Kathryn Knowles  00:05

Hi, everyone, we’re on Season Eight, Episode 14. And today I have Matt van back with me how you doing, Matt?

 

Matt Rann  00:11

Good morning very, very well, the sun is shining my comment about the weather, as always, always very, very glad to say that, although I’m sure there’ll be a little bit of a look when you say I’m off to the West Indies on Friday. Lovely, Happy

 

Kathryn Knowles  00:29

holiday.

 

Matt Rann  00:30

So thank you so much. So at least a little bit more so than the first one we’ve had for at least three weeks, and no rain. So thinking to my lawn like,

 

Kathryn Knowles  00:42

Well, I was gonna say I’m getting touching words that there’s no rain for you. But I also wonder anyway, good to hear from listeners at some point, if they would like to take out a betting system of some sort, so that when you each episode, when you tell us what holiday you’re going on, we can maybe do like a bet of like, where’s Matt going next? Maybe we should have like, tactical protection podcasts. This is where Matt’s going and like a globe or something and have a little aeroplane with your face on it just moving around the globe every now and then it could be bet fixing

 

Matt Rann  01:14

going on here. Because bear in mind, my wife works in our protection industry. And she books them all. And songs when we go then just just email her or drop her a text. When

 

Kathryn Knowles  01:29

Wow will advocate that Matt as an advisor?

 

Matt Rann  01:36

Absolutely not.

 

Kathryn Knowles  01:39

Okay, everybody today, this is the last episode of season eight. So next time, we’re back with season nine. And but today, we are going to be talking about anti phospholipid syndrome, and what can be available when people apply for protection insurance. So this is the practical protection podcasts.

 

Kathryn Knowles  02:02

So as always, I’ll give a little bit of like sort of like the basic background as to what anti phospholipid syndrome is, and then that will take us into the real stuff on the medical side of things. And so anti phospholipid syndrome is also known as a P S, that’s Alpha papacy error, it did used to be referred to as Hugh syndrome. So some people, it’s important to advise if someone says to you that they have you syndrome, and that you know, that now will be classified as the APS side of things that underwriters will or should know what you’re on about if you say you syndrome, but if you’re going to do a bit of a Google and all of a sudden you’re seeing everything coming up saying antiphospholipid syndrome or IBS. And it’s just because of the fact that you know, it’s now changed this new naming. And so with APS, I might go with that more than antiphospholipid syndrome, as I’m sure you can tell, it’s not the easiest of words to make sure that you pronounce correctly each time. So when we go to APS, it is what’s clusters potentially known as sticky sticky blood, which means that there is an increased chance of blood clots. So it looks like we were looking at insurance protection insurance side of things we’re thinking, life insurance, critical illness, cover income protection, increased chance of blood clots, then a lot of the time you know there is that, you know potential that there is a high risk this person potentially having a heart attack, or stroke, possibly having a deep vein thrombosis, it is a blood condition. So it does affect all parts of the body, and is a number of charities. So when I always say to advise you, it’s a good idea to have a look at a charity site do try and whenever you’re looking at something put and the website, the thing you UK in your search field, just to make sure that you’re getting the United Kingdom side of things just because he wants to make sure that you understand the medical understanding. Here, obviously, we do have listeners from all over the world. So you could always do the same thing. But put your country reference in the search term to find out what the medical professionals say in your location. But most of our listeners are UK based. So with the UK, we do have a charity called APS support UK. And there are some statistics on there. And one of them is quite important for us to be mindful of as advisors, but I’ll just go through them. So about one in every 2000 People have an anti phospholipid syndrome. And when it comes to are we talking about increased risks there. So one in six young strokes, so that would be the cost factor. people under the age of 50 are thought to be linked to APS. One in six young diagnosis of deep vein thrombosis are thought to be due to APS and one in six young heart attacks are thought to be linked to the anti phospholipid syndrome. Now the ones to be very mindful of here as well when you are speaking to people and they’re giving you information is obviously you could potentially speed somebody’s foods quite vulnerable about their diagnosis and that can happen with any condition. But quite specifically, one in six people that experience recurrent miscarriages are believed to have antiphospholipid syndrome APs and it does tend to be something that if you do have recurrent miscarriages that is checked for. I don’t know, obviously all the medical side of things to that. But you know, if you are a an advisor, and someone tells you that they have APS, and you ask them about the situation, in terms of, you know, what were the kind of symptoms were you having, when you’re diagnosed, you’re probably thinking, you know, have you had blood clots, you know, that’s probably the thing in your mind, but it could well be that the person starts to explain that they have had recurrent miscarriages. Now, that’s obviously very emotive for that person. So make sure that you become obviously going to empathetic mode and make sure that you don’t rush on to the next things. Next questions don’t be flipping so ignore what’s being said. But also for yourself as well, you know, potentially be mindful for for yourself, as to how am triggering, that can be depending upon your own situation. And I’m fine to share that I had an early miscarriage between my second and third child, and it was very, very difficult. And I can’t imagine what it would feel like to have recurrent miscarriages. So and obviously, for myself, that could be you know, a bit triggering, depending on how I’m feeling, depending upon certain dates of the year, that might be something quite emotional. So as anything, and we always say with this kind of, though, I always say this, just just be a good, nice person, you know, be be, be supportive, you know, don’t prolong the conversation. Don’t watch the conversation. And and just be mindful that you you might yourself be feeling so sensitive sometimes after this, depending upon your own circumstances. But now we’ve done all that math, can you please start us off by telling us about APs and how it does affect the body?

 

Matt Rann  06:42

Yeah, absolutely. It won’t be the first time. In fact, with English, it’s consecutive podcast podcasts, where I’ve actually talked about autoimmune disorders. But APs and I will, I completely agree with you that anti phospho lipid syndrome is bit of a mouthful, so I shall break it down into APs. But here, again, we have an autoimmune disorder. And for those people who are who are kind of catching up, there are a good number of very well known conditions that are that fall into this category. And effectively it is where the immune system which of course, in its normal function protects us from infections of all types, is where it for one reason or another, and it’s not known medically, the why the absolute why anyway, the our own body starts to attack elements internally, and that can cause as you can, well imagine, problems, to say the least. And so with APS, we have another, say autoimmune disorder. And Catherine, as you’ve alluded to, it causes abnormal blood clots to form in the veins or arteries. Okay, veins, little bit unusual veins and or arteries. The mean, what it effectively does, I’ve talked about the immune system response, and what it does is produce abnormal antibodies called anti phospholipid antibodies, and you can then see the the pay back into the name of the syndrome. And the effectively, these antibodies target proteins, which are attached to fat molecules, or phospho lipids, which make the blood much more likely to clot. So the little bit of technicals around that. And if I say targets, phospho, lipids phospho lipid is a major membrane lipid. And what I mean by that is that all our cells have membranes, all cells, millions make up our body of membranes, and it’s incredibly important in their own function. So if you have an antibody that is attacking those cell membranes, then you can clearly I hope, you can clearly see that it’s not going to have the greatest impact. That said, and when I come on to how the insurers look at APS, I’m pleasantly surprised, I think in what I will, will say and before we get too worried, then, as customers alluded to, I think in some of the areas already, often this APS has actually detected by screening another condition and be glad to know with into the ratings or the underwriting guidelines just a little bit here. But if ABS is detected by screening, without any history of complication, particularly for thrombosis or SLE, another autoimmune disease systemic lupus erythematosus I’m and completely asymptomatic, then life insurance, the guidelines for life insurance at least is normal terms for life critical illness, income protection across the board. So I hope that will at least take some of the oh my god, this is this is horrendous away. But noticing that issues of generally look at if there are complications of this particular antibody. Rather than it’s actually being in the body if you like so thrombosis, then they will look at rating for thrombosis. Okay, as I’ve said, there’s not no more causes the immune system to reduce these abnormal antibodies. And with other autoimmune conditions of which there are a good number. You’ve got genetics, hormonal, and also the favourite environmental factors that are thought to play a part. But at the moment, the scientists can’t actually put their finger on the mechanics of what is actually happening. I am sure as they are with many cancers, they will in due course, but not not just yet.

 

Kathryn Knowles  11:18

I find it really interesting about when I was doing the research, I have helped people with with APS. So in terms of research for the insurance, I understand what will happen there. But in terms of doing the podcasts, I always like to do some research into the condition even more. So just so I can try and catch up and know what you’re on about with certain things and all this kind of stuff and obviously give people ideas, if they want to jump to me. Yeah, but But yeah, and I found it really interesting, actually, when I was doing the research that it basically said it said that they think it is environmental factors generally, you know, it wasn’t like, it seemed to stress, there wasn’t really a genetic link. Which, which I found quite sucks, I was find that really surprising. Because again, I was I’m sure people know, if they listen is often my dad has Parkinson’s. And you know that there’s not really it’s very rare for there to actually be a very specific genetic link to the development of Parkinson’s is often environmental. And I think in my mind, I’ve always thought of Parkinson’s as genetic, and I think probably quite a lot of people would. So it’s, it’s interesting to me when something I think, is going to be genetic ends up in a sense, not necessarily being it’s unlikely, actually, there’ll be genetic, and I was reading a prophecy, the environmental causes in it, it kind of sort of like seemed to suggest that there’s the can be any number of things that can potentially cause this condition to develop.

 

Matt Rann  12:42

Absolutely, I think one of the standard, some of the standard things on cancer, we talked about genetics here, you obviously have some genetic conditions, which are very, very strongly linked with, with cancer. But the way that my understanding and it is, you know, in the scheme of things effect with him, he’ll be limited was with obviously, some of them have the greats out there. But they could have there may be a genetic weakness, of which just have to be unlucky that something from an environmental perspective comes on and triggers it, or does it as the case may be you can live your life completely normally with absolutely no problems whatsoever. If you come across this, this this chemical that say in the environment, the triggers that weakness, and that’s where these conditions can occur. But you’re absolutely right, in terms of some of them are certainly not strongly linked in some of the some of the conditions that we talked about. But my understanding of the environmental conditions is that those could be a little bit of a genetic weakness there, which that environment factor then triggers. But it I mean, who knows, I think is the answer. But certainly that’s some of the pseudo logic that’s been used in InfoSec for some conditions, I know. So I’ve got it. Again, you’ve covered it already. But APS can affect people of all ages, including children and babies. But most people are diagnosed between the ages of 20 and 50. And it affects three to five times as many women as men. In covered not entirely sure. I think you did throw her to statistics, certainly that from what I’ve been looking at. I didn’t look at your website, which I apologise for the APS website. It kind of I’m hearing that because the people can go wandering around and I’m assuming this is the why. People can go wandering around DPS and like even knowing and never having any complications of ABS. That he’s not really known. It’s not very clear on how many People in the UK actually have the condition. Yes,

 

Kathryn Knowles  15:02

I got that. About one in every 2000, roughly one over 2000. Obviously, that’s just from quite a limited. Yeah, sample, and then, you know, kind of doing the multiplications. And stuff to estimate and things like that. So it is really tricky. I found sort of a to get any definitive kind of well, actually, this is your thing is this,

 

Matt Rann  15:26

unless everybody, every single person is screened, then yeah. That just won’t happen. may happen in Star Trek, but it won’t happen in, in during our lifetime, I think or mine, I should say, going going going on to diagnosing APS now, it can be difficult. Let’s be honest here, the symptoms APS, you mentioned the problems that can occur, like DVT, stroke, Tia, heart attack, high blood pressure. But if none of those are obvious, or you don’t go to your doctor for one of those, then APS, from what I can read is certainly can be difficult to actually diagnose. And some of the symptoms can be similar to multiple sclerosis, pins and needles, Paris, mine as well, in terms of APS minor areas of paraesthesia, and so on and so forth. So effectively, the only way you can diagnose it is diagnose it is by blood test, and two, and there are blood tests available that can identify the antibodies responsible. And once those blood tests are done, those antibodies are found, then that diagnosis can be made with certainly good, good, the good degree of confidence how anti phospholipid syndrome was treated. At the moment, there is no cure for APS, which probably follows to a degree from well, we don’t really know what causes it, therefore, we can’t cure it, however, and what we’re looking at obviously, is the risk of developing blood clots. And the good news is that the chances of actually getting a blood clot or thrombosis can be greatly greatly reduced, if it is correctly diagnosed. And it’s no surprise then that anticoagulant medicine comes into play, such as warfarin. And we talked about some of the impacts of warfarin. So importantly, if anybody is on anticoagulants, they do need to see their GP and get a blood test to make sure that the treatment itself is not impacting any of the major organs, particularly the liver. But again, it’s quite often the low dose aspirin is also prescribed, which again, I think, if you think that aspirin is often used with people who’ve had a stroke, or had transient ischemic attack, or TIA or otherwise known as a mini stroke, then that that particular medicine couldn’t no surprise. Now, as we know those reduced to likely those particular medicines reduce the likelihood of unnecessary blood clots forming but it’s still importantly if you think about it, it still allows cuts to form when sorry clots to form when you’re when you cut yourself. So you don’t want to go completely over the top otherwise, if you did have fortunately was cut then you didn’t want to bleed out. So those drugs are good, they work and they’re proven to work but as I say do need to ensure that the dosage isn’t impacting other organs within the body. Treatment with those I think importantly, treatment with those types of medications can also improve a pregnant ladies chance of having a successful pregnancy. So Katherine, I don’t know it’s APA is one of the I should know bear in mind my daughter’s recently well fairly recently had a baby but can you remember whether you were tested for APS during your three

 

Kathryn Knowles  19:22

Yeah, no, I I don’t believe I don’t believe I was but also as well obviously I I’d had two pregnancies that had obviously I don’t know what the right word. I’m gonna say go full term. I don’t know how else to say it without it kind of feels like any other word would be insulting in some way. And then I’d had my early miscarriage. So I think in terms of my miscarriage, it would have just being a case of it was one of many because obviously that one of medics obviously there are so so many people who have I think there’s probably I imagine there’s probably times that I’ve maybe had one and just had no knowledge of it because obviously they can happen so, so early. And but yeah, so I think because I’ve had not had any difficulties previously that I wasn’t tested. But no, I know, the only thing I do remember with blood clots, is my sister got a blood clot with her second pregnancy. And it was I think it was during or after, I think it was a bit after when she was in the hospital, she has been in hospital. And the reason I remember this so distinctly, and I know that this is absolutely this is nothing compared to the treatment other people obviously have to have. But it’s still one of my contention things is obviously, and the world was when I had my third child, because I had a sister who had had a blood clots. And because I’ve had my third child, I had to have Warfarin injections

 

20:49

for a certain amount of time, just to make sure I mean, obviously grateful that you know, very much taken care of and that button, I didn’t like the self, the self stepping, I’m gonna say it’s, you know, and injecting myself with that, but I certainly wasn’t going to allow Alan to were to do it. That was the goal for me to do it.

 

Kathryn Knowles  21:08

But, but for that one, it just kind of felt like I’ve just been through all of that. Now, I’ve got young kids, um, firstly, I kind of just feel like I’m, I’m kind of just laid here is like, like feeling like a cow, just sort of light, and everything like that. And, and then I’m having to like, inject myself as well. And sorry, I know, we’re going completely off topic here. But yeah, no, that was the that was the only thing that for me in terms of the that was because the at the time, which was six years ago now. And the rule was, it might be different now. But the rule was sibling blood clots, so many pregnancies. That’s it, you’re getting blood clot preventers, or just in case,

 

Matt Rann  21:49

you know what I yeah, I mean, I suppose? Well, no, I was gonna say I suppose I wouldn’t know about that anyway, because I’m a male. But let’s be honest here cause Trisha, and I’ve had two children. My daughter’s got a child, and, you know, uncles, aunts, cousins, and I’ve not heard of that. So I’m not really mentioned in reports, either, which is probably the way where I would see it, rather than anything else. But

 

Kathryn Knowles  22:11

yeah, I think that there’s certain criteria, like there was like a three tick box thing. And like, you know, there was and there was certain things and it’s obviously I tick to, which meant I had to have it, but I think maybe when you reach a certain age as well, then that was maybe something that was sometimes factoring, and I didn’t I wasn’t at the age factor for it, but it was. Yeah, it was, it was all my sister’s faults. So every time I had to do the injection, I was like, This is your fault. I think that she was fine, though. I’d say I’m absolutely fine. I wouldn’t be joking and so much if if she definitely.

 

Matt Rann  22:45

Okay, now it’s interesting. It’s all very, very interesting. Okay, so, again, with the treatment, talking about pregnant ladies, again, when with this treatment is very, very good chance of successful pregnancies. So this testing certainly sounds good Warford self inflicted self inflicted Warfarin injections apart. And I think probably mentioned to you that it gave you an idea of the ratings and insurance look at here, that most people respond very well to treatment and can lead normal healthy lives. And that is reflected in terms of way insurers look, the people who have APS but just noting that they’re gone any of the complications then we move on to looking at those particular complications, the most obvious one being in the thrombosis because of the clotting itself. There is something which sounds absolutely bloomin awful medical medical term called catastrophic anti phospholipid syndrome. Often, again, using these wonderful terms, C A P S caps. And it’s in very rare cases, you can get blood clots suddenly form which sounds horrendous throughout the body, resulting in multiple organ failure. And of course, we just take this remote back to basics. And I know this is kind of like, I don’t know what they call it these days. In my days, it was first year in senior school, I think it’s a tech there’s much more technical way of putting it these days. But either way, that kind of biology of blood clots, what they do what the problem can be. It’s kind of obvious to most but by definition, if blood can’t get to or from an organ, then that can cause failure. And that is actually known as catastrophic anti phospholipid syndrome. It goes without saying probably from the sound of the way I’ve described the complication, which is multiple organ failure that it requires immediate emergency treatment in the hospital with very high dose Antica. microloans if people have had that, then if you come across a client who has had that, then the underwriting view on it really will come down to how long ago? Yes was, if there are any ongoing complications, what the end going ongoing treatment is and how often you reviewed? might, depending on certainly how long ago you had it and as obviously, people who survived by definition, otherwise they wouldn’t be singing for life insurance. What you then it’s a bit dare I use this wonderful handwriting to them individual consideration, I think a lot of it will be different to how long ago? And what kind of what the complications were arose from the multi organ fee elements of that particular syndrome. So I wouldn’t say no, but I would go go into those individual. I think when you when we look at underwriting as a whole, when you when you hit in very rare cases, or this is a very rare disease, then you almost definitely get you should get an underwriter discussing the case with their chief medical officer.

 

Kathryn Knowles  26:21

I was gonna say I would have expected probably the CMO kind of out of out and I think, I think as well, when you say no about, you know, when we’re talking about catastrophic APS, you know, it does sound you know, the word catastrophic, it makes it sound obviously varies, and obviously, it is a very, very intense situation that’s happening at the time. But I think, you know, from an advice point of view, if you hear that, obviously, you possibly going to think wow, what, what do I do, and this is going to be possible, but like you say there might, you know, catastrophic APS events that happened 10 years ago, is probably going to be less concerned than say, somebody who’s not had one but actually has developed deep vein thrombosis two months ago, you know, so it’s, it’s all about, as you’re saying that the timings are really, really, really key to this.

 

Matt Rann  27:07

Yes, yeah. As they are almost when underwriters will almost always ask when. full recoveries, and so on and so forth. Now, I also would say that my experience, particularly in the reinsurance worlds, and we had within Cheltenham, where we’re m&d strips, which really were based at the time there was London as well. We had six different CMOS, the consult in the Cheltenham Gloucester area. And it wouldn’t be uncommon at all for these guys to say, ladies and gentlemen, my dad, good grief, that’s so rare, I’m going to have to go away and either research myself or phone a friend. Yeah. So you know, it’s not just the underwriters will say Good grief, this is this is very, very, very difficult. But it also be your your consultants, consultant status, doctors saying Good grief, I need to go away and often phone a friend, you know, a specialist in a particular area. So that’s a bit more kind of going outside caps just for a second, but more into the generalities. If something’s very rare, then yes, it can work way by the CMO as well. Okay, now, I did mention in terms of ratings, ratings, the insurance view and remember, every all our listeners, these are guidelines, okay? So an underwriter needs their experience, and their view on the case as a whole to come up with a rating. Like these are the actual eventual rating, but these are the guidelines. So if somebody’s had a thrombosis, then we’re looking generally at plus 50 For three years, and then Standard Rates thereafter. Interesting point Catherine wants to discuss with you actually, on the basis of it. I don’t know if we have the time. But if you could, when when you advise a client, let’s say they’ve had a thrombosis as proposes. And let’s say they had to have a thrombosis two years ago, where it’s even be more cheeky, and say two and a half years ago. Would you advise them to take out the plan now? Yes, they really broke it in, say six months? It’s been cheeky, yeah. Or would you say, Well, look, it’s gonna cost you 50% More for six months. If, again, I’m gonna be even cheeky by saying that in six months time, you can get standard rates, but we have to ensure that you’ve had no other medical problems in the meantime. What do you actually do on an invoice process?

 

Kathryn Knowles  29:56

So what I would say good so would do. Yeah, yeah, no, absolutely, I’d say a good adviser would do would be give both options. Yeah, absolutely. And suggest and say, from their point of view, you should start the policy. Now. I think all I think the majority of advisors in the UK, I would say, and I imagine a lot of underwriter sort of experiences as well, is where an application goes also for an underwriting application goes in, sees the underwriter going for medical reports, and something happens in the meantime, and it’s not offered same happens to advisors, we chat to a client, they want to go, you know, you’re wanting to do something, you suggested that they go ahead with something, they decide, well, actually, I’m going to wait this long. And then ultimately, something happens. And then it’s even more expensive. And you know, it’s such a lot of people, it comes down to what the clients are wanting to gamble. And I guess this is probably going to be where I’ve gone a little bit of a side tangent on advisor side of things. So do forgive me. And really my last question before I got my side tangent gone? No,

 

Matt Rann  31:12

please do not think it’s personally bear in mind, I’m not an advisor isn’t very interesting question.

 

Kathryn Knowles  31:18

Yeah, you would, you would advise them to take the policy and say, We’re doing this now. And we’re going to change it in six months, assuming that everything is as it is, I actually, I have somebody that I’ve been supporting for a year now. And we did an application. And it ended up last year that they were given, I want to say that was a per mil rating. So it was a significant rating to the policy premium due to a medical condition. And we at the time, so this is another thing that you should really do. Is it advisors say to them, right? This is what you’re doing now, when will it be standard terms? Or when will it go to a percentage rate? Or you know, obviously, and if someone’s postponed or declined? When will you be able to look at this, you know, find that out, put it in your diary. And so we’ve come up to around the 12 month mark 11 month mark ish. So I’ve contacted the person. And so I said, just checking any health change set? I obviously did, what I advised last year was take the policy out now I know it’s expensive. Take it out. Now it is going to be significantly cheaper in 12 months time. But you never know what might happen in 12 months. Yeah, yeah. But the person decided not to go ahead and they’ve waited, they’ve waited, everything’s been fine. There’s been no changes from what I’ve been told. And we should be able to get standard terms, and which is brilliant. It’s really, really positive that we should be able to do that. And the GPO report is still within time, so we won’t even need to go for more medical evidence, you know, you know, it’s working out very, very well. But there are often times when that doesn’t happen as well. So from an advisor point of view, you would say take it out, and then we’ll adjust it going forward. Now, I know that there’s probably some advisors who would say, and I have seen a bit fall on social media as someone who hasn’t gone oh, well, if you’ve done a good enough recommendation, people are going to take out anything that you suggest. So it will and I just it’s that kind of irks me a bit, I have to say, because of the fact that, you know, I certainly don’t think that there’s any advisor who’s got 100 percents in a sense conversion rate that will refer to an advisor terms, you know, conversion from initial chat to policy going live. I don’t think anybody has that. It’d be amazing to chat. So most if you are someone who has that be brilliant to chat to you to just find out what’s what you’re doing that that will make it so interesting. Exactly. Yeah, but ultimately, not the person I spoke to last year, they simply couldn’t afford the higher price. Yeah, you know, and even if you say, Well, why don’t we do part, the price even got the thing of all, I don’t ever want to apart the price, because I feel like it’s not worth, you know, the value of it. And there’s only so much you can do as an advisor at times to explain the worth of an insurance policy if, especially if it has been rated. And that really key thing to do with that is from the start is to say, this is what we expect it to be. So when I’m advising pupil and select with this person, you know, the advice was, I expect the payment to be this I didn’t say what was going to be on the accuracy on the comparison engines, I didn’t see what was going to be in the illustration documents. You know, I’m not going to say to somebody or it’s gonna be five pounds a month, when I know it’s not, you know, there’s no point you should calculate and that’s where we will say you should do the research before you’re doing any kind of application because that’s the way that you’re actually going to be able to to encourage people to take the policy because you know, even for myself who said it was gonna be five and it ends up being 30 quid a month. I’m just making up numbers there by the way, but if I’m really thinking someone going hang on if she says 30 quid a month what Max percentage loading is that up I try to catch me out with something. But if I think it’s gonna be five or for someone without my condition, it’s almost like that I’ve said it before where it’s like the that darts shows like, this is the price you could have won, you know, kind of thing was lovely shiny car behind the door, but you missed out on it kind of thing. And, and we don’t want to do that. So we really need to manage expectations, tell them from the start. And that is the best that you can do as an advisor, but always stick to what you are going to be suggesting. So my advice is this, if you choose not to go ahead with it, that is your choice. I’ve made you aware that if your health changes or any other circumstances change in the next year, this might not be available, even though they’re saying it now. And also the insurers might change their underwriting rules within the next 12 months. And I can’t guarantee that what they’re saying now will be the same in 12 months time.

 

Matt Rann  35:48

Very good point,

 

Kathryn Knowles  35:49

that last one. So you know, it’s you know, everything can go absolutely hunky dory for the client. But then, you know, we do have it sometimes where, you know, even with number of different conditions that if an insurer suddenly becomes better, in a sense, with one underwriting risky, it can mean that another underwriting risk gets a bit worse in terms of options in terms of the clients. So not always, but you know, we can see that because the insurers will change risk appetites as they go along. And so in answer to the question in a very long, roundabout way of saying it, yes, I will tell them start the policy now. And I would redo it in six months time, it won’t look great for my KPI in a sense, because that’s what we as advisors are monitored on, you know, in terms of key performance indicators, where we’re saying, Well, what’s your persistency ratio in the first 12 months? So that’s how many policies stay live within the first 12 months of them starting. So it will affect that statistic a bit. But if you’ve got an example, so if somebody were to I’ve seen an advisor, someone says to you, how are your KPIs a bit lower, and you go? Well, actually, that’s because I’ve done right by my client. And I can show you that on these handful of cases. I’ve done this and it was kind of like seen as temporary so that I could get them even better going forward. And some advisors obviously won’t necessarily want to do that in terms of their go to offices workload, its resources, depending upon the way that they take their renumeration, if they are commissioned based on the ticket indemnified, then it means that they’re going to actually get more money and then have to give some back to the insurer, because they’ll end up you know, in a sense, earning less for the work they’ve done, because the premium will be lower if they do that change, but ultimately, in terms of consumer duty, and the rules that were being upheld to that commission shouldn’t be used as a reason for not redoing the clients cover and getting them a better option. So there’ll be a long answer for that.

 

Matt Rann  37:43

I think that was really, really, really important point that you made about what I would call purely on the basis I’m just an underwriter, the clawback point that you make, you shouldn’t point again, nothing was very, very, very valuable. So no, it’s an interesting when I complete decided not to be alone got into today, otherwise, he will be here for a long time. I think the as an underwriter quite often, I try and put myself in the position of the advisor when trying to understand what to say with

 

Kathryn Knowles  38:18

underwriting I try it for myself in the mindset of the underwriter.

 

Matt Rann  38:22

Great minds will actually do the same as me try. And one of the one of the challenges that I have nothing to do with thrombosis or anything else is at the moment with the movement of smoking ratings from somebody who hasn’t smoked at 12 months to now, Lolly issues. Now, as you know, you very well know, Katherine, that a lot of jurors have moved to actually rating for five years.

 

Kathryn Knowles  38:51

Yes, which doesn’t show so advisors that does not show up on your comparisons. When you’re doing your comparisons. The only time you will see that is once you’ve actually started the application and gone through it.

 

Matt Rann  39:01

Okay, that’s very, very interesting. Well, yeah, good point. Good point, is, again, is how we handle that in his totality. What I’m what I’m hearing at the moment is I haven’t done the full survey and to be honest with you, it’s not an underwriter, writing issue, per se, but is is actually what those what insurers do that that 12 month period, because they would actually change the weighting. As you notice, I’m a smoker as we know it. Once it’s a smaller loading that is added to the nonsmoker rate. It’s mine stone. Yeah,

 

Kathryn Knowles  39:39

so it’s staggered as well over usually over five yearly basis. So what we what we do is in our fact find we specifically altered of fat fine to say, have you used any form of nicotine products in the last five years? Yeah, yeah. And we open it up to any form of nicotine because for people again, advisors who don’t realise this Is the nicotine aspects of a sense? So we need to make sure that we’re figuring out cigars, gum, patches, cigarettes, any other farm, you know, obviously that people might be using? That’s

 

Matt Rann  40:12

not exactly moving part of that question out smoking, and it’s not smoking, is tobacco usage? You’ve said, well, nicotine use? Sorry,

 

Kathryn Knowles  40:20

absolutely. And it is a surprise, because, you know, it’s one of those things where it started happening. And that was that hang on a minute, what’s going on here, you know, because it wasn’t sort of like, going out to the industry of advice. And, by the way, just so you know, when you do your application, was suddenly if they’ve smoked three years, five months ago, the premiums gonna go up, and it was something like, Hey, what’s going on in your sock? And it was, it was a learning experience, I think, for a lot of advisors, just to start, and so like, obviously, we have obviously, our our quotation systems work internally to keep our systems as well bespoke built. And so we actually specifically have it in ours, where it flags towards the insurers that would do that, just so that if we do have someone who’s been a previous smoker, we can really quickly identify right, that price I’m seeing there isn’t the actual price. And you know, so I just said that it makes it a lot easier when we’re trying to give clients the the right outcome. And also, it makes it a lot easier as well, compliance wise, when I’m doing my audits, like, why haven’t they chosen that person are because they were actually going to rate them and make it much more expensive? Overall, that makes sense makes it nice and nice and quick to be able to check things.

 

Matt Rann  41:28

Yeah, it’s, for me, I suppose the element or an element, an additional element is quite how you advise on somebody, and sort of what the actual practice of that insurer is, do they at the end of the five years? Again, I suppose they would have to look at the whole case, again, from an advice perspective and say, what actually, is the rating that was applied for that period from one to five? Still cheap. Is it still an option? Yeah. Would you do better? Bear in mind that individual is now four years older, five years older?

 

Kathryn Knowles  42:03

Yeah, I’ve had that exact situation where somebody is you know, we set up a policy on smoker eighths is then been, there was other some other health factors as well. But obviously, they’re all really wanting to get nonsmoker rates. But actually, by that time, the same pot thing like I was mentioning earlier, by the time we’d gone, the it was about four years or so for about four or five years, because just because of the just because of the medical history, we needed to wait a period of time and, and by that time, the insurer had changed their underwriting. Sort of like rules for the medical history of this person. So actually, to get them nonsmoker rates at this point was more expensive than keeping them on smoker rates from the four year prior. So it isn’t usually you know, you can often chip save quite a lot of money. If somebody becomes a nonsmoker, but not always, but realise that we’re getting very, very close to time, a bit of a side tangent every so I’m going to do a quick summary. So when I was an advisor, I’m going to ask somebody, when were you diagnosed with APS? You know, have you had any blood clots? I’m going to find out how many where they were, when it was, you know, and things like that. I probably wouldn’t ask specifically catastrophic APS I’d maybe say to be to be to make it sort of, like less intense, maybe say, Have you ever been hospitalised due to the APS? Sorry, get a bit of clarification that way. Something else? I know we had a bit of a debate about this as well. So it’s an interesting thing, I think as advised as well. Sometimes you get an options you’ll go forward you’ll get the underwriting decisions. Sometimes you won’t get the decision that you expecting like maybe postponing decline, you think, Oh, hang on what’s going on everything. I’ve seen the same data. And there was one situation I was helping somebody with APS and it ended up being a postpone and I didn’t know what was going on. And what ended up happening was there was another kind of side tangent diagnosis to it that the client wasn’t really aware of. And I wasn’t obviously familiar with this at all and it was something called Budd Chiari Malformation now is to do with the liver and to do with blood clots, blood flow, things like that. And I hadn’t been aware of this and obviously spoke to the client they’re like, What on earth is that? You know, and obviously, they obviously had a chat to the GP and everything like that, but it was it was a note you know, in the in all the medical information and everything and stuff like when they’ve been chatting, speak to the specialist about the ABS diagnosis, all this other stuff have been set at the same time they hadn’t picked up but what I tend to do now because I’ve had someone with ABS and then the outcome I’ve expected wasn’t what it ended up being because of something else. I try to remember to bring that in. So what I’m saying to somebody right, when you’re diagnosed, how many block all those things are just like have you ever heard of the word Budd? Chiari malformation? Have you ever heard that? It’s a very, very unusual term. It’s not sorry, your usual set of words you’d like SPECT. So if somebody goes What on earth is that, and they’ve probably never come across it, it’s probably unlikely that they have it. And I know that from when you were looking at it, it was quite rare actually, to have that. And but then at the same point, if they have heard it, then it’s really important that you’ve heard it because it will massively changed the underwriting outcome. But there’s other things as well, obviously, I was just going to go I’ll go through some cases where I talked about some linked conditions as well. But so very, very quickly, maths in terms of life insurance, critical illness, income protection, what are we expecting if it’s APS, just APs? We’ve not had any catastrophic APS events in say, the last five years or so. No recent blokart so what would you be thinking?

 

Matt Rann  45:40

Okay, the I’ll just go back on catastrophic APs. I’m reposting too much time on that. But having just scrolled down on my notes here, I can actually say one of the manuals in writing manuals actually says literally history of tourism, give it time, date, life and all of the benefits decline. Now, guideline guidelines or guidelines, it personally if I’d have had, if I as an underwriter saw somebody who had catastrophic APS 1015 years ago, I would want the underwriter to explain why it’s been declined. Okay, so remember guidelines. Again, standard if APS on its own no history of SAE systemic lupus or isn’t ptosis, completely asymptomatic standard rates across the board. The most common side effect in fact, when you first get diagnosis with a slight complication, in fact, one of the reasons we get diagnosed with AAPs is thrombosis. And again, what you do when the underwriter would look at there is the APS itself, sorry, the thrombosis. And you can in the market say this is one example of underwriting guidelines. Within three years, you’ll be rated plus 50, for life insurance, decline, critical illness, and keep the answer and income protection. Once it goes over three years, its standard rates for life but still decline, particularly illness and income protection. For critical illness. I think I would maybe look at an insurer who can exclude but we’re looking at cardio cerebrovascular events here. So it’s worth asking the question, but get be too surprised if you’re going to shove back if you’ve got some say APS before link often linked with SLA. And with those, you’d get rated for the for the SLA. Yes, in terms of catastrophic, and I’m sorry, I should have scrolled a little bit further in my notes, that is a decline. But if it’s a long time ago, then I would question that with the with the insurer. But Chiari Not surprisingly, to see if this is even in the same field as catastrophic to be honest with you, if not even more rare. But looking at the survival rates from this, I would say it’s probably going to be very much in the could be in which again, was catastrophic. But again, it is worth asking the when and what the current situation is all those cases, just because they help let an underwriting helpline says decline, then if it doesn’t make any sense to you, as you’re already highlighted, don’t ask why. Given particularly if it’s 1015 years ago,

 

Kathryn Knowles  48:26

absolutely. And I think if that’s

 

Matt Rann  48:29

if that’s okay, in terms of the way

 

Kathryn Knowles  48:30

Yeah, or, yeah, and especially I think, you know, if there’s anything there where it’s, it’s, it’s a bit extra to the APS, so say like that put Keowee where, you know, it isn’t something that’s a complication, you know, it’s it. Yeah, it’s complication aspects of things. And it’s not saying that it’s specific to APS, it just sometimes, you know, happens that it can be there. And you’re probably you really do want to be pushing for a senior underwriter to look at it, because you know, that there are plenty of times where, you know, frontline kind of rules, engines and you know, probably, you know, more junior underwriters, in a sense, you haven’t had that experience, that knowledge, you obviously will have will at times very much. follow exactly what the manual say. And obviously, I do appreciate that. You kind of think, well, shouldn’t they all do the same thing, but there are times like you said, where it might be saying, well, no, not if it’s been more than, you know, if it’s ever happened, but then, you know, there’s some times you need to go well, actually, it’s yeah, it should be fine. Maybe not standard terms, but some potential. Yeah, absolutely. So I’ve got a couple of case studies, just to chat through just to explain potential pricing for people to see that. So, first one is somebody that was in their early 40s, nonsmoker. We were going for level life insurance of 30,000 over 20 years. Now this person had APs and sickle cell anaemia, and they actually had a crisis for the sickle cell anaemia, within a couple of years of was doing the application multiple sort of like closer to the one year mark. And it was mainly it was Saying that matters well about what they would tend to look at it. It was mainly the sickle cell anaemia that was looked at the APS obviously was a contributing factor to their decision for the insurer. But it was a sickle cell that really stood out to them when they were doing the the assessment. So the 300,000 level life insurance over 20 years was a little under semi two pounds per month. And then the next case study was someone in their early 30s nonsmoker, decreasing life insurance of tuition of 52,000, over 35 years. Now, this person had lupus and it was so as SLE lupus and they were actually on very strong medication. So if anybody listened last time to rheumatoid arthritis, so essentially, Matthew was saved by the ultimate condition. So we’d had last time was rheumatoid arthritis, autoimmune, this time saps, salt immune, so we’ve got lupus, which is autoimmune here, very strong medication and that the medication really influences as well what the underwriting outcome can be, but also with this person, they had APs and they’d had multiple blood clots, including blood clots in the lungs as well. So decreasing life insurance, tuition and fee to 2000 over 35 years, and the premium was only 27 pounds per month. I imagine from me saying those are the bits there people probably assuming it was a lot higher than that. But that’s just to show that even though when we’re getting these things, we are saying that we’ve got some quite serious medical conditions, serious symptoms, medications, it doesn’t mean that it has to be silly prices. Okay, so as always, thank you, everybody, for listening. Thank you, Matt, for joining me.

 

Matt Rann  51:33

My pleasure.

 

Kathryn Knowles  51:34

It’s always good to have you here. Look forward to hearing where you’re jetting off to next time, and we’ll do our next episode together.

 

Matt Rann  51:40

I can tell you that if you like, oh, no, we’re gonna be back.

 

Kathryn Knowles  51:46

Next time as say we’ll be back with the first episode of season nine of the podcast, and I’m gonna be looking at key person cover and how to advise on it. If you’ve listened to this as part of your work and wants a CPD certificate, please visit the practical hyphen protection dot code at UK website. And we are able to do that thanks to our sponsors, the Oxford members. So thank you very much, everybody, and I will speak to you soon. Bye MAs.

 

Matt Rann  52:10

Take care bye