BACK DISORDERS rarely affect life expectancy, however they are a major cause of disability. Symptoms...
BACK DISORDERS rarely affect life expectancy, however they are a major cause of disability. Symptoms of back pain will often lead to the discovery of an underlying spinal disorder, although in some 30% of cases no cause can be found, prompting the diagnosis of non-specific back pain.
The statistics clearly demonstrate why an underwriter needs to take care when assessing applications for total and permanent disability benefit (PTD) and income protection insurance where the proposer has a history of back pain.
A person's occupation may contribute to the cause of back pain, in particular those occupations that include any of the following:
l Manual work (in particular lifting).
l Uncomfortable, prolonged or unnatural postures (for example, when driving).
l Physical activity.
l Psychological stress (for example, caused by pressure of workloads, nature of business).
As an underwriter, the extent of the back disorder and nature of the occupation are important features when assessing PTD and income protection. In addition to this, the length of the deferred period for income protection and the definition of disability for PTD, in particular the 'own occupation' definition, will also influence the underwriter's decision.
Disparity
The underwriting of disability benefits where a client has a history of back pain is a complex area. There is a great disparity between life offices when assessing applications with a history of back pain. This is often based on each company's claims experience. Certain offices will impose a full back exclusion where a client has any history of back problems. This is regardless of whether they have lost time from work or had any recent episodes of back pain.
Other companies prefer to adopt the approach of trying to offer full cover but with an extra premium to cover the risk, and some companies may use either extra premiums and/or exclusions depending on the particular scenario.
Companies who adopt the latter two approaches will also consider offering standard terms if they feel the risk is minimal. It has to be stressed that the philosophy adopted by each company is based in the main on their own actual experience particularly surrounding claims.
For PTD on an own occupation basis it may be necessary to amend the definition to any occupation and also impose a back exclusion but this will depend on both the medical features and specific occupation details.
Exclusions
A typical example of a full back exclusion wording would be: "No benefit will be payable for any illness or disability arising directly or indirectly from any disease, disorder or injury to the spine, its discs, nerve roots or supporting musculature."
IFAs occasionally raise concerns that a company will impose a full back exclusion where the client's history of back pain is limited to one particular area and they therefore feel that the blanket exclusion is not justified.
Although this view is understandable as it is often the case that back pain is limited to a specific area, the actual underlying condition could be more extensive and involve different parts of the back or spine.
If the exclusion is too specific the life office will not be adequately protecting itself, leading to higher claims and in the long term, higher premiums.
The adult's vertebral column consists of 33 vertebrae that are distributed as follows:
l 7 cervical vertebrae (C1 - 7).
l 12 thoracic vertebrae (T1 - 12).
l 5 lumbar vertebrae (L1 - 5).
l 5 sacral vertebrae (S1 - 5).
l 4 vertebrae fused into one or two bones called the coccyx.
Non-specific low back pain
The most common causes of low back pain are usually associated with an incident, for example, bending, lifting or turning in the wrong way.
It may also be due to wear and tear that has occurred over a number of years. Other causes can be poor posture, pregnancy, standing or sitting for long periods or being overweight. Low back pain is the main cause of disability between the ages of 19-45.
The symptoms usually are:
l Pain across the back and either legs (sciatica).
l Tenderness radiating around the whole back region.
l Numbness.
l Parasthesia around the back and leg region.
l Straight leg raising (SLR) is less than 90 degrees.
Treatment is usually conservative, for example physiotherapy, anti-inflammatory drugs, traction, stress management or relaxation exercises and exercise programmes.
Slipped discs
Disc protrusion is often referred to as 'slipped discs'. With increasing disc degeneration material may protrude or herniate through the disc fibres. This will cause pain if it exerts pressure on the nerve roots.
Other names used for herniated discs are prolapsed, bulging or ruptured discs. A prolapsed disc is where there is displacement of part of the vertebrae, the most common levels is L4/5 and L5/S1 - 95% of disc protrusions are at this level.
Pain is the main symptom and may develop acutely or gradually. Its severity and duration depends on the degree of prolapse and the relationship it bears to adjacent nerve roots.
With adequate rest the vast majority of prolapsed discs settle spontaneously within two or three weeks with the localised pain subsiding within one or two days.
Where the proposer's responsibilities do not allow prolonged bed rest, the spine may be supported in a plaster jacket or spinal brace but these measures are not as effective. Surgical removal of the disc is necessary in the few cases that do not respond to conservative measures.
Incapacity periods for administrative occupations vary between two and 12 weeks for medical treatment and eight and 16 weeks for surgical treatment. The incapacity period for manual occupations is significantly longer and may result in the proposer taking up a role with less arduous duties.
Spondylolisthesis is where there is a forward shift of one vertebra upon another due to a defect of the joints that normally bind them together. This may be congenital or develop after injury.
As stated previously, the terms offered by life offices vary based on their own experience but some features will heavily influence an underwriter when assessing PTD and income protection (see box right). Where an adviser has a potential applicant with a known history of back problems for PTD and income protection it is recommended that they take advantage of any underwriting helpline made available by a life office.
These helplines are normally staffed by experienced underwriters who will be able to give an indication of terms and whether an exclusion may be imposed.
It should be noted that the underwriters can only give an indication of the likely terms based on the evidence presented and will only be able to confirm terms once an application and medical evidence have been received and assessed.
Mark Preston is life and disability underwriter for Guardian Financial Services
(Source of data: Swiss Re Life & Health)
