To: Angela Faherty, Editor, COVER From: Keith Sankey, financial marketing and product development c...
To: Angela Faherty, Editor, COVER
From: Keith Sankey, financial marketing and product development consultant
A couple of years ago the Association of British Insurers (ABI) revised its Statement of Best Practice for critical illness (CI) cover. This tightened the model definition used for the core condition of cancer. For all policies issued after a certain date, tumours of the prostate gland, which were within stated thresholds - a Gleason score of no more than six or a TNM classification of less than T2NOMO - were to be excluded.
This led me in my naïveté to assume that patients who were within these limits were not suffering a critical illness. However, my own personal experience as a prostate cancer patient over the last few months has turned this opinion on its head.
I now know that the diagnosis of and treatment for prostate cancer can have a harrowing effect on the lives of individuals and their families. Could it be that the prescribed prostate cancer wording is designed to enable insurers to avoid paying out on what would otherwise be a major source of claims?
Just consider:
• Two forms of treatment predominate: radical prostatectomy and radiotherapy. Because of the location of the prostate gland - it is hidden away among other organs and tissues - even the very latest of surgical techniques tend to be highly disruptive. Radiotherapy has various side effects and the prognosis is not as favourable as that of radical prostatectomy.
• The biopsy procedure used to diagnose the presence and state of the disease is rather unpleasant. The after effects include bleeding in the faeces, semen and urine.
• Following radical surgery, for three weeks it is necessary to wear a large diameter catheter which drains into urinary collection bags. All patients experience at least some haemorrhaging.
• Once the catheter comes out, the individual has to regain control of their urinary sphincter. It is normally at least three months before a patient regains enough control to discard incontinence pads. A minority have to undergo further surgery.
• Potency can take up to two years to return. In many instances, it never comes back.
• Following treatment, the patient's condition is monitored regularly for at least ten years as the medical teams look for any early signs of recurrence.
• Many patients will need to take at three months off from work.
I am aware that the ABI's CI definitions are once again being reviewed. I would urge the working party to consider adopting a more inclusive approach to prostate cancer, which is such a common condition in men.
Without a change in attitude, UK insurers run the risk of a public relations disaster.
The reputations and livelihoods of financial and insurance advisers are also currently at stake. Intermediaries should consider pointing out to clients the significance of the current cancer definition wording and obtaining their written confirmation that they fully understand the implications. This could avoid the unpleasantness of a future disputed claim, a complaint being referred to the Ombudsman and a hefty compensation bill.
Have your say:
• Is the current prostate cancer wording designed to enable insurers to avoid paying out?
• Should the ABI look at adopting a more inclusive approach to prostate cancer? What should this entail?
• Have you got any examples of cases where prostate cancer claims have been in dispute?
To have your say, please send a letter of response to Angela Faherty at [email protected]
