Kathryn Knowles  00:08

Hi everyone. We are on season 10, episode one, and we are going to start this season with Alan Knowles from cure financial services joining me. Hi Alan, hi Kathryn. Hi everyone. Today we’re going to be talking about Crohn’s and Ulcerative Colitis and what can be available when you apply for protection insurance. This is the practical protection podcast.

Kathryn Knowles  00:34

Well, we usually start off these episodes with me asking the person that I’m speaking to how their weekends been. But considering that we’re married, I kind of know how your weekend’s been, but how do you weekend being Alan, challenging.

Alan Knowles  00:45

It’s been interesting at the moment. Does everybody know about

Kathryn Knowles  00:49

fudge? I don’t think everybody knows about fudge, but would you like to share what’s happened? So, yeah,

Alan Knowles  00:53

very sadly, fudge. Basically, I don’t know what’s the right word for it, but he became paralyzed from the

Kathryn Knowles  01:01

from the way, he’s had three and a half year old cockapoo, just for anybody who doesn’t know.

Alan Knowles  01:05

And yeah, he he just lost used of his legs. Nothing. It wasn’t an accident, nothing specific happened. But yeah, very sadly, just lost, lost control over his legs in within about a 24 hour period. And he went in for emergency spinal surgery at a week in rehab. And he’s now at home getting rehab from me and you, which is interesting.

Kathryn Knowles  01:24

It is and really intense. And I have to say as well, many people listen to the podcast will know that my dad has Parkinson’s and that he’s been quite ill over especially last year while Sonia was back in hospital again. Recently, I have to say it was absolutely phenomenal to see how much better he was getting ice packs, dirty physio, being hand fed, food, all this kind of stuff. And he’s still pretty much getting that now that he’s home. So yeah, I’m doing physio about three or four times a day, and you’re doing the other bits, like the walks and the night times to try and do that so and start trying bear the load together. But it’s interesting, very, very interesting, very, very hard, but he’s worth it, and he’s actually just coming to try and get a little snuggle from us as we’re doing this. So definitely worth it. Okay, so let’s get on to Crohn’s and Ulcerative Colitis. So Crohn’s is a form of inflammatory bowel disease. It’s usually diagnosed before the age of 30, and it can affect different parts of the body. So usually we think of Crohn’s as something to do with the gastrointestinal system. So that is your risk of your intestine. So the Upper Gastrointestinal area, the small bowel, the end of the small bowel, the colon, and the perianal, on mouth, potentially. And this is, I actually found this really interesting because I didn’t realize this, and it can potentially affect the lungs and the vulva as well. So I’ve always thought of this, and sorry, come across this mainly to do with it being towards the intestines, and it’s really important as well. When you are chatting to somebody, to know exactly where in the body the Crohn’s is affecting them. And it’s quite interesting as well. So with Crohn’s and Colitis, and there’s a Crohn’s and Colitis UK actually did some research in 2022 that showed that in the UK there’s one in 123 people are living with Crohn’s or ulcerative colitis, which when you kind of like thinking that up in terms of the maths, and that suggests there’s about 500,000 people that are living with the condition that we know of in the UK. And when you are looking at the data, obviously, as well, NICE guidelines do suggest that it’s, it’s more men than women that typically are affected by Crohn’s. I don’t know why that is. Maybe some underwriters out there, or some actors know that side of things, but I just thought that was quite interesting, because we know a few people with Crohn’s actually and and they are men. It’s it’s not been women that we have. We’ve come across clients, but in terms of personally knowing people, it’s mainly been men that we know. So then, very quickly, onto the ulcerative colitis. And there are more people living with ulcerative colitis than there are Crohn’s. Is the one that’s diagnosed more often. It tends to affect the large bowel. It’s also a form of inflammatory bowel disease, and there are lots of types of this. So bear with me while I try and pronounce some of them. I’m not going to get them all right. So we’ve got proctitis, and I’ll pronounce that right. So this next one is that one that’s going to be interesting. So the procto sigmoiditis, I think I’ve done that left sided colitis, which is also called distal colitis, total colitis, and you can have things like pan colitis or extensive colitis. And again, niece says it tends to be, again, slightly more men than women. And it’s, it’s interesting in terms of diagnosis, because it tends to be between the ages of 20 and 40, and then there’s a bit of a gap, and then it’s from ages 60 and over, where it tends to, sort of the data is generally lying. But that’s sort of like a very, very quick background into some of the stats. Hopefully that shows as well seeing just hearing how many people are living with this in the UK, why it is so important to be aware of it. Especially for any clients that you might be speaking to. So Alan, we’re going to get you coming in on this bit for me, please. So what I’d like you to do is, can you just take everyone through as an advisor and as obviously, just for anybody wondering. So Alan does have incredibly extensive knowledge from the underwriting side of things. You’ve worked alongside underwriters and others and actuaries for for well over a decade, and sort of getting and building the knowledge upon this. So from your technical minds and the underwriting side and your technical mind and the advisor side, what are you going to be asking somebody if they come to you for advice and they are living with Crohn’s or ulcerative colitis? So,

Alan Knowles  05:37

I mean, first thing I will always ask is kind of how, how it’s affecting them. You know, how often are they having flare ups? Is it? Is it daily? Is it weekly? Is it is it monthly? Is it yearly? How long since they’ve had a flare up now, somebody who’s living with inflammatory bowel disease, or Crohn’s or ulcerative colitis. I mean, interestingly, from an underwriting perspective, the two conditions aren’t hugely different. Obviously, some of the questions we will ask will differ a little bit between them, but, but the time since the last flare up is is probably one of the biggest questions that you’ll need to ask. Now that’s not to say symptoms, because some people who obviously, who live with this condition will have little symptoms at time up times. But a flare up is something that is kind of much bigger in a sense. You might need medical intervention, might need time off work. Somebody will know when they’ve had a flare up of one of these conditions. Medication taken is probably the next biggest one, because some of the stronger medications used to control these conditions can really have an impact on the terms offered for things like life and especially your illness related policies. I’m assuming

Kathryn Knowles  06:51

that’s because with those stronger medications that when obviously stronger indications absolutely fantastic, they make the the condition, you know, much, much more bearable for people. But the very nature than being stronger medications means that there is then that’s having influences and impacts on other areas of the body as well. Yeah, 100%

Alan Knowles  07:10

so, so you’ve got different types of medications, so and again, forgive my pronunciation, maybe on some of these, but you’ve got amino amino salicylic, which are things like Mesa Leanne as a call sulfasalazine, for example. These are quite common. You will see these. These basically treat the inflammation in the gut. Now, these mixed opinions, but they are usually not too bad in factoring in for underwriting and steroids. So prednisolone is probably the most prominent one that you will come across, and you will see long term steroid use is never particularly attractive from an underwriting perspective. So if you’ve got somebody on them long term, it will have an impact. But you tend to find with these conditions that steroids are used more to treat a serious flare up. So if somebody is in the midst of something and they really just need a boost to help them fight it. That’s when steroids are used. So finding out if they’ve used steroids, and if so, when the last time was is really helpful. The ones where I guess the biggest complication comes with that we will see with this condition are immunosuppressants, so things like azathioprine, methotrexate and inflicty Mab, typically, if you have a medication that ends in Mab, M, A, B, you can take a reasonable assumption that that will be an immunosuppressant, and that works by suppressing the immune system. Now, the problem with suppressing the immune system is obviously it can stop the body from attacking itself where it shouldn’t, in the likes of Crohn’s and all sort of colitis, but it can also prevent it from doing what it’s supposed to do, which is preventing your, you know, almost your immune system, fighting off colds and bugs and flus. So that’s where, obviously it can have a bigger impact. So finding the medication name, maybe googling it, you know, running that past insurers is a really, really important thing with the

Kathryn Knowles  09:00

immunosuppressants as well, aren’t they? Just trying to remember the top of my head, and they’re the ones where you probably hear something like, oh, I have an infusion every so many weeks, or something like that. It tends to be quite a it’s I tend to hear more that side of things like, you know, every six weeks I go and have this medication.

Alan Knowles  09:18

Yes, absolutely. And the beauty of these infusions that somebody has is that they tend to really control these conditions and keep them at bay, which is fantastic, but especially since the pandemic, where obviously immune systems were, you know, people who were immunosuppressed were at more risk the we did notice changes to some of the underwriting around these types of medication, and it gradually getting better again. But yeah, they are the ones that you typically see more of the infusions of, I

Kathryn Knowles  09:44

think, as well, obviously, going back to basics as well is just make sure you get your standard things of when was it diagnosed, you know, how many months or years ago was it? You know, like you say, on the medications, but also any other treatments. You know, sometimes there. Will be surgery. Sometimes people maybe have to have a stoma fitted, because they maybe had to have some of the bowel removed. It might be that there’s surgery due to come up, which would obviously be something that would be very, very important to know about. And another won’t be any hospitalization, because you talk about the flare up. So a lot of obviously the flare ups can be very, very uncomfortable for people, and if you stay Alan, they might suddenly need, like, maybe a bit of a course of steroids to just help them get through that. But there are potentially times where even with the steroids, there might need to be some hospitalization just to give that extra bit of monitoring, potentially some slightly different medications or treatments just to really get through everything. That would be a particularly unpleasant flare up if somebody was in that situation. But again, it would be, it would be finding out within it, sort of like the time frames.

Alan Knowles  10:47

And the the other part is where the people have had complications as a result of of the bowel disease as well. That was

Kathryn Knowles  10:54

probably my next question. Fair enough. So go. Okay, so Alan, let me ask you what kind of complications could we maybe come across, or specifics that would maybe make it quite difficult to actually get an application through with an insurer?

Alan Knowles  11:10

So interestingly, anemia, so anemia in itself, if you’ve got someone who’s iron deficient, anemia is not usually a concern, but when you’ve got someone who’s got a condition like, I keep on, irritable bowel disease, sorry, inflammatory bowel disease, like Crohn’s, like ulcerative colitis. Actually, anemia can show that the body is is losing eye in some ways, losing those vitamins that it needs. So anemia is taken into account. So definitely, you know that is something worth, worth flagging. It’s not to say you won’t get terms for somebody. It might just mean that it’s higher loading, or it might mean that some of the illness policies aren’t available. And then you get into more serious things. It can affect the liver and other organs as well. So obviously, if you start seeing liver damage, which is less likely now, and I’m not sure whether that is relating more to the medication or the condition itself, but obviously anything that damages other organs is going to be seen as more problematic. And then you’ve got things like, you know, eye problems. It can, it can actually affect the eyes as well. So those are probably your your higher risk things. Now, interestingly, smoking, I think a lot of people would think, because smoking does make this condition worse, it actually doesn’t really impact the terms for what they call it a standard ish case. You know, if you’ve got someone who is well controlled, they’ve not had any of these major complications, actually, because they’re paying a higher rate for being a smoker anyway, it’s not going to have a huge impact. But if you have someone who’s had liver problems, or they’ve got anemia, and they’re getting into these more complicated versions of it, then the smoking will really come into account, because it just adds yet another risk factor onto them. And actually, what I find quite interesting is you mentioned stoma bags. So when somebody’s had a stoma fit, as long as it’s not recent, and as long as they’re not having problems with it, it actually doesn’t impact the policies as much as what you would think they would do. So somebody lives with one, and they are controlling it. Lots of people have these. They manage them really, really well. And obviously, yes, there are increased risks of infection around the site if they don’t clean them and things like that. But it really doesn’t impact as much as what you would think. The biggest impact probably that we will see our recent flare ups, that recent flare ups, hospitalizations, things like that, are probably one of the hardest to because actually, if you’ve had someone who’s had a flare up in the last six months, for example, it’s most likely to just result in a postpone for life insurance, and definitely for critical illness cover, just until you’ve got to a period of stability again. I

Kathryn Knowles  13:36

think that makes him a lot of a lot of sense you were saying with all those bits. So what would be the outcomes that you’d be thinking? I know you’re just saying there about a bit of the postpone everything. But if you were going forward, you know, say we’ve got somebody, they’ve got Crohn’s or ulcer colitis, they’re wanting life cover. They want in kick they want in income protection. What would you be thinking, and I do have some case studies to share at the end, as usual, what would you be thinking in terms of, you know, this is what I would be expecting, and obviously I appreciate there is a really broad scale. And it’s like you say, there could be some people that will be postponed, there will be some people that are potentially going to be declined. You know that they’re more likely the declines at where there’s going to be outstanding surgery, or there is maybe the, there’s been the the conversation that they’re going to start the immunosuppressants, and they’ve not started them yet. You know, there is the potential that Some insurers might go, Well, let’s just see how things are going, because the very nature of that is that one, there is a change of medication. So they probably want to see what’s happening and how the person reacts to the change of medication. But if you’re going on to that, it probably does signify that you’re having some symptoms that aren’t controllable at this moment in time, so they would just want to see some stability, but, but what would you be expecting? Alan for clients?

Alan Knowles  14:46

So I guess I’ve probably been talking about the more serious side of things and what to look out for, what the risk factors are. The good news is, actually, for most people who have got Crohn’s or ulcerative colitis where it is well controlled, they will for life insurance, get Standard. Rate or maybe a slight loading. So somebody who doesn’t take immunosuppressants, for example, you probably expect standard rates, no recent flare ups in the last year or two, and somebody who’s had, say, has immunosuppressive treatment check each insurer individually, because some are better than others. Could be anywhere from standard to, you know, to a smallish loading. It’s once you start getting into these more complicated territories of having other risk factors, like anemia, or, as Kathryn said, you’ve got a recent flare up, which might result in a postponement. Obviously, if you’ve got someone who is really struggling with their control, and they’re having lots of problems with it, because it can be associated complications, obviously down there, then they’re the ones that are more likely to be a decline or a postpone but, but actually I find declines rare. For life insurance, you’re more likely to see a postpone until they are in a better position. The illness policies are where it gets a little bit trickier. So critical illness cover, it is actually possible to get somebody standard rates for critical illness cover with Crohn’s and Ulcerative Colitis, but only with a provider that doesn’t offer Crohn’s and Ulcerative Colitis as a claimable condition, which is kind of understandable. So actually, some providers will remove those conditions from the policy. Some will put an exclusion on for anything linked to IBD, so to inflammatory bowel disease or complications thereof. Be careful when you’re looking at these exclusions and do a little bit of shopping around, because actually some of the wordings can be a little bit more favorable than others. Some, you would imagine by the by the very nature of how they are worded, could even stretch into things like bowel cancer as well, whereas if they just remove the conditions. That’s obviously not going to be be applicable. So it’s, it’s that complications thereof or associated conditions to watch out for. I was gonna say, I think

Kathryn Knowles  16:49

I’ve said this because I know you still got IP to chat through as well. But so with criticalness, I’m sure I’ve said this on an episode before, but just to remind everybody, so just really, if somebody’s got COVID civil colitis, keep an eye out on your core critical illness cover versus your enhanced critical illness cover, because there’s a few insurers now that on their enhanced cover will cover claims for Crohn’s and Ulcerative Colitis in terms of them being diagnosed. So what you can find is you could be thinking, Oh, I’m doing absolutely amazing for my client. I’m going to get them enhanced. Oh, but it’s going to have an exclusion for Coronavirus, because they’ve already got those conditions. And an exclusion never, ever sounds great. And I kind of said sometimes it can then lead on to exclusions in other areas as well, like potentially bowel cancer, which, you know, that’s that’s huge. We wouldn’t want to be having that in there, or any kind of connection. And the thing is, is, if you just gone for the car cover, there wouldn’t be an exclusion because of the fact that the Crohn’s your sift crisis aren’t covered by the core cover. So they don’t go ahead to state that exclusion there anyway. So what you can find is from a quality contract for the client that you actually is far, far better quality to go for the core than to go for the enhanced now, this is insurer dependent. Not all insurers have Crohn’s and Ulcerative Colitis in their enhanced contract, but do just keep an eye on it, because, like Alan says, it can have broader reaching effects on the claim set and and you just really, really want to be careful of that. So Alan income protection.

Alan Knowles  18:19

So IP, definitely, for me, has been the most challenging since the pandemic. It is getting better, but, you know, you stretching into sort of a year or so out. You know, after, after the pandemic, it was an absolute nightmare, if not nearly impossible, to get anyone who was on immunosuppressive treatment and income protection policy. So I’ll just dial that back actually a second, sorry, so I would expect anybody looking for income protection who doesn’t take medication with Crohn’s or ulcerative clients is just to get standard rates, and maybe even if it’s one of those sort of early and non immunosuppressive treatments that I mentioned, probably to get Standard Rates once they start taking immunosuppressants, which, by the way, is a lot more common now, because actually, the surgeries that you know, they are so successful, these types of treatments that they do, tend to just put people on them. The problem is, is the majority of insurance will just decline as soon as you mention an immunosuppressive treatment. There are a couple that will take dosages into account. So a lower dosage, obviously, is better than a higher dosage. But the good news is that we are getting better now, so sort of, you know, obviously a number of years down along from the pandemic. Now, there are a handful of insurers who will consider people who take immunosuppressant treatments. Other than that, it has to be well controlled. You know, if you’ve got someone who’s having regular flare ups, time off work for it, the chances of getting income protection, then, as a fully underwritten policy, are slim to none. So it’s a difficult one. It’s very case by case, I would say just if it feels like it’s a very good case, you’ve hopefully got a good chance. If you feel like this person’s actually struggling a little bit with the control, taking time off, things like that are really needing a lot of Medicaid. Or steroids, or anything like that, your chances of income protection obviously start to decline a lot quicker at that stage.

Kathryn Knowles  20:06

Fantastic. Thank you for giving that insight. Alan, so I’m just going to do a couple of case studies just to show everybody what we’d potentially be looking at. So first one is somebody who was living with Crohn’s. They were in their early 30s or a non smoker. They were diagnosed at the age of nine and had surgery and stoma fitted a few years before the application, and based upon obviously what Amy said as well, they had previously had an Amy due to condition, but that is no longer something that they are having complications with. So for this person, decreasing life insurance of 220,000 over 35 years was roughly 14 pound and 50 pence per month. So the other case study I have is somebody with ulcerative colitis. Now, this person’s in their late 40s, and they’re a non smoker, so they were diagnosed in the early 30s. There’d be no surgery, but there had been a small flare up of symptoms about six months before the application. And so that, in itself, was something that was, you know, certainly came into the underwriting consideration that had been that quite in the insurance world recent and flare up. They also had atherosclerosis, which is to do with the heart, and osteoporosis, with some outstanding checks. And you can find with the outstanding checks, sometimes, some insurers, again, will, will just want to wait until those checks are done. But in this situation, in the specific circumstances, it was it was okay for it to be considered for the application, another complication that we had was the fact that the client had only been resident in the UK for about 12 months prior to application, and had spent quite a bit of time outside the UK each year for work. So there’s quite a few things, different things going on. So in this situation, decreasing life insurance of 480,000 pounds over 10 years was approximately 91 pounds per month. So you can see that there’s quite a difference. Part of the difference in this in terms of the premiums, as well as the fact that you’ve got the person who was living with Crohn’s was in their early 30s, and the person with ulcerative colitis is in their late 40s. But there is differences in terms of recency of symptoms. There is also as well. For the person with ulcerative colitis, there has been that little bit of a heart complication as well. So everybody slightly different format to the way that the underwriting Insight has been done this time. I hope you’ve liked it. I hope you’ve enjoyed having Alan with us. He’s going to come and do some more. Thank you very much for joining me. Alan. Very welcome. I’ve enjoyed it fantastic. It’s been brilliant to have you. So next time, I’m going to be doing an overview of type one diabetes and some income protection products updates with Simon sister friendly. If you’d like to listen to more episodes, please visit the website, www.practicalhyphenprotection.co.uk dot practicalhythmprotection.co.uk, and don’t forget, if you’ve listened to this as part of your work, you can claim a CPD certificate on the website. Thanks to our sponsors, the ox members. Thank you for listening, everybody and speak to you soon. Bye. Bye, everyone. You