Hi everyone, Alan is back with me and this time we are focusing on coeliac disease. A lot of people think of gluten when they hear coeliac disease and have a feeling that all it means is don’t eat bread, pasta, etc. But, it can be much more than that when it comes to underwriting.
A lot of the time coeliac disease is not a concern to insurers looking at life insurance, critical illness cover and income protection. However there are quite a few things you should check with your client about the condition, before you assume that their insurance applications will be accepted at standard terms.
The key takeaways:
- Approximately 1 in every 100 people are coeliac and it is estimated that around 500,000 people are undiagnosed in the UK
- Whilst it is not common, coeliac disease can increase the risk of other medical conditions such as bowel cancer
- Three case studies of arranging protection insurance for people living with coeliac disease
Next time I am going to be focusing upon critical illness cover being written into Trust. There are some specific technicalities at the point of the claim that are worth knowing, so that you can properly advise your clients about placing the cover into Trust or not.
Remember, if you are listening to this as part of your work, you can claim a CPD certificate on our website, thanks to our sponsors NextGen Planners.
Kathryn Knowles 00:11
Hi everybody. I have Alan back with me, and we’re doing the first underwriting session of season 11. We’re on Episode Two, and today we’re going to be talking about celiac disease and some of the changes that we have seen in under eating. This is the practical protection podcast.
Kathryn Knowles 00:38
So Alan, how are you doing?
Alan 00:40
I’m actually okay. Thank you. I’m better than I was yesterday. Today’s good. Okay, so what was yesterday? Barely any sleep, and one Why have I barely had any sleep?
Kathryn Knowles 00:49
Kathryn, well, I might have encouraged us to have another puppy.
Alan 00:53
So to be fair, you’ve taken the lion’s share of it, which is brilliant,
Speaker 1 00:58
but the one night actually, because I really don’t like it. But on the one night,
Alan 01:03
I decided to be really nice and look after the puppy. He backed for about three or four hours Alan song, which was lots of fun, but
Kathryn Knowles 01:10
absolutely, absolutely. Well,
Alan 01:14
you agree to the puppy, but actually he’s very, very cute, so we’ll forgive
Kathryn Knowles 01:20
him, does make up for it? Yes, so everybody celiac disease. Okay, so I’m sure many of us have heard of this, and I think a lot of people automatically think gluten, and that’s kind of like synonymous with each other, celiac and gluten, those two words. So Celiac disease is an autoimmune condition, and it’s where the body starts to attack itself when a person has eaten gluten so it can cause damage to the small bowel and tissues, and it causes issues with things like the absorption of nutrients. They actually think that about one in every 100 people have celiac disease. But what’s really interesting about that is, if you look on celiac UK, they estimate that only 36 of people, 36% of people with CEREC disease are actually diagnosed. So whilst it’s one in 100 you know, we’ve only got 36% actually are aware that they have this condition, because it is something that can develop. It’s not something you’re automatically born with. It can kind of emerge at any point. And so with that 36% that actually means that they think that there’s about a half a million people in the UK that haven’t been diagnosed with this, and obviously it can be quite a serious condition if you’ve not had it diagnosed. So it’s definitely something just to be mindful of and aware of things like symptoms and always speaking with your GP if you think that there’s any kind of connection there, it is more likely to develop in women, but it can develop at any age, and you are also at high risk of developing CDAC disease if you have type one diabetes, a condition known as autoimmune thyroid disease, Down Syndrome and Turner Syndrome. So we’re going to go right into everything with the underwriting. I know that’s what people really, really like to do. So Alan, can you tell us more about celiac disease and the kinds of things that underwriters are looking out for? Yeah, yeah,
Alan 03:09
absolutely. So, I mean, I think the first thing to say is that it is different to a gluten intolerance. So you will find people who will say, Well, I’ve got an intolerance to gluten. And I think if somebody presents that to you, you should always ask, can I just ask, is it celiac disease? Because actually, a gluten intolerance is probably not going to impact any insurance. Now, it might be that celiacs might not, and will obviously, I know we’ll get on to that, but a gluten intolerance is not but obviously, then I suppose if somebody says, yes, I’ve got a gluten intolerance. You know, have you ever been diagnosed with celiac disease? Or are you, are you being tested or checked for anything like that? Because, again, outstanding investigations, things like that.
Kathryn Knowles 03:47
Well, since I imagine the underwriters would probably quite if someone says I’m gluten intolerant, they’d maybe wonder, well, what have you been checked, in a sense, for celiac disease, that could potentially be maybe wary that you get Yeah, but even
Alan 04:00
then it might not even come up if they’re not being checked out for it, and it’s just something that’s almost self diagnosed. Of you know, well, I’ve got an intolerance to gluten, as many of us do. Find out certain foods that we, you know, disagree with. Actually, it might not even come up in the question set, necessarily. But I think for you know, avoidance of doubt. Asking somebody, have you ever been diagnosed or checked for celiacs, is not a bad way to go about it. As you said, it can come on suddenly, and usually does, actually, and people start to suffer, I think people, because we know quite a few people with celiac who have been diagnosed as adults and and the head never goes there, because it’s like, you’ve not been celiac all of your life, and then all of a sudden, wow, bang, there you are. And you know, it can be things like pregnancy could be a virus that’s caused it, and I think ultimately, a lot of the time, people don’t know what, what’s actually led to it and what’s caused obviously, something’s gone in on the body that’s made the body then essentially attack itself. Sounds horrible, doesn’t it?
Kathryn Knowles 04:54
Sounds terrible. No autoimmune condition, does your body, you know, the body’s alert system that with you. Usually fight off infections, as decided that, you know, in a sense, gluten is this attacking thing that’s in the body, and so it starts to attack the area and obviously, just completely misdirects where it needs to be focusing.
Alan 05:13
Yeah, absolutely. So there’s not really any medication for the condition. The advice is, just don’t eat gluten. That’s which is harder than it sounds as well, you know? Because, yeah, you know. You know. We know from from, again, having friends who are who are celiac disease, how things can sneak into foods, or there’s traces of it here and there even things like porridge. Well, there’s no gluten necessarily, in porridge itself, it’s naturally gluten free, but the cross contamination from women processes exactly, can introduce gluten into them. And you can find that with lots of things. So it
Kathryn Knowles 05:50
can be, obviously, as well, very, very serious, can’t it, you know, I know that we have so we obviously, our children, some of their friends, are celiac, you know. And it can be this, you know, it’s such a range. So with with one of the children that we know, you know, if we, if they come around and we have a pizza night, obviously we’d get them a gluten free pizza, and for them, they can, actually can all be cooked in the same oven, and that’s okay for them, obviously, you know, we’d make sure that their pizza isn’t anywhere near the others. It’s on the top shelf. There’s no chance of anything dropping down and things like that. And that’s absolutely fine for them, but maybe for another child that we know is celiac, actually being in the same oven would be horrific, and that would actually set them off even sometimes, even if it’s just being near that kind of if somebody was making something with that had flour, and they happened to have the flour, went near them, came up, it could potentially trigger a flare up. So it is a very, very varied condition, absolutely.
Alan 06:46
So you also asked what underwriters would want to know? So we’ll say, and this is probably the most important thing. So if you’ve got a client who says, Yes, I have celiac disease, what do you need to ask them? So first and foremost, When were you diagnosed? So how long since diagnosis? Really, really important. And obviously we’ll get on to possible outcomes. But you know, the longer, the better, in reality, within reason anyway, you know, sort of, I guess a month or two is going to be a little bit trickier, maybe, than someone who’s been diagnosed for four or five years, any outstanding investigations and tests? So this is quite a big one, because obviously, going back to that first point, have they actually been diagnosed, or are they undergoing the test for it? Now, somebody’s outstanding an investigation for celiac. You might say, well, it’s only celiac disease. What does it matter?
Kathryn Knowles 07:41
It’s just gluten. Not eat gluten. That’s what some people think. But actually,
Alan 07:46
if you’ve not been diagnosed, well, the risk to an insurance company is, what if it’s not that? What if something else is going on that’s more sinister and more severe? So if there’s an outstanding test for a diagnosis, the chances are insurers got going to want you to wear unless you went for some sort of a guaranteed acceptance policy. But actually, the diagnosis can be quite tricky for celiacs. And I don’t know how many people know this, but in order to properly test and accurately test for celiac disease, you’ve got to eat gluten. And the problem for someone who suspects that they’ve got celiac disease and reacts badly and could be bowled over in pain for hours. That’s a really hard thing to ask somebody to do. So I’ve had a client recently who said, I am outstanding this test, but I’ve got to eat gluten to do it, and I don’t want to, yeah, because it’s going to put me through agony. And I can kind of understand that. Oh, absolutely. You know, so interesting case, but I will obviously do I’ll enter that any other autoimmune conditions. So like any immune autoimmune condition, sometimes you can find these things come with other autoimmune conditions. A big one that I’ve come across is type one diabetes. So and again, I’m not saying it’s a regular thing, but sometimes you can see these things together, and if you do get a combination of more than one autoimmune condition, it’s not to say insurance isn’t available, but it might complicate it a little bit. One that a lot of people won’t think about is anemia. So have they have so if an insurance company asks you this, don’t be surprised, because if you think about it, what’s happening when you know, basically, somebody’s eating gluten in it, the body’s attacking. It will your body’s not actually absorbing the nutrients from that food. So then that can lead to deficiencies and other things. So it shows almost a malabsorption type symptom that can come across with it. So I think,
Kathryn Knowles 09:33
yeah, I think that’s really important then to actually talk like slightly on the medical side of it as well. So when we’re saying that the body is Attacking the Autoimmune thing is, it is attacking itself. What that does mean is that it’s the surface of the intestine becomes inflamed. It becomes red and swollen. There’s these little, tiny things on the intestine that are there to, you know, absorb those nutrients. And what happens is, is that they get damaged, which then means that, you know, that. Ability to absorb all the nutrients actually goes because, you know, it’s, it is literally damaging the ability for the body to absorb all the goodness that is meant to be getting from the food. And I just think it’s quite important to be clear on that, because I think sometimes we hit autoimmune and the body’s attacking itself. It’s quite hard to understand. But what does that actually mean? What’s actually happening. And what’s happening is it’s just saying, for celiac, the surface of the intestine is just not going to be able to work in the way that it should, like you say, the malnutrition. And also, as well, there’s a knock on effect for that. So it’s important to be very, very mindful that when you are not absorbing the nutrients, the underwriters, they’re having to think about long term impact and effects. But if you’re not absorbing the right nutrients, that’s going to have a direct issue for the organs. How the organs are working, the quality of our blood, our breathing, everything, because, you know, we do need to have those nutrients there
Alan 10:59
absolutely and actually, that leads sort of nicely on to the next question, which is any surgery to kind of the stomach? Any gastric surgery, so bypasses things like that, any pancreatitis. So again, you know, all these things can sort of be a side effect of it, how it’s affecting you day to day. The majority of people with celiac who have had the condition diagnosed stop eating gluten. It will have no effect on their life or their ability to work. But obviously, some people really struggle with it. Some people struggle with the diet change. Some people struggle because they’ve had complications, potentially from years of eating gluten when maybe they shouldn’t. So for some people, it can, but the majority of people will probably not have any any symptoms or issues usually find. And you will get a bit of a laugh from a lot of clients who have celiac with this one. Do you eat gluten? You know, how many times have you eaten gluten in the last year? And the majority of people will go, Well, I don’t, because it would make me very, very poorly and almost have a bit of a laugh about it. But the thing is, actually, it can be done accidentally. As we said earlier. We you know, some of our friends, it’s the question usually isn’t, how many times have you intentionally? It’s how many have you done it and and, okay, once, twice, probably not going to cause a major issue. But if somebody is regularly eating gluten, even by mistake, well then it maybe shows that they are not quite been strict enough in terms of their checks and what they’re eating and things like that. So that one’s actually really, really important. And I guess kind of the key thing with this is, are they stable? Are you stable? Is it in a good position going back to that? Have you been diagnosed for a bit? Is it affecting your life? Is it affecting your work? If not, you’re probably going to be fine. If we’ve got complications, we’re going to maybe have a few complications with the insurance. Okay?
Kathryn Knowles 12:53
And so what are the really specific complications that you know, obviously this comes from, like our years of doing this and speaking with underwriters, and obviously speaking with clients who have lots and lots of different sort of, like CO symptoms or CO conditions. So what are the complications that are the kind of thing where the underwriters are going to go? Maybe just want to ask a little bit more about that.
Alan 13:14
Yeah, so outstanding diagnosis, obviously, is the biggie, and then kind of somebody who’s eating gluten still whilst being celiac, and then it’s your comorbidities. It’s your your sideline conditions, type one diabetes, for example, I did a range income protection recently for someone with both type one diabetes and celiac disease. The majority don’t want to know, to be honest, just for type one diabetes. But actually, once you add the celiac in, that really complicated it, and it does for life insurance as well. And I have been caught out by the anemia point before as well, where I’ve not expected that and made the connection. And obviously I do now, because I got caught out by it because, you know, it caused an extra loading that I wasn’t expecting at the time.
Kathryn Knowles 14:02
Yeah, but there’s, I know, there’s quite a few other things as well, isn’t it, so we’ve got, especially if we’re talking about, like, the absorption of nutrients. So there is potentially the risk of osteoporosis, which means that the bones are becoming a bit weaker. So somebody who has been diagnosed, depending on their symptoms, might have what’s known as a DEXA scan, and just to confirm, basically, what is going on on the inside. How much is the celiac disease affecting this person? How much that’s probably more, like a longer time frame of it being active and not knowing that it was there. So they’re just trying to figure out, like, what, what’s what’s been done? Has there been any damage to, like, the skeletal structure we do have, obviously, there’s iron deficiency anemia. We’ve got things like bitumen B 12 and folic deficiency anemia. And there is also, and it’s not, I think, common, but there is potentially the increased risk of bowel cancer, bowel a small bowel lymphoma and Hodgkin lymphoma. And I think, again, we’re. Sort of like we’re talking back to the beginning of it. A lot of people just go celiac disease. Well, just don’t eat gluten. And why is it an issue? Well, actually, when you have the underwriters looking at these things, they’re actually in the background going, well, well, what is the risk? What is the likelihood of somebody with celiac disease developing bowel cancer, and that they’re using all that data, those decades worth of data that they have to try and establish things like that, and that is something that can come factor into decisions. And I think what’s
Alan 15:28
interesting about that is actually sometimes some of that damage can already be done from having years of eating gluten when it’s disagreed with somebody and they’ve not known about it. So, you know, you can kind of understand where that that nervousness and increased risk come
Kathryn Knowles 15:41
from Absolutely, we have things like unexpected weight loss, which, again, would indicate that that absorption the intestines have been really, really affected. You know, we might even be at a point where there’s some surgery to potentially repair or remove some of the intestine, depending upon the amount of damage that is found and how difficult that person is finding to, obviously, to keep that nutrition level up. And we have things like peripheral neuropathy, so that is your tingling and your numbness in your hands, your feet, things like that. There can also be quite an increased risk of things like sepsis and pneumonia, meningitis, again, because of the fact that the very nature of it being an autoimmune condition means, and this is going to sound really daft, but like with our children, whenever I try to explain, like, how, you know, the body works and things like that, in the Autoimmune System, I always used to say they had like soldiers. And like, the cells in the body were little soldiers going around to Blue battle, and they’d go to a certain area to do the battle, and things like that. So it’s like with this in terms of, like the increased risk of these infections. What it is is that if the body and those soldiers are having to focus on sort of attacking whatever’s in the intestine, if that’s if the body is thinking that gluten is a foreign thing that needs to attack, then then those soldiers, then don’t have that ability to be elsewhere to fight off these other potential infections, and there is also, I’m probably, I’m hoping a Graham would say this right, refractory celiac disease. Now this is a much, much rarer form of celiac disease, and it can need some quite stronger treatment to be able to that person, to be able to just do day to just do day to day things and live quite comfortably. So you might find there’s something called prednisolone. So if you’re speaking to somebody and their clients and they’re saying they have celiac disease, you do need standard questions, any treatments, medication, and they mentioned prednisolone, that would not usually be the standard initial go to approach for treating celiac disease. So you would just probably want to explain want to explore that a little bit more. Yep, sounds bad. So what do we expect in terms of underwriting? What are the outcomes we talked about? What they’re all wanting, the underwriters, the importance now, what is the results?
Alan 17:54
What’s the result? So the good news is the majority of your customers with celiac disease will probably walk away with standard terms that is kind of, you know, as long as you do your research properly, the majority are going to be absolutely fine, but there are times when there can be loadings and exclusions or even declines. So life insurance generally is standard terms, as we found out relatively recently, there is it two years now, some insurers
Kathryn Knowles 18:24
used to be six months, and once you’ve been diagnosed for six months, you could potentially get standard terms and then, yeah, doing some research for a client not too long ago, and most insurers have changed that to two years.
Alan 18:37
Yeah. So it’s not everyone, and actually for life insurance, you could get standard terms for somebody who has been diagnosed with celiac disease a month ago, if you do your shopping around right and pick the right insurer, but the majority of insurers are loading life insurance now, or certainly a good proportion of them are loading for up to one to two years post diagnosis. And I can, I can, I can sort of surmise that that is probably because they want to make sure that somebody is adhering to the diet, not eating gluten, not slipping up, and that none of these other things that we’ve mentioned about anemia and other bits are going to crop up. So it does just give that period of stability, critical illness cover pretty much the same. You’re not really going to see exclusions on a on a kick policy, not something that I’ve certainly seen. You are more likely to see a load in. So some insurers actually now load regardless of time frame diagnosed. There is always something like maybe a 25% load in applied. I feel that’s a little bit harsh to be honest. And you you can get standard rates for CI cover. Did you want to income protection? Again, it’s usually standard rate. You don’t usually see an exclusion or a load in for income protection, but it does happen. Sometimes I have seen exclusions for certain. Cases, usually when I’ve seen the exclusion. So sort of give an example, that client that I arranged cover for with type one diabetes and celiacs, he got an exclusion on both of those. It was the only option that we could look at. Not ideal, because it’s two autoimmune conditions, obviously excluded, but it’s better than having no cover whatsoever for that client. But yeah, you again, usually standard. Now, I guess all of this is caveated by it being stable, it not affecting their work. Them not eating gluten, them not being under investigation, them not having the refractory version of it, not having any sideline conditions. So as I say, your majority of clients with celiac who are well controlled, well managed, probably going to get standard rates if you pick the right insurers. If it’s a bit more complicated, you might need to go specialist. You might find that CI maybe becomes a little bit more tricky, for example. But yeah, that’s probably a reasonable summary.
Kathryn Knowles 20:55
I think what’s quite interesting about this, just I’m thinking back over all the underwriting episodes that I’ve done, is that a lot of the time we it feels like it’s almost like the role reversal here, in a sense, because we’ve got like the outcome is generally standard terms for the majority of people, but there’s actually so much complexity in the condition that, you know, it’s usually that we find that the outcomes will be, or there’ll be at least a rate, and there’ll be at least an exclusion. But on this one, you know, we have the potential for standard across the board. And as you said, for a lot of people, that will be the case, but it is absolutely crucial that you do the research and speak to the right insurers for being able to offer that support to people.
Alan 21:36
I’m gonna say I think what’s interesting about celiac disease is the solution and the treatment for most people is just to withhold basically a piece of dietary, you know, food, basically, so something that you would eat, but but actually, with a lot of autoimmune conditions, you see heavy duty treatment like auto immunosuppressive treatment, which suppresses the immune system. You don’t really get that with celiac, but then they are what cause a lot of the concerns and a lot of the extra risks that you do with the others. So because people can just basically say, Well, I’m just not going to have this, yeah, you know, this gluten, and just cut it out the diet, well, actually, the risk reduces massively, absolutely.
Kathryn Knowles 22:18
Okay. Then. So I’ve got some case studies, and I’ve got case studies for all the things that we like to talk about. So I’m going to start off with income protection. So we were supporting somebody in their late 30s. They were a non smoker, and they’ve been diagnosed with cereal disease about five years prior, and then I’m really sorry for pronouncing so I’ve got schroding syndrome and diagnosed about two years prior too. That’s another autoimmune condition. So for this person, we’re able to arrange 1700 pound a month benefit with a six month deferred period to match the sick pay. We went close to age 60 to match the retirement forecast for them, and it was claimed right through to retirement age, and that was a little under 32 pounds per month for this person, for the life insurance. We had someone in the late 20s. They were smokers. So just always bear in mind when we say that they’re smoked, that the premiums are higher because of the fact that they are a smoker, almost roughly double. So non smoker half what I’m going to say. So they’ve had functional neurological disorder that have been diagnosed three years before, anxiety diagnosed a year before the application. And celiac had been diagnosed about eight years. So we arranged for them decreasing life insurance of 113,000 over 40 years, and it was a little over 16 pounds per month. And then the very last one is a life and critical illness policy that we arranged for somebody mid 30s, non smoker, they had celiac disease, and they’ve been diagnosed for three years. They also had some anxiety and a higher BMI as well. So for them, for the life and critical illness cover, we did 50,000 pounds of both over 27 years, and that came to 56 pounds per month. So that’s it. I hope that everyone’s found it really, really useful. Thank you for listening, everybody. Thank you for joining me. Alan, thank you for having me again. I’ll let you come back another time as well. I think. Thank you. Okay, next time, I’m going to be chatting about some technicalities of placing critical illness cover into trust, please do visit the website. Practical hyphen protection.co.uk. Don’t forget, if you’ve listened to this as part of your work, you can claim a CPD certificate on the website too. Thanks to our sponsors, the next gen planners. Thank you, everybody. Bye, bye.
Transcript Disclaimer:
Episodes of the Practical Protection Podcast include a transcript of the episode’s audio. The text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record.
We often discuss health and medical conditions in relation to protection insurance and underwriting, always consult with a healthcare professional if you are concerned about any medical conditions and symptoms we have covered in any episode.
