Multiple sclerosis (MS) is a disease of the central nervous system in which the myelin sheaths surro...
Multiple sclerosis (MS) is a disease of the central nervous system in which the myelin sheaths surrounding the nerve fibres degenerate and are replaced by fibrous tissue. This process is known as 'demyelination'.
MS is a progressive disease, but its course is difficult to predict. A person may have an initial attack but then go many years before experiencing a second. During this time, known as a period of remission, signs and symptoms may decrease or disappear completely.
However, after the occurrence of a second or third acute attack or relapse, more permanent disability is likely, which then increases over time.
In other cases, sufferers may progress to total disablement in a very short period of time. Chronic quadriplegia (paralysis of all four limbs) and recurrent genito-urinary disorders are typical of the later stages of the disease. In general, MS will follow a more benign course for those who develop the illness at an older age and permanent incapacity may not occur until after retirement age.
Diagnosing the illness
MS is a difficult illness to diagnose and, in many cases, it takes more than one episode of symptoms to occur before diagnosis is formed. It is so difficult to diagnose that often the symptoms may initially be misinterpreted as those of a less serious condition.
Where MS is suspected but no definite evidence is available the diagnosis will be labelled as 'tentative'. Unfortunately, such a diagnosis may take several years to be confirmed or refuted. Where the diagnosis of MS is certain this is known as 'definite diagnosis'.
Nowadays, the results of a computerised tomography scan or use of magnetic resonance imaging may help doctors to reach a diagnosis.
Looking out for symptoms
Motor symptoms of MS include weakness, stiffness or heaviness of limbs, loss of abdominal reflexes or exaggerated tendon reflexes. Co-ordination is also often affected, including intention tremor, which mainly affects hands or arms but can affect other parts of the body, and ataxia (unsteady movement, such as when walking).
Many sufferers experience sensory symptoms, such as numbness or tingling in the extremities, an alteration of sensation or occasional intense neuralgic pain. Common ocular, or eye, problems are retrobulbar or optic neuritis (inflammation of the optic nerve causing blurred vision), nystagmus (a rapid involuntary movement of the eye) and central scotoma (a small area of abnormal vision in the visual field surrounded by normal sight).
Other symptoms include giddiness, vomiting, tinnitus (buzzing or ringing in the ear), scanning speech (disorder or the articulation of syllables) and deafness. As mentioned above, many of the symptoms could, of course, be related to ailments other than MS.
There is no specific treatment for MS. During an acute relapse, ACTH (adrenocorticotropic hormone) injections may be given, which can bring swift improvement, but otherwise treatment tends to be limited. A sufferer will be encouraged to take complete rest during an acute attack to avoid fatigue or to undertake physiotherapy and exercise to prevent contractures and to maintain or improve co-ordination.
Tentative diagnosis
An underwriter cannot wait for many years to elapse before knowing whether a diagnosis is certain. In addition, they cannot repeat medical examinations over a period of time to assess the progress of the illness. Instead, the underwriter must make a decision with the evidence available at that time. In cases of a tentative diagnosis the ratings will be based on a level of probabilities that a person who is exhibiting certain symptoms will go on to develop MS. Here the recommended ratings are heavily influenced by the number of episodes of symptoms. In general, the greater the number of episodes then the higher the rating.
l One episode: This category imposes the lowest ratings as there is a chance that the attack may be an isolated incident or a symptom of another ailment. Typically, ratings would be charged on applications received within two years of an episode.
l Two episodes: In general ratings are greater than for one episode as there is an increased chance of a definite diagnosis.
l More than two episodes: Most offices tend to follow the ratings recommended for a definite diagnosis.
Assessment for life assurance
Where MS is disclosed, most life offices will request a report from the client's medical attendant to establish the level of certainty in the diagnosis. Was the diagnosis made simply on the clinical findings or were the results of CT or MRI scans used to validate the clinical picture? In addition, information on the date of onset, severity and frequency of relapses and the current effect on the lifestyle is important. In many instances the client will also be requested to undergo a medical examination which provides the underwriter with detailed information about the extent of the disease and what effect it has on the client's daily life. The examiner will look for signs of the extent that the central nervous system may be affected.
Underwriters initially base their decision on a doctor's diagnosis, with the ratings imposed on definite diagnosis significantly higher than those imposed for a tentative diagnosis. The recommended ratings are at their severest for younger lives (under age 40) that have recently been diagnosed. As the time period between diagnosis or the last attack and the placing of an application for cover lengthens, the ratings become more lenient - so much so that if the condition has gone into complete remission, say for 10 years or more, standard terms may be available. As mentioned, those diagnosed at an older age tend to suffer a more benign form of the disease, reflected in slightly less severe ratings.
If the medical examination reveals significant signs of disturbance to the central nervous system an additional amount may be added to any rating chargeable. In cases showing more moderate signs an extra rating may be applied as well as restricting the term of the cover available.
In the severest cases, where there is more extensive neurological deficit, such as incontinence, paralysis, use of a walking frame or wheelchair, or the inability to work, terms may not be available.
Critical illness and PTD cover
Many offices include MS as a covered illness in critical illness and permanent total disability plans, along with blindness, loss of speech, paralysis, and permanent and total disability. Where MS has been diagnosed either tentatively or definitely cover will normally be declined.
Where medical evidence reveals the presence of some of the symptoms listed above, an underwriter must proceed with extreme caution as the symptoms could be the early signs of MS. In some instances critical illness cover may be declined or an exclusion included.
Underwriting helplines
Where an adviser has a potential applicant with a known history of MS it is recommended that they take advantage of any underwriting helplines made available by the life office.
These lines are normally staffed by experienced underwriters that are able to give an explanation of whether terms are likely to be available and possibly indicate a level of loading.
It should be noted that the underwriters can only give an indication of the likely terms based on the evidence presented. Terms will only be confirmed once an application and medical evidence have been received and assessed.
Nigel Kirkpatrick is underwriting support manager at Guardian Financial Services
