UNDERWRITERS SEE applications where a wide range of conditions have been disclosed that could be cla...
UNDERWRITERS SEE applications where a wide range of conditions have been disclosed that could be classed as 'female complaints'. In the majority of cases, most benefits will eventually be accepted at standard terms. However, delays can occur in the underwriting process. This will usually be due to the applicant having provided only limited information causing the underwriter to make further enquiries. Where full information is made readily available to the underwriter, terms can often be offered almost immediately.
Applicants should be encouraged to supply as much information as possible with the original application. If necessary, the client should be allowed to put details on a separate piece of paper which can be placed in a sealed envelope and submitted with the application. If the underwriter still requires further clarification on certain points, they may ask the applicant for further details. Alternatively, a medical attendant's report may be requested to obtain the necessary information.
The most commonly disclosed conditions, excluding cancers, are listed below.
Endometriosis: Small cysts, arising from the endometrial tissue that lines the uterus, can develop in the pelvic area. The most common sites for these cysts are in the ovaries and fallopian tubes. Symptoms are chronic pelvic pain and/or dysmenorrhoea (painful menstruation) and this usually occurs during the reproductive years. Treatment for older women will normally take the form of surgical removal of the ovaries or, alternatively, an artificial menopause can be induced by x-rays. Younger women will usually be treated with hormone therapy. However, this method does not necessarily provide a permanent cure and the condition may re-occur.
If surgery has been carried out and a full recovery has been made, or if the condition is not severe, life protection and critical illness protection should be acceptable at standard terms. If the condition is more severe, a small rating may be applied in respect of life, but should still be acceptable at standard terms for critical illness protection.
Income protection can usually be accepted at standard terms if surgery has been carried out and a full recovery has been made or if there have been no symptoms for more than 12 months. If there are current symptoms, a small rating or an exclusion may be applied.
Hysterectomy: A hysterectomy is the surgical removal of the uterus or part of the uterus. The procedure can be carried out for a number of reasons including the removal of a malignant or benign tumour, or displacement of the uterus. Probably the most common reason is for fibroids - masses of fibrous tissue that usually lead to menorrhagia (abnormally heavy bleeding at menstruation).
If a hysterectomy has been carried out due to a benign disease or disorder then all benefits will be acceptable at standard terms. If there is evidence of malignancy, the application will be assessed on this basis.
Dilatation and curettage: Usually abbreviated to D&C, this is the dilatation of the cervix uteri and scraping of the interior of the uterus. It is done to remove the superficial lining of the uterus and is usually carried out for diagnostic purposes. It may also be done following an incomplete abortion or miscarriage. If the removed tissue is confirmed as benign, life and critical illness benefits will be acceptable at standard terms. If there is evidence of malignant tissue, then all benefits will be assessed on that basis.
Ovarian cyst/polycystic ovaries: Benign ovarian cysts are quite common during the reproductive years. They usually pass undetected and are generally of no consequence. However, they may occasionally rupture and cause severe abdominal pain. Symptoms tend to be either pelvic pain, menstrual dysfunction or infertility, but often there are no symptoms at all.
Polycystic ovaries is a condition where the ovaries become enlarged with multiple cysts. It is quite common in women who are obese. Menstruation may become infrequent or stop completely as a result of the condition and some women may become infertile.
Both conditions can be diagnosed by ultrasound or laparoscopy. So long as the diagnosis has been confirmed and there are no other factors present, all benefits will usually be acceptable at standard terms.
Pelvic inflammatory disease: This is a condition whereby the ovaries, fallopian tubes and uterus become inflamed. The infection can initially arise from another infected adjacent organ such as the appendix, transmitted by blood or via the vagina. Symptoms include acute onset of pelvic and low abdominal pain, tenderness and fever.
The condition can be serious if left untreated. Short-term complications include peritonitis (inflammation of the membrane of the abdominal cavity) and septic shock (bacterial infection of the abdominal cavity) which can lead to death. Long-term complications include intestinal obstructions, ectopic pregnancy, infertility and a possible increased risk of ovarian cancer. The underwriter will usually postpone all types of benefits until full recovery.
Menstrual disorders: If there is confirmation that the condition is not due to any other serious disease, for example, tumour, nephritis, anorexia nervosa or an endocrine disorder, these conditions can usually be disregarded. If an underlying cause has been confirmed, then the application will be assessed on the basis of that disorder.
Abnormal cervical smears: Carcinoma of the uterine cervix is increasing in incidence in the UK. However, an effective screening method is available and women are encouraged to undergo routine cervical smear tests. This screening can detect pre-cancerous changes and any appropriate action can be taken at an early stage. (See box for possible results)
Treatment is not usually required for CIN 1 and 2, but the patient will be asked to have regular follow-up smears (usually at six-monthly intervals). This is to check that there is no worsening of the condition. CIN 3 will necessitate treatment with either laser, cryosurgery (freezes and destroys the abnormal cells), coning (surgical removal of a cone of tissue), diathermy (eradication by heat) or, if the patient does not want any further children, a hysterectomy may be carried out. A follow-up smear will usually be done to check that the abnormal cells have been completely eradicated.
Life and income protection will normally be acceptable at standard terms for CIN 1 and CIN 2. CIN 3 cases will be acceptable at standard terms after appropriate treatment has taken place. If follow-up smears have been normal, critical illness cover will usually be acceptable at standard terms. If no follow-ups have been carried out, critical illness applications will generally be postponed until a normal smear is reported.
Pregnancy or ectopic pregnancy: Pregnancy-related mortality in normal healthy women in the UK is minimal. Those deaths that do occur are usually due to either haemorrhage or embolism. Those most at risk are older women or women who have had no prenatal care.
If there have been no complications during current or previous pregnancies and as long as the applicant is currently healthy, then life protection and critical illness protection should be acceptable at standard terms - although some life offices may prefer to postpone until after the birth. If there have been complications in previous pregnancies most underwriters will usually postpone until after the birth. Applications for income protection will generally be postponed until the applicant can confirm that she has returned to full-time employment.
If an applicant is pregnant and discloses that she is an established diabetic, or if diabetes has been diagnosed during pregnancy (gestational diabetes), all types of cover will usually be postponed until after the birth.
An ectopic pregnancy is where development of the foetus takes place outside of the uterus (usually in one of the fallopian tubes). As the foetus grows it may cause the fallopian tube to rupture. If this happens, any resulting haemorrhage can lead to death. Those most at risk are women who have a history of either pelvic inflammatory disease, infertility, endometriosis or have had a previous ectopic pregnancy. Generally speaking, a history of ectopic pregnancy can be disregarded for insurance purposes.
Pre-eclampsia or eclampsia: Pre-eclampsia may occur in the second half of pregnancy. The symptoms are raised blood pressure, oedema (excessive accumulation of fluid in the body tissues) and protein in the urine. The condition can progress to eclamptic seizures and can lead to death. Those most at risk are women who gain more than 60k during pregnancy, women who have had multiple pregnancies and women who have previously miscarried.
Eclampsia (convulsions) is a condition that can occur in the latter stages of pregnancy or just after giving birth. If there has been a full recovery all benefits will be acceptable at standard terms. If there are any residual complications then any relevant ratings will be applied.
Menopause/hormone replacement therapy (HRT): Women going through the menopause will generally be acceptable for life and critical illness protection at standard terms so long as there are no co-existing psychiatric symptoms. But some women may experience a variety of physical and psychological symptoms that may have a severe impact on their functional capacity. As such, applications for income protection will need to be carefully assessed and a rating or exclusion may be necessary.
A disclosure of HRT can generally be disregarded for underwriting purposes. Exceptions to this are if the applicant has disclosed any co-existing condition, or if she is of pre-menopausal age. In either instance, the underwriter will assess the application based on any underlying disorder.
Julie Dorsman is life and disability underwriter at Guardian Financial Services
