Although much focus is placed on critical conditions, advisers would do well to get to grips with the underwriting implications of everyday illnesses, says Debbie Bolton
There are certain medical conditions the IFA will encounter on a regular basis. A good knowledge of the information to obtain can help avoid delays in the underwriting process and can often mean immediate acceptance with no need for any further medical evidence.
In effect, the adviser can act as the initial underwriter by obtaining specific information at the time of proposal. This information can be the difference between accepting a case on the spot and the need to refer back to the customer or the GP for more information.
Below are listed some of the more frequent medical conditions that an adviser is likely to encounter. There are, naturally, certain conditions where a GP's report is necessary and in this case, good disclosure at outset may enable insurers to go directly for a GP report rather than back to the client.
Asthma
Asthma is an inflammatory disease of the airways. As a result of this inflammation, the airways become blocked or narrowed due to swelling, muscular contractions and mucous production. These effects are usually temporary, but they cause shortness of breath, breathing trouble and other symptoms.
If an asthma attack is severe, emergency hospital treatment may be needed to restore normal breathing. Usually most attacks are short lived, lasting minutes to hours and the patient will recover completely following an attack. In most cases treatment can control asthma sufficiently to allow a normal and active life.
95% of all asthma applicants can be accepted for life, critical illness (CI) and sickness-related benefits at standard rates. These are applicants who have not needed a hospital admission, or required the use of oral steroids (for example, prednisolone) within the last two to three years. Inhaled steroids, which have now become standard maintenance treatment, are not linked with an increased mortality risk and can therefore be largely disregarded when assessing an application.
What information are underwriters looking for?
• Date of last attack and cause (such as heavy flu, exposure to cat hair etc).
• What treatment is required and how regularly is it taken.
• How often the client is admitted to hospital and date of last admission.
• How often they are treated with oral steroids and date of last course of treatment.
• Time off work.
Epilepsy
One in 130 people in the UK suffers epilepsy ' around 420,000 ' making it the second most common neurological condition after migraine.
In epilepsy, the normal pattern of nerve cell activity becomes disturbed, causing strange sensations, emotions, and behaviour or sometimes convulsions, muscle spasms, and loss of consciousness. For about 80% of those diagnosed with epilepsy, seizures can be controlled and avoided with treatment.
The underwriting decision is, in the main, influenced by the number and type of fits. We cannot normally offer cover to anyone who has been diagnosed with epilepsy fewer than six months ago. However, if an applicant has a mild form of epilepsy, known as petit mal, and had very few attacks, insurers could offer standard rates for life cover immediately following the six month postponement.
If the attacks are of a more serious nature, such as grand mal epilepsy, then insurers like to see the condition well controlled with a two to three-year period since the last attack before they offer standard rates.
What information are underwriters looking for?
• Type of epilepsy, for example, petit mal or grand mal.
• The treatment required.
• Date of last attack.
• Number of attacks per year.
• Time off work.
Thyroid problems
In healthy people, the thyroid makes just the right amount of two hormones, which have important actions throughout the body. These hormones regulate many aspects of the metabolism, eventually affecting how many calories are burnt. In short, the thyroid runs our metabolism. These hormones also have direct effects on most organs, including the heart, which beats faster and harder under the influence of thyroid hormones. Essentially, all cells in the body will respond to increases in thyroid hormone with an increase in the rate at which they operate.
Underactive thyroid (also known as hypothyroidism) is a condition in which the body lacks sufficient thyroid hormone. Since the main purpose of thyroid hormone is to run the body's metabolism, it is understandable that people with this condition will have symptoms associated with a slow metabolism such as lethargy and tiredness. In fact, as many as 10% of women may have some degree of thyroid hormone deficiency.
An applicant with an underactive thyroid condition can expect standard rates for life cover, CI cover and sickness-related benefits if the condition has been adequately treated and controlled and there is no hypertension or cardiovascular abnormalities present. This is the case in the majority of applicants.
What information are underwriters looking for?
• Date of diagnosis.
• Is the condition well controlled with no complications?
Overactive thyroid (also known as hyperthyroidism) is a condition caused by the effects of too much thyroid hormone on tissues of the body. Because the body's metabolism is increased, patients feel hot and can slowly lose weight even though they may be eating more. Trembling of the hands and a hard or irregular heartbeat (palpatations) may develop. When hyperthyroidism is severe, patients can suffer shortness of breath, chest pain and muscle weakness. This condition is potentially more serious than an underactive thyroid.
From an underwriting point of view, insurers would need to postpone an application until fully investigated and stabilised. The condition can be controlled well on treatment, which may attract a small loading for life cover of around +50%, or in certain cases can be cured surgically or with radioactive iodine treatment. Subject to adequate follow up, normal thyroid hormone levels, no complications or recurrence insurers should be able to offer standard terms to such applicants.
What information are underwriters looking for?
• Date of diagnosis.
• Type of treatment past and present.
• Whether the condition is well controlled on treatment.
Hypertension
Hypertension (high blood pressure) is dangerous because it causes strain on the heart. This strain leads to heart enlargement and contributes to heart attacks and stroke. High blood pressure also causes damage to the arteries and can affect kidney function.
Mild cases of hypertension can be treated through behaviour modification such as changing diet and increasing exercise. More severe cases of hypertension require medication like diuretics and beta-blockers. Diuretics rid the body of excess fluids and salt, beta-blockers reduce the heart rate and the rate at which the heart circulates blood.
In most cases underwriters would require a GP's report if an applicant has a history of or is being treated for hypertension. However, the more information given at outset enables underwriters to write the case in a smarter way. If an applicant is applying for life cover only and has disclosed the type of treatment, past and present blood pressure levels, and details regarding any investigations performed the insurer may be able to offer standard rates from the application without going for a GP's report.
If an individual has well controlled hypertension, does not smoke, is within the normal weight range for their height, and has no complications insurers can usually offer standard terms for all benefits, even for critical illness and sickness-related benefits.
As a result, this information is useful:
• Date diagnosed hypertensive.
• Treatment.
• Nature and results of any investigations.
• Most recent blood pressure readings.
Cysts and polyps
Cysts may be found in virtually every organ of the body. The most commonly affected organs are breasts, skin, ovaries and thyroid. Most cysts are usually benign but some may be malignant or pre-malignant.
Polyps are normally benign and often harmless tumours, usually occurring on a mucous membrane and attached to the underlying tissue by a narrow stalk. Polyps occur in the nose, nasal sinuses, throat, stomach, bladder, large intestine and the uterus.
Of most concern to the underwriter are polyps in the large intestine (bowel or colon). Some intestinal polyps if left untreated may become malignant and they have a tendency to recur. These type of polyps usually attract a small loading for CI to reflect the risk of malignancy or an exclusion in respect of cancer of the colon or rectum.
An applicant with a disclosure of a cyst or polyp can generally be accepted at standard rates for life and CI depending on the site of the growth and confirmation that it was benign (non-cancerous). If we have the basic details at outset we can ascertain if a GP's report is required, or if we can sign the policy at standard rates.
What information are underwriters looking for?
• Medical diagnosis of the growth, for example, lipoma, sebaceous cyst and so on.
• Exact site.
• If confirmed benign (non-cancerous).
• Treatment carried out or planned.
• Nature of follow-up care (is any follow up required or has the proposer been fully discharged?).
There are clearly many conditions the adviser will come across and insurers appreciate they have limited time to go into great depth regarding the medical disclosures. However, a few minutes spent obtaining some specific information for the more common conditions can prove extremely beneficial for the adviser and for the underwriter in turning a proposal into a policy as quick as possible.
