Planet Insurance - a cautionary tale

clock • 4 min read

Richard Walsh points out when it comes to IP, it's not the fairy stories that are Grimm...

Once upon a time, in a faraway forest, Gregory the elf and his wife Julie wanted to extend their home. They just had their fourth child and their cottage had only two bedrooms.

Although Gregory worked very hard - he cut down trees - they could not afford it. Julie said: "Why don't you go into the woods and ask the trolls? They have lots of gold they could lend us." So he did.

The trolls said yes, they might be able to lend them money, but they would need to have a meeting among themselves first.

These trolls were very devious. "I know," said one. "Why not lend them the money and charge them 40% interest on top of their monthly repayments?"

"They wouldn't buy that." said another. "The elves might ask around and someone else might make them a better offer."

"What happens if they cannot make the payments? Suppose the husband falls out of a tree and injures himself?"

"I know," said one. "We can sell them an insurance policy, which will cover them if that happens - and if you add the charges together, it comes to the 40% we want."

"Not so fast," said the most devious one. "At the end of the day, we can take their house if they don't pay, so let's sell them the policy but add a load of conditions so they will never get their money - and we don't need to tell them that. So they get their loan. We get our 40% and we take their house if they don't pay."

"Excellent," they said. "So how can we make the insurance policy do this?"
Quick as a flash, the most devious troll said: "Let's say he falls out of a tree, but he can still hold a pen. We say he can still work. Or we can exclude injuries caused by falling out of trees?"

"What about checking if he has fallen out of a tree before? I bet he has. We can then say we don't cover things that have happened before.

"Wait a minute - his dad died when he fell out of a tree. So we can say he had a family history. Also, we could tell him he is covered, but not actually cover him until the renovations are finished. And if he falls out of a tree in the meantime, we can refuse to pay him."

"But what if he does fall out of a tree and ends up in a coma? We might have to pay out. We could pay him less than he expects based on a proportion of his actual income. That way, we can charge him even more - bringing us to 50%. He pays more and even if he can claim, he can never get the full benefit."

So they called the Gregory back and said: "Good news. You can have the gold. One thing - we are really worried what would happen if your business failed. Suppose you fell out of a tree and couldn't work? Now, you wouldn't want us to be forced to take away your home. So we will insure you in case you cannot work." Gregory agreed. 

Five years later, Gregory did fall out of a tree and the trolls came round for their money. Gregory said: "I don't have to pay you because I cannot do my job."
"Oh, but you can work - you can hold a pen," the trolls replied.
"But I cannot write. Julie tried to earn money, but did not earn enough to make the payments."

So they went to see the Tony, the head elf. "What can we do? Tony said you could have got a much better deal from the orcs and I have heard that the trolls have been doing this a lot."

With that, Tony raised an army of elves. They took all the trolls' gold and stopped them selling insurance.

All fantasy? Well, not really. On 21 May, The Times carried out an exposé of IP sold with Activities of Daily Living headed: "If you are well enough to hold a pen, don't bother claiming on this cover". That's why we need a quality standard for IP.  

Richard Walsh is a director and fellow of SAMI Consulting, www.samiconsulting.co.uk

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