Respiratory disorders are among the most common conditions that underwriters see disclosed on propos...
Respiratory disorders are among the most common conditions that underwriters see disclosed on proposal forms.
When an applicant states that they have, or have suffered from, a respiratory problem, the underwriter will need to obtain further information regarding the condition. This information might be obtained by asking the applicant to complete a 'respiratory disorders questionnaire'. In some instances, it may be necessary to obtain a private medical attendants report (PMAR) and special questionnaire from the client's GP. If the condition appears to be severe or if information is lacking then a medical examination may be required.
In addition to obtaining medical evidence, the underwriter will also take into consideration the applicant's occupation. Particular attention will be paid to occupations where the applicant may be exposed to irritants such as dust or flour, jobs requiring a high degree of physical exertion or those that might involve high stress levels. Any of these factors could cause 'attacks' or aggravate certain respiratory disorders. In addition, smokers with a respiratory disorder will generally be treated more harshly than non-smokers.
There are many types of respiratory disorder, but the most commonly disclosed conditions are outlined below.
Asthma
The main characteristic of asthma is difficulty in breathing that is usually combined with a wheeze. The condition occurs as a result of the airways becoming narrowed. This narrowing can be caused by extrinsic factors, for example an allergy to pollen, or by intrinsic factors such as a respiratory infection.
Extrinsic or allergic asthma usually commences in childhood and the individual may find that they are allergic to pollen, dust, animal fur or certain types of food. Symptoms will generally be intermittent and mild, the frequency of the attacks usually reducing as the individual gets older. Often the condition will disappear altogether. Treatment, when required, will normally be in the form of bronchodilator drugs, for example ventolin or salbutamol. These are inhaled drugs that help to open up the airways and make breathing easier. They may be taken on a regular basis as a preventative treatment or, if the condition is mild, on an 'as required' basis.
Intrinsic, or late-onset, asthma normally commences in adulthood and attacks tend to be severe. Attacks may be precipitated by factors such as stress, respiratory infection, inhaled irritants or even changes in the weather. Symptoms tend to be continuous and, in severe cases, the airways remain obstructed between attacks. In some cases the individual may develop status asthmaticus, a condition whereby breathing becomes extremely difficult and respiratory failure may occur, leading to death. In addition to treatment with bronchodilators, oral steroid therapy is often required, and the long-term use of steroids can, in themselves, pose additional risks.
The underwriter will use the evidence obtained to place the applicant within one of three classifications.
A classification of 'mild' would indicate that symptoms are infrequent and will respond to self-administered remedies such as an inhaler. It is unlikely that there will have been any acute attacks in the last two years and the condition will not have caused any time off work. For life protection and critical illness protection, most cases will be acceptable at standard terms. Income protection with a deferred period of four weeks will normally require a small rating, while longer deferred periods will usually be acceptable at standard terms.
'Moderate' cases include individuals who have had more than three acute attacks in the last two years. Those requiring more frequent use of anti-spasmodic treatment or requiring occasional steroid therapy, or those individuals taking up to two weeks annually off work due to their condition, would also be in this category. Moderate cases will normally be acceptable at standard terms for critical illness protection, but life protection and income protection will require a small to moderate rating.
A 'severe' classification would indicate the continuous use of steroids or a history of hospital admission or status asthmaticus within the last two years. It is highly likely that abnormal lung sounds will have been noted by the applicant's GP or by the medical examiner. For life protection and critical illness, a heavy rating will be applied and some cases may even be declined. Income protection will almost always be declined.
Bronchitis
Acute bronchitis is characterised by a cough and is usually caused by either a cold or flu. In non-smokers an attack will usually resolve within a few days. If an individual suffers from more frequent attacks and has to take time off work, then it is likely they have an inherited susceptibility to respiratory disease.
There is a high probability that these people will develop chronic bronchitis at some time in the future. Individuals suffering from chronic obstructive airways disease (COAD) and who continue to smoke may also suffer attacks of acute bronchitis. In these cases, attacks are likely to occur with increasing frequency and severity. As the individual gets older they may find it increasingly difficult to work.
A history of acute bronchitis, where the applicant has made a full recovery or has only one attack each year, will usually be acceptable at standard terms for all benefits. Applicants that suffer more than one attack each year should be assessed as though they suffer from chronic bronchitis.
In chronic bronchitis the bronchial mucous glands become enlarged, causing the sufferer to cough up excessive mucus. The condition cannot be relieved by bronchodilator drugs.
There are two stages of chronic bronchitis, the reversible stage and the irreversible stage. In the reversible stage the symptoms will not usually cause the individual to take any time off work. If the irritant, such as smoking, is removed the condition will often cease. Irreversible chronic bronchitis, or COAD, indicates either a continuous presence of an irritant to the bronchial mucosa (usually inhaled tobacco smoke) or an inherited predisposition to respiratory disorders.
At the reversible stage, life protection and critical illness protection may be accepted at standard rates or with a small rating. Income protection will be acceptable with a rating with shorter deferred periods attracting higher ratings.
Irreversible chronic bronchitis can be classified as:
l Mild. Regular attacks of bronchitis in the winter months, with a productive cough and wheeze. The condition will probably cause no more than one week off work each year. Life protection will normally be acceptable with a small rating. Critical illness protection will almost always be acceptable on standard terms. It is unlikely that income protection will be offered for a deferred period of four weeks. Longer deferred periods for income protection will attract a moderate rating.
l Moderate. Recurrent acute attacks that may occur throughout the year. The individual is likely to become short of breath on effort. For life protection, applicants falling in this classification will normally be acceptable with a moderate rating, with under-40s being treated more harshly. Critical illness protection will usually be acceptable with a small to moderate rating. It is unlikely that income protection will be offered for a deferred period of four weeks. Longer deferred periods will attract a moderate to heavy rating.
l Severe. Continual symptoms with a chronic productive cough. The individual will become breathless with little effort. They will most likely be able to work but will take frequent time off. Applicants in the severe category will attract a heavy rating for life protection and under-40s may be declined. Critical illness protection and income protection will normally be declined.
In any of the above categories, an additional premium will be applied if the individual continues to smoke. Applicants that are unable to work due to their condition will normally be declined for all benefits.
Bronchiectasis
Bronchiectasis can be congenital or acquired as a result of lung fibrosis, bronchial obstruction or the late stages of chronic bronchitis. It is a condition where the bronchi widen and pus forms. This causes the sufferer to cough up purulent sputum and blood may also be present. The condition can be treated with antibiotics (to treat the infection) and physiotherapy (to drain the sputum). Surgery may be undertaken if only a few bronchi are affected.
In its mild form, symptoms occur for only a short period of time after a cold. However, many sufferers have symptoms throughout the year and, if severe, on a daily basis. In severe cases a wheeze and breathlessness may also develop and these may be associated with COAD.
When assessing cases of bronchiectasis, the underwriter will classify the condition as mild (very occasional symptoms, no continuous cough or regular drainage), moderate (infrequent infections, regular drainage, very little time off work) or severe (frequent symptoms and infections with associated COAD).
Applicants who have associated COAD will be offered terms on the basis of that condition. All other cases are likely to receive the following terms:
l Life protection for mild cases will normally be acceptable at standard terms for the over-40s but a small rating will usually be applied for younger lives. Moderate cases will attract a small to moderate rating, while severe cases will receive a moderate rating.
l For critical illness protection, a small rating will probably be applied to mild cases, while moderate cases will normally attract a moderate rating. Severe cases will almost always be declined.
l Income protection will not normally be offered to applicants with severe bronchiectasis. Moderate cases may be offered rated terms for deferred periods of 13 weeks upwards, but will not normally be acceptable for a deferred period of four weeks. Mild cases will usually be acceptable for all deferred periods, but with an additional premium.
Julie Dorsman is life and disability underwriter at Guardian Financial Services
