy to imagine that it is corporate customers who want to push rehabilitation the most. Does this mean that individual IP policyholders are losing out? "Almost all the interventions that we see come from group customers, although the issues are the same as they are on the individual side, like stress and musculo-skeletal complaints," says Thomas. "Very few income protection providers do anything other than pay the claim. They simply substantiate the validity of the claim and then start paying the benefit, rather than pushing rehabilitation options."
Whether or not individuals need to be given more information about their entitlement to rehabilitation services, or indeed whether the policy they are buying comes with such facilities included, is an ongoing debate .
With stroke the biggest cause of disability in the UK, protection provision for rehabilitation has to ensure that those who need help most receive it.
Although it is frustrating that there are no hard and fast answers on how much help stroke victims can expect from their insurers, we should take heart from the fact that providers are taking a more flexible approach to try and help the unfortunates who do suffer stroke to get better faster.
Case study
Howard Tighe was just 42 when he suffered a stroke in July 2004. As a husband and father, Howard was keen to insure himself against ill-health and took out two critical illness policies just months before disaster struck.
The stroke left Howard with severely impaired speech, memory and mobility, and hospitalised him for seven weeks. His cover included a rehabilitation service that allowed him access to a nurse who provided practical assistance by tending to Howard during his recovery, allowing his wife Louise the time she needed to look after their two young children, as well as giving her emotional support.
When Howard left hospital his nurse suggested a further course of physiotherapy. His plan provided him with nine sessions with therapists specialising in neurological injuries. The treatment had a profound effect on Howard's mobility and now, just over a year after his stroke, he is back at work in his printing business and busier than ever.
Source: Bright Grey
