The key to underwriting is information. The more information available the more accurate underwritin...
The key to underwriting is information. The more information available the more accurate underwriting can be, which is why, where possible, full copies of all clinical notes are requested when underwriting breast cancer.
The two main pieces of information required are:
l Histology. The microscopic study of the structure of the tumour allowing us to differentiate between different types of tumour such as those already mentioned.
l Staging. The system used to establish how far advanced the cancer is, the general staging system as applicable to breast cancer is:
Stage 0 ' This stage is used to describe non-invasive breast cancer. There is no evidence of cancer cells breaking through to or invading neighbouring normal tissue.
Stage I ' This stage indicates invasive breast cancer in which the tumour measures up to 2cm and no lymph nodes are involved.
Stage II ' This stage represents invasive breast cancer in which the tumour is between 2cm and 5cm in size or the cancer has spread to the lymph nodes under the arm.
Stage III ' The tumour is larger than 5cm or the tumour has spread to the breast skin, chest wall or the internal mammary lymph nodes.
Stage IV ' This applies to a tumour where distant metastasis has occurred. This is where the tumour is carried elsewhere to start up a new, secondary tumour. Breast cancer commonly metastasises to the lungs, liver, brain and bones, but secondary tumours can occur literally anywhere in the body.
If there is a history of breast cancer, it is unlikely critical illness (CI) cover will be accepted unless it is with a full cancer exclusion and most applications will be considered for life cover only.
Stage 0 tumours are likely to be acceptable more or less immediately after treatment. A temporary extra premium is likely to apply in the first two to three years post treatment somewhere in the region of £5 per mille (£5 per thousand pounds sum assured per annum). This reflects the possibility of incomplete excision and therefore development into an invasive tumour.
Stage IV tumours will almost always be declined due to the spread of the tumour to other organs and sites within the body.
The majority of tumours underwritten come from the Stage I to III categories. Unlike 'in situ' tumours, these applications are likely to be delayed anything from one to five years post treatment, obviously the more advanced the tumour, the longer the deferment period.
After the deferment period, an additional premium will apply, this will likely take the form of a temporary extra reflecting the reducing risk of recurrence over a period of time. For Stage I tumours this is likely to be in the region of £12 per mille reducing to ordinary rates six to 10 years post treatment.
For Stage III tumours ratings will be higher at around £20 per mille after a five-year deferment period, there will also be an additional £5 to £15 per mille extra, which will apply throughout the whole contract reflecting the higher risk of recurrence due to more extensive disease.
Ratings will depend on how many years it is since the end of treatment when the application is submitted. An application made three years after the end of treatment will attract a higher loading for more years than an application made six years after treatment. The fact that ratings are charged for a set number of years depending on the staging, reflects the risk of relapse in the early years. The best case scenario Stage I tumour would attract standard rates six years after the end of treatment when the applicant, from an insurance point of view, would be deemed to be in complete remission and considered to be standard rates.
Clearly underwriting breast cancer is a complex area with many variables, and will not become apparent until the underwriter has assessed the GP's report and hospital reports. The IFA should be aware of the possibility of the application being postponed if still in the 'delay' period and after that the likelihood of a loading to the premium. This way, he or she can manage the client's expectations. It may be useful to discuss the application with the insurance company's underwriting helpline.
