Episode 1 | Epilepsy

Hi Everyone,

This is our first official, proper, hopefully fantabulous, brand spanking new episode. Can you tell we are a bit excited?
In this episode we are focusing on epilepsy and what you need to know, if you have this condition and want insurance.

Our 3 key takeaways,
1. There are approximately 60 different types of epileptic seizures
2. Epilepsy is not often a huge red flag for insurers
3. Two case study clients living with epilepsy, you might think are uninsurable
Don’t worry, we know insurance is boring and Kathryn and Andrew have done well to avoid the jargon!
There is also a teaser at the end where you get to decide in this episodes ‘Truth or Lie’ if it is Kathryn or Andrew that is a liar. But! You have to tune in for episode 2 to hear the answer, see what we’ve done there, enticing you back, we’re so smooth.

Kathryn
Hi everyone. This is episode one and it’s all about epilepsy. I’m Kathryn.

Andrew
I’m Andrew. This is the practical protection podcast.

So this is episode one, a big week for us and for anyone listening, who you get to have the honour when we’re playing big sell out stadiums in the future to say you were here for epilepsy episode one.

Kathryn
I love that, the idea of us in the O2 or something. Just like a big barstool type thing (laughter), a beer in each hand.

Andrew
Yes, sell-out crowd waiting to hear ours and other’s thoughts on protection.

Kathryn
Absolutely! Probably not the beers then (laughter).

Andrew
I don’t know. Before we get into that Kathryn, how are you? How’s your last week been?

Kathryn
It’s been good. It’s been, as always I’m sure with all of us, it’s just been manically stressful. Work and kids, it’s just been non-stop. The kids yesterday just seemed to be on one (laughter). It was a tough day, but I think there could also be a bit of a fall on because I on Thursday and Friday myself and Alan did the mental health first aider training and it was two days of really intense kind of learning about mental health and different types of mental health, the different symptoms that maybe you all see. How that could potentially be a certain diagnosis or basically how your reactions should be to it.

And obviously being a big advocate for mental health, I expected, I expected to be involved and everything like that, but I actually found that I became really involved and I was sharing quite a lot of my own experiences and sharing things that I don’t generally share with people. But it felt like quite a safe group. It was very, very draining but just so incredibly important. And it was, there was so many fantastic techniques that we learned from that as well. And hopefully we are now that first line of kind of help if somebody really does – if they’re struggling possibly with some symptoms that they’re not really sure how to manage. But yes, on a hopefully on a more jollier note, you’ve had a bit of a better last week and a half than me?

Andrew
I did something for the first time this weekend, which is always good, at the ripe old age of 41. So I’ve always lived around London, but this was the first time we went to Madame Tussauds. Basically we’re at the end of our family year of Merlin passes (laughter). So picking off the dregs, and it’s fair to say as a good underwriter I definitely preferred the bodyworks exhibition, which we’ve done before, to kind of seeing Ed Sheeran in wax, which is slightly less impressive. But as always with these days, it looked very good on social media and let everyone else think that we’re a perfect family and have great weekends! So we ticked that box anyway.

Kathryn
Fantastic. So yeah, yay us! So back to the facts of the day job now. So yes, here we go.

Well we did, I was going to say, we did Madame Tussauds once and I have to say I’m to sharing this because I’m going to be shaming Alan here and I will shame him well and truly.

It was when, I think it was one of our first anniversaries, so probably about 15 years ago now and we went to Madame Tussauds and they had this feature floor, which was like, a terror, horror house type thing and we decided to go through it and I, quick thinking that I am, thought right we’re in a set of four, there’s two girls in front of me. They’re really giggly and hysterical and the actors will swarm for them. Alan was just like in his head, was like hang on Kay’s rushing through this, she’s not enjoying this experience. I’m going to hold her back, so she can kind of just enjoy it a bit more and inside I was like no and I’m shouting at him what are you doing. And he was just saying like, you’re not enjoying it and I was like, I’m clearly getting through this as quickly as I can. And he was like, but we’re not enjoying it. And so obviously the actors then deliberately swarmed for me and I’m screaming at the top of my voice ‘I’m really sorry but if you jump in my face I’m going to punch you, I’m so sorry it’s an instinct!’.

Anyway, let’s focus on epilepsy.

One in every 100 people are diagnosed with epilepsy in the UK and the stat I actually found really quite surprising is that one in every 220 children are diagnosed with epilepsy and that just seems like – I feel like everybody knows about epilepsy, but I don’t feel like everyone – that just seems like a lot of people that I would potentially come into contact with.

Andrew
Yes I agree, so well, the one in 220 I guess is a powerful number for me because my children go to a one form entry school with 30 children in each year, primary school. So you quite quickly do the maths and go, that probably means that there’s a child there who has epilepsy. I will confess, or if I need to confess at the start of this, I’ve never seen anyone knowingly have an epileptic attack. I know people who have epilepsy, I agree it’s one of those conditions that I think if you do see, then it’s obviously memorable. The frequency of it is probably underestimated and for me that’s quite interesting in itself, because I don’t think it’s ever almost been a really hot topic for underwriters or insurance.

Kathryn
Another thing as well with epilepsy is that there’s just been a recent change in the name of it. Which I think some people aren’t necessarily aware of and I know sometimes, even when we’ve spoken to people. I think there’s still that kind of change of dynamic of which version of the term that people are using. So previously I think a lot of us are familiar with the term ‘grand mal’ and ‘petit mal’ epilepsy. That would have been like what it’s been referred to for quite a number of years. Whereas now they’re now they’re called tonic-clonic and absent seizures. But there are, and again this really surprised me, there are around 60 different types of know seizures.

Andrew
If you look to the future of medicine the reality is there is just going to be more and more of these subgroupings, so whether it’s heart attacks or cancer or whatever. I guess the labelling that goes on with these things is quite broad and then gradually, as with epilepsy, you figure that even though the attacks might look quite similar, what’s going on inside someone can be really quite different and the consequences of that be really quite different. It would have only been a couple of generations ago where, you know, you wouldn’t have had six different types, let alone 60.

Kathryn
Does that make it just – one of the things I’ve always had a query about in regards to underwriting – is the fact that we’re able to diagnose so many more conditions and we can identify them so much earlier – could sound a bit daft, but is that in a sense kind of being counterproductive to us being able to arrange these policies and do these applications. Because, whereas before somebody may not have been classed as having epilepsy because they didn’t fit specifically into the criteria or any other condition or something. But now that we know that there’s so many different types and different types of seizures, they now need to say well I actually do have epilepsy and it’s this type.

Andrew
It’s important to remember, sad as it is though, sad as it is at times, that underwriting isn’t the most important thing in medical advancements and you can sit there going oh this just makes my life harder, but there’s a few more important things to go on in that journey. That it is an ongoing challenge, so you kind of have, I guess simple things like relabelling a condition which ought to be a relatively straightforward mapping. But yes, the progress is really difficult, where so for life insurance, to say this for the first but no doubt the last time, for life or critical illness or income protection, you are underwriting today, for typically for the next 25 years.

And so to do that you’re generally looking at research that isn’t, you’re not looking at the latest medical advancements, you’re looking at what’s happened, let’s say 10 years ago. So that you know that the side-effects of that wonder new drug don’t, nothing terrible happens etc. So almost the modern research that in most cases, unless it’s absolutely certain, would be taken in, would be probably 2000’s research and then you kind of try to overlay that to all the changes you’ve just described. Which can absolutely create some difficult situations and some situations where you are into those individual considerations and actually, needing to get full disclose to get medical records potentially and to walk an underwriter through that process to get the fair decision.

Kathryn
Going back to some of the stats that I’ve looked at recently, I’m not saying that this negates how many people at all died, but I suppose from a risk side point of view, it’s around 1,000 people that die in the UK every year due to epilepsy. Now obviously, I mean those 1,000 people would have meant a significant amount to their families, but from a business point of view, from an insurance point of view, that’s really quite a low figure I imagine statistically for the amount of people that are in the UK. And I think it’s about half of those that are actually due to sudden unexpected death in epilepsy and I know that that’s had quite a lot of resurgence in attention at the moment, because there was this story recently of Amelia Roberts and her order of service was found by a women called Hari Miller in her new office drawer. And another thing that really shocked me is that when were chatting about this in the office – and obviously we’ve got about 15 – 17 people in our office – and out of those people two of them had actually known people who had unfortunately died due the sudden unexpected death in epilepsy. And that really obviously shocked me that even in that small group that we have that there were two people that had obviously had that with people who were in a sense close to them.

Andrew
I think the physical nature of attacks probably means that people have an almost primal understanding of the dangers of this condition and then the very modern kind of overlay with the DVLA – once people have seizures or attacks if you’re of adult age then your doctor will say that you need to send a letter to the DVLA and it could typically be 12 months from your last seizure or until there’s a diagnosis confirmed before you can drive.

So I think almost those two separate things create quite a, I guess, a realistic conversation around this condition and around the risk of this condition. And as you say, the numbers – so from an underwriting perspective the primary decision here for most cases is whether it’s acceptable at standard rates at the same rates that any healthy life without any medical condition would pay or whether there would be a small extra applied. But those are the two most common decisions for people with epilepsy and we’ll come onto when those don’t apply in more detail as I guess we talk through.

Are you saying there’s something wrong with me? There’s nothing different from me? I kind of think people with epilepsy, there’s, as I say that physicality of it makes them aware of it and there are, you know, as you would imagine, plenty of medical studies that will estimate that the increase risk from having epilepsy is kind of between about 1.5 and 4 times depending on the type of epilepsy and how well it’s being controlled at the time. As I say, it’s those kind of numbers.

Kathryn
I think this is time for you to get your absolute underwriting cap on Andrew and tell us all. I’ll just let you loose and see if – I’ll time you, if you go for too long (laughter).

Andrew
Well, I guess the aim, to flag what I or we are trying to do here, it’s certainly not to explain in great detail what epilepsy is – I mean it’s fair to say that the nervous revision course for me on a Sunday night is likely to be going to NHS websites and charity websites and I think those are a good resource for anyone listening to these. Sort of prognosis and decisions that come out of underwriting for these are the classic rubbish underwriting guide of standard decline or standard to postpone certainly.

So to kind of go through that journey, I think the bit – often the most difficult bit for underwriters and let’s be clear, the person who’s in the middle of all this – is through that period of diagnosis. But through that process typically most insurers would give a postpone decision and there’s pretty logical reasons for that, because it may be epilepsy it may be something else. You’re about to go and have scans of your brain etc, so there could be a very early claim either for life, critical illness or income protection potentially depending on what’s appeared. So that’s a tricky 12 months, once you’re in to a point where either a trigger has been found or the condition is controlled through medication or through any other way, then as I’ve said in most cases there, the decision would be standard rates. You ought to be able to get standard rates and there the only sort of ratings will be if there’s still a trigger present, if the medication isn’t working i.e. you’re still having a lot of attacks or still having very serious attacks when you do have them.

Kathryn
So could I just quickly jump in with that? So say like if, just as an idea then, so say if someone that is on medication and they were having more clonic seizures, so the stronger ones. But say they’ve not had them for a couple of years or something, but they’re still having really regular absent seizures – I know what would be the experience from our clients and I’ll come onto some case studies in a bit – but would you expect kind of a consistent approach across the market or would you imagine there is going to be quite a varying response depending upon the different insurers’ view points over it.

Andrew
I think there can definitely still be variants, I mean the I guess lifting the veil off what insurers are doing and seeing here, epilepsy is quite a table driven ratings approach. So what the underwriters are looking at, and in fairness, why this is a condition that tends to be heavily underwritten by systems, programmed by underwriters, rather than probably physically seen by underwriters, is that is does tend to end up being a table which is applied. You are diagnosed by epilepsy, number of attacks in the last year and type of epilepsy, almost then within the spreadsheet, depending on what the latest research that that insurer or reinsurer has used, then you may well get different outcomes. Again in the specific situation that you’ve highlighted there, there potentially is some underwriter judgment going on as well in terms of whether the grand mal epilepsy or the tonic-clonic epilepsy is still, whether you can take the view that that is effectively cured or whether that’s still there and the seizures are kind of minor, less frequent versions of those. So I think that’s where you can get very different decisions, where people are almost diagnosing the condition differently.

Kathryn
Ok, so I mean one of the things I was thinking as well, so as an advisor I have a lot of people come to us and chat about epilepsy and the different situations. Now we get a range of different reasons, it could be that it’s a genetic factor that’s caused it, a brain injury, a tumour. It could be the result of possibly quite heavy alcoholism, so I know because it’s what I do, is that I’ll need to know what type of seizures they have, the type of epilepsy, when they were diagnosed, what medications are in use. So that cause behind it, and obviously the regularity of the seizures as well, so say if I we are an advisor and we’re coming to an insurers or speaking to an underwriter or something – obviously I appreciate that you say that quite a lot of it is automated now, so sometimes it’s going to go through those systems – but is there any kind of specific things that would possibly throw an application out of the automation, what are the flags that would typically go, well actually that medication has now reached this dosage or actually they’ve gone from 10 seizures a month to 12 seizures a month, so now that it’s at the 12 we’re going to have to have somebody physically look at it.

Andrew
Rules in those systems are still being actively written by human underwriters and the data that comes out of them is being analysed by human underwriters, so we’re certainly nowhere near AI in any form or life insurance as yet. So I guess the more complicated the case, the more likely it is to get referred and I’ll try and explain what I mean by complicated.

What an underwriter would view as a simple case is someone who’s had epilepsy for a relatively long time, who may have had a very traumatic start to their life with epilepsy, has now not necessarily experienced no symptoms or is on no medication, but has a controlled pattern. And a predictable pattern, that’s the good, that’s probably going to go through a system of standard rates. Opposite to that is the further you deviate from that the more likely is to get referred, so those would typically be either newer cases which are just outside of this postpone period, where you’re still changing medication, where there’s still more attacks, but there’s a story that’s saying this is being controlled quite quickly or there’s a trigger, probably a trigger has been identified and there’s some question marks about whether it’s truly epilepsy or not. Because I think one of the challenges around this is, and in the long term for people with epilepsy and their health, is that epilepsy can mask other conditions.

Kathryn
One of the things as well, is that I know, because there’s something that I’m always trying to explain to my clients, is that we all see one in a sense level of the insurers, but then obviously I try to explain, there’s the reinsurers in the background, the names that people aren’t necessarily going to think of straight away when they think of insurers. And how does it work then, given your background, how does it work in regards to the reinsure to the front line insurer and how those epilepsy guidelines get washed together and that?

Andrew
Reinsurance in 60 seconds or less or trying to explain to my mum what I did for a job (laughter)!

Reinsurers insure insurers. In the UK life market there are typically, there are roughly two year contracts, so an insurer which is the name of the company who you would buy your policy from, would then give about, well between 50% – 90% of the risk to their reinsurer and in return the reinsure gives them promises to pay that much of the claim and helps them make sensible decisions based on lots of medical evidence.

So in practice – back to practical – there are reinsurance underwriting manuals which have lots of global medical research behind them and really do drive underwriting in the UK market, so insurers can choose to do their own thing, but they have to explain to the people who are actually going to pay the majority of the risk why they are taking it. To materially change things it is those reinsurance underwriting manuals which, where most decisions originate from.

Kathryn
Is it subjective I imagine as well as an underwriting? There are times we’ll even speak to the same insurer twice and we’ll get completely different indications and I think that’s obviously not the right scenario, in a sense that shouldn’t really be happening, but I think it is that thing as well that sometimes it comes down to underwriters are human too and, you know, sometimes they are going to have different opinions or maybe they’ve just learnt it in a slightly different way for that condition to potentially someone else, it’s difficult sometimes to know what to do.

Obviously we in our company in Cura we have built our rate and our business model to work alongside that and we know if someone gives us an indication for someone with epilepsy and we know it’s not right then we will, double check it it’s a case of well hang on a minute. We had one, not for epilepsy, we had one last week where someone had spoken to an insurer and they were indicated standard and immediately obviously one of the senior advisors said that’s not, that’s completely untrue. Not untrue, that’s just not going to happen in a sense, and the other advisor immediately ran back and was going through the underwriting and again and then we’re told that at the very least it was plus 150.

Andrew
It depends on the case right, there are going to be some decisions which are simply wrong or unreasonable or you know, unfair or whatever label you want to put on them. I think the vast majority of times when there are differences though, they are going to be just like if you see two different doctors and they take a different view of your symptoms and your treatment and don’t you know, actually know which one is, in inverted commas right or wrong. It’s really hard.

Kathryn
We don’t necessarily have it with epilepsy, and it could well happen with epilepsy, people who’ve been recently diagnosed with HIV where they do come to us and they’ll say things like I’ve got life insurance, but they’ll say I’ve been diagnosed with HIV, I need to get new life insurance. And you immediately go, hang on, let’s not get rid of the original pre-diagnosis thing. I can’t think of that specifically happening with epilepsy, but I think it possibly could happen at some stage, especially when you’re looking at things like critical illness cover maybe even income protection. People possibly start to get maybe a little bit confused and I don’t know, I wonder if that’s maybe, that’s people doing things directly and not having things explained to them or if it’s kind of insurers documents or even though I can’t think, I don’t think there needs to be any more explanations in insurers documents, because they’re already so hefty (laughter). Compliance people please do not add any more jargon to these documents you know!

Andrew
Yes I agree, it happened to my – so my brother in law got diagnosed with rheumatoid arthritis earlier this year and he was absolutely half way through cancelling his policy by the time, you know.

Kathryn
You suddenly got there and went nooo!

Andrew
Yes I did that kind of slow motion run to a computer to kind of. I don’t know in the same way you’ll try not to tell me how to do your job, I’ll try not to tell you how to do yours. But I guess it must get kind of not emphasised enough through some sales journeys that this truly is guaranteed, you know in the same way that, that classic kind of well if you chose, if you genuinely chose after taking up the policy to take up this hobby or to go travelling to this place that would be fine you would still be covered. Exactly the same for these conditions. Whatever you do, don’t cancel policies just because you’re diagnosed with a medical condition. And I guess as well, there’s lots of things that you can get access to if you have these medical conditions. Which you may have experience of?

Kathryn
Oh yes, absolutely, I mean I obviously, I’m sure everyone probably knows. For anyone who’s listening to this and knows me on social media will know, that I have obviously a few difference insurance policies, as you can imagine I’m insured quite well even though I do have medical conditions, I still manage to get the insurance. But I have a lot of the value added services now, so you know I’ve used Square Health, I’ve used Red Arc Nurses, I’ve used sort of like the on demand GP services that are available with some of the insurers and they are incredible.

When I’m chatting to people, well what I think of as a brilliant example, I was doing a policy for somebody and it comes down to that whole thing of being able to having been advised and give somebody that advice and not just doing for the cheapest policy. Because I had this option for this person, I was like right I’ve got two options for you this one’s 30p cheaper, but before you think yes I want to go for the 30p cheaper option, you know the cheapest option gives you the insurance policy, the one that’s 30p more per month, so £3.60 per year is going to give you, your family and your children access to on demand GP services, nutrition support, you know counselling, emotional support. All these things that I was like really to have an on demand, not private, GP service. Especially, I mean the NHS is fantastic, but I don’t think there’s anyone, who has, I don’t hear anybody say they can get an appointment in a couple of weeks, unless it’s really more of an emergency appointment. You know where we are it’s easily that you could be waiting four weeks before you can get a GP appointment, so to have that on hand is just absolutely fantastic and I think when we’re looking at those policies it does come down to – for a lot of my clients, in all fairness and I do say this, for all my clients the support services aren’t the deciding factor.

If I had people who were going straight through online applications, then yes support services would probably be one of the most or the most important thing when I was advising my clients. But for me it’s not a case of it often having that luxury of a good 10 – 15 insurers to look at or whatever or whatever comes up on the comparison sites and everything, well the advisor comparison sites not your general comparison sites that you would just use as a general consumer. But you know, I usually have to pick from a very small pool, maybe two or three insurers or it could even just be one insurer, at which point my hands are tied in regard to the support services. But I do think there are things that if an advisor that is sort of on the bench as to whether or not they see it as something important for their client or not, I would say just really do look at those kinds of experiences or even if you want to give me a shout, there’s myself, there’s Alan, there’s a number of people in my organisation who’ve used these services and have seen practically how useful they are.

But I just want to jump back for a second as well Andrew if it’s ok, because you were saying, sorry go on.

Andrew
Yes from that, I think, someone I know at the moment is six months in from first going to a GP for epileptic seizures and is now a month away from a sleep deprived EEG, which she is mainly annoyed about because she’s too boring to have fun all night, but she has to stay up all night! Which in her 20’s would have been fine, but in her 30’s she’s like I can’t even do anything, I just have to stay awake.

But, I think in terms of support services you look at that journey and almost for epilepsy specifically, so she’s falls into that classic, dare I say it, and again hugely positive stuff about the NHS, but her seizures are mild nocturnal seizures, but there are enough that she can’t drive, she can’t drive her kids around and all that. If there was any way for speeding up that process, even by a week or a month, by having a slightly earlier GP appointment, you know all these different things, that would be life changing to her.

K – Oh, absolutely.

Andrew
So I think yes, there are many practical examples where that comes to the fore.

Kathryn
I was going to say one of the things from what you were saying triggered something in my mind in a sense, is that you were saying if someone takes that policy and if they suddenly start taking up a dangerous sport or something later in life – they hadn’t had the original intention in a sense, that in a sense it’s ok. So another thing is, it’s that kind of, it’s difficult as an advisor – and if it’s difficult for an advisor, it’s definitely difficult for a consumer if they’re doing it direct – is that kind of fine balance about what is an intention.

I’ve spoken to people before and they’ll say, you know what in a few years’ time I’m going to go and live in Spain, I just want to go and live in the sun. And then it’s a case as an advisor, that you have to stand back and go, well ok, so what do you mean by intention? You know and then it’s a case of well what do the insures mean by intention and what do I class in my head as intention, because you know is it the fact that they’re saying, in three years’ time I’m going to go and live in Spain. Well is that actually disclosable, it would be interesting to hear your point of view, because well it’s something that may happen in three years’ time and I’ve got this vision and I know someone who would definitely like to go and live in Australia. You know, is that actually going to happen or is that kind of just like a dream that you have, that says I’m going to go and do this in a few years’ time or whatever. Is it more a case of if somebody actually has the plane tickets booked and they’ve got their accommodation being built or you know, they’ve already started looking for jobs and everything like that. When does that line between intention and actually doing, when does that come into play?

Andrew
So yes, it’s kind of timely to talk about this. So the start of Feb 2020, so just after Brexit. And I guess this podcast is two people from different sides coming together and in the spirit of that, I think I genuinely think that there’s so many people who would around that time have said, well if Brexit happened then I’m, or if Brexit doesn’t happen, then I’m leaving the country or whatever. And you would say that semi-flippantly and almost work back from there.

I think the practicality and most practical answer is, that an underwriter or probably in reality a claim assessor looking for mis-representation, non-disclosure you know, whether the claim is ultimately valid, is going to be looking for some kind of hard evidence that some steps had been taken. So, you would definitely need to tell us if there is a contract of employment or I would say if you are going for interviews for jobs in other countries. Because frankly that is evidencable and would be discovered, whether that’s you’re going to work on an oil rig in a different place or whatever. I think the looking at websites of other countries and wishing you were in Australia in February, is quite realistic and again if you weren’t doing that I’d probably worry more about you! So it is, I think it’s, whether you have started to take actions towards that happening, would be my rule of thumb for it. I’ll do the first small print of these – it is worth checking with your individual insurer, but often having sat there – probably more the proper tone of this podcast, sat there as an underwriter, you do often wish that people had never told you things.

Kathryn
I was going to say, I’m going to edit that out (laughter). I’m going to say check with the underwriter – I wish as an underwriter you’d just not told me anything. Because wow – Andrew’s said it now, that’s it!

Andrew
I think now I have to deal with this kind of ‘oh well I might possibly do this, that or the other’ and yes you end up with some pretty harsh decisions right, if you’re including everything I’ve ever thought of doing.

Kathryn
Absolutely. Well if it’s ok with you, I wanted to give a couple of case studies, obviously from an advisor side of things and also as seeing these decisions, I’m not saying that I’m maybe going to revolutionise and spark something in all the insurers in the land, but it could just be, I think it’s healthy for insurers to hear other insurers offerings as well. You know which can be good sometimes. But mainly for advisors, just to sort of give that detail out there, that you may have somebody who’s maybe sort of an extreme situation of epilepsy that you may be a bit, you may think I’m not sure if I’m going to get anywhere with this. And I just want to use these examples to show don’t give up, that there are options.

So the first one I wanted to talk about is, it was a 36 year old male that we know and we know him personally he has epilepsy, so 15 years prior to come to see us for his life insurance and critical illness cover he’d been shot in the head twice whilst he was on tour in Iraq. Incredible guy, now has a family, has children and considering he was a paratrooper he’s one of the softest people you could ever see or meet, he’s just incredible I think I completely demasculinised him the other week when I spoke to him, by saying I can’t imagine you as a big burly paratrooper and I’m thinking afterwards, shouldn’t have said that!

But anyway, so he was left with epilepsy, he’d been in a coma for a bit as well, for four weeks. But he has the nocturnal seizures, he’d not had any for five years, he was on steady medication. At first he was paralyzed on one side, but now he’s only left with slight weakness on one side, but he’s really active, he likes to do kick-boxing. So when we originally did the research – I’m not sure, people are probably assuming, when they hear that – we did have some insurers which were saying it would have to be referred to the chief medical officer, we also had some people who said he was potentially standard to a 50% rating, possibly with a paralysis exclusion. So that’s obviously a massive difference in the types of offering that are out there. But I’m really pleased to say that we actually did manage to get him the life and critical illness cover arranged both at standard terms, which I don’t think many people who would have started hearing that story and would have thought that would have been the outcome. You can’t judge what one experience of epilepsy is compared to another.

So as an example, I’ve got another person to just explain to everyone. So we had here a 40 year old male with epilepsy, so 20 years prior to us he had been drinking quite heavily around 160 units per week and it went up to 240 units per week. So he had stopped nine years ago and he had developed temporal lobe epilepsy, he was on medication and he was still having quite regular seizures. I think there was more that absent seizures, there was none of the tonic-clonic seizures or grand mal seizures for over 10 years. He had been as I say sober for 9 years and very, very strictly sober to the point where he wouldn’t even eat food if it had been cooked in alcohol or anything, he was absolutely adamant he wasn’t going to touch a drop of it ever again. His liver function tests had been consistently normal for a while and again we did research, all your standards in a sense standard names, everybody declined, they wouldn’t touch it at all.

I think primarily as well because of the amount of alcohol that had been used in the past, even though the liver function was now ok. I think that had been a concern and the amount of seizures. We were able to find an insurer that was able to offer him the insurance at a plus 250% on life. Again I think a lot of people would probably have listened and thought – when I said declined, everyone thought yer it’s going to be probably declined most places. But it is having that kind of knowledge and ability to go around and speak to different insurers and also I have to say, and we always do it in a very respectful way, I will say this, but we do challenge decisions as well. Because sometimes, I wouldn’t say if it’s a new condition that we have come across that we’ve never know about, we’re not exactly going to go in guns blazing challenging insurers. But if it’s something that we are very aware of and we know of the general decisions that are going to be available on the market and different things. If somebody is giving us quite a high indication then we’ll probably ask why is that with you, compared to XYZ over there, who are obviously potentially looking at a much more favourable option. Even if just for information purposes, can you just in a sense educate me and let me know why because then in the future I’ll know why that this is essentially your stance and to possibly know what to expect. So even though I may come back again and ask in the future in case the background manuals have changed at all.

Andrew
A relatively easy thing about epilepsy to underwrite specifically and obviously, there’s other factors in that second one. But it is the symptoms are so physical, that there’s less risk of there still being something underlying. And I think that’s what enables us to get quite good decisions for epilepsy, whereas maybe for other conditions you would still be thinking, you take coronary decisions or things could still be building up inside. I think with epilepsy you can get more confident that that has at least stopped.

Kathryn
was going to say as well, you say that 10 years ago everyone would have declined. Well that’s what Cura is there for.

Andrew
I’s the difference between declining and postponing somewhat, which I’ve probably been guilty of being quite lazy about in the past, but you know in both of those cases, I think wind the clock back let’s say 10 years ago. All insurers would have declined them because of where they were at that point.

Kathryn
Well that depends, I was going to say that’s what Cura is there for.

I’m being very conscious that people may come back and listen to this a few months down the line, they may catch up whenever. But I believe that Andrew you would like to talk about something that’s quite topical at the moment.

Andrew
We are aware, so this is as I think I’ve said before, this is being recorded February 2020. So at the moment, the news is all Brexit and Coronavirus. We are a topical podcast around all issues underwriting and risk, that it would be worth at least mentioning what insurers do about things like that. The short answer as of today, nothing has changed. The insurers choose to ask questions and when we set those application forms and when insurers set their prices, they know there will be even more widespread or increases in severity of mutation severity to something different. Then I think it’s realistic to expect, potentially different questions to be added to applications or different approaches to be taken. But at the moment, all you need to do as an application is to answer the questions as an advisor or anyone in that part of the process, to ask the questions and that shouldn’t result in any different decision being made.

Kathryn
So as an advisor then, just thinking. Say I have a client come to me and they have just spent the last three months in China and they’ve come back the last week or so, obviously the likelihood is very unlikely, but just as an example. They come to me and they say, right I want life insurance. So when I’m detailing the application, I will need to say that they’ve been in China for the last three months or so, is that, do you think there’s a potential that all of a sudden that maybe kind of triggering some kind of a flag, that I’ll then have to answer more questions about the exact region they were staying in?

Andrew
I’s always in theory a reason to have automated application, rather than rely on paper applications. So in the old days, about five years’ ago, it was very, very hard in these examples because to change a paper application would take about 24 months, as of today, potentially companies could re-programme and change questions. I don’t think that anyone will be doing that urgently today, but I imagine there will be some discussions about checking, you know those risk.

Kathryn
We’re obviously coming towards the end of the podcast. So please do keep listening everyone, because we have a little bit of a teaser. So we wanted to try and think of something to entice you all to come back. I’m assuming that you’re doing to want to do that anyway, seeing as this has been absolutely fabulous!

We are going to do a truth or lie feature, now myself and Andrew – one of us is going to say a truth and one of us is going to say a lie and we may even do a social medial poll to see if you guess which one of us lying and which one of us is telling the truth. This is going to be really interesting actually, underwriter voice and advisor voice (laughter) – who’s the deviant?

Andrew
Who’s the most trustworthy?

Kathryn
Absolutely. So Andrew, would you like to go first with yours?

Andrew
Yes ok. So my interest in all things medical begin when I was five years old and I chopped my middle finger off in a deckchair that was being used to hold up my mini snooker table.

Kathryn
I love the cough you did at the beginning, it sounded like you were really preparing for it. Right so, my thing is that – I’ve got to try and pronounce it now – I have thalassophobia, which is a fear of dark water and I’ve never been on a boat.

Andrew
Good pronunciation. I don’t know whether it’s true of not (laughter)!

Kathryn
I feel like I was trying to read a Pokémon name or something, that my kids have brought to me.

Andrew
This is just a service for any underwriters who you ever phone up, describing a presales enquiry to. They can monitor your voice, if they take two of these they’ll know which ones you’re lying on.

Kathryn
The inflection in my voice! ‘Are you telling us everything Kathryn?’ ‘Yes!’ (laughter)

Andrew
So as Kathryn says, we will reveal all, or at least the answers to those at the start of the next podcast, which should be with you in a couple of weeks. But, for today thank you all so much for listening, I hope that you’ve made it this far and we really hope that you’ve found it useful. If you have any questions that you want to discuss or if you want to disagree with us or any comments at all, please please do contact us.

Kathryn
And I think Andrew you said you’re quite happy for people to disagree with you if I remember from the pilot episode. So if anybody wants to disagree with Andrew do send those in. Please don’t disagree with me! I’ll just ignore them. I won’t really. (laughter).

We will be back in two weeks and if you would like a reminder of the next episode, when we’re going to be chatting about rare diseases please do drop us a message on social media or this is our website, which is www.practical-protection.co.uk and yes I’ll get all that out to you on social media and get out our poll as to which one of us is lying and which one of us is telling the truth. So there we go!

 

Thank you very much everybody.

Andrew
Cheers all, bye bye.

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Episode 1 | Epilepsy

Hi Everyone,

This is our first official, proper, hopefully fantabulous, brand spanking new episode. Can you tell we are a bit excited?
In this episode we are focusing on epilepsy and what you need to know, if you have this condition and want insurance.

Our 3 key takeaways,
1. There are approximately 60 different types of epileptic seizures
2. Epilepsy is not often a huge red flag for insurers
3. Two case study clients living with epilepsy, you might think are uninsurable
Don't worry, we know insurance is boring and Kathryn and Andrew have done well to avoid the jargon!
There is also a teaser at the end where you get to decide in this episodes 'Truth or Lie' if it is Kathryn or Andrew that is a liar. But! You have to tune in for episode 2 to hear the answer, see what we've done there, enticing you back, we're so smooth.

Kathryn
Hi everyone. This is episode one and it's all about epilepsy. I'm Kathryn.

Andrew
I'm Andrew. This is the practical protection podcast.

So this is episode one, a big week for us and for anyone listening, who you get to have the honour when we’re playing big sell out stadiums in the future to say you were here for epilepsy episode one.

Kathryn
I love that, the idea of us in the O2 or something. Just like a big barstool type thing (laughter), a beer in each hand.

Andrew
Yes, sell-out crowd waiting to hear ours and other’s thoughts on protection.

Kathryn
Absolutely! Probably not the beers then (laughter).

Andrew
I don’t know. Before we get into that Kathryn, how are you? How’s your last week been?

Kathryn
It’s been good. It’s been, as always I’m sure with all of us, it’s just been manically stressful. Work and kids, it’s just been non-stop. The kids yesterday just seemed to be on one (laughter). It was a tough day, but I think there could also be a bit of a fall on because I on Thursday and Friday myself and Alan did the mental health first aider training and it was two days of really intense kind of learning about mental health and different types of mental health, the different symptoms that maybe you all see. How that could potentially be a certain diagnosis or basically how your reactions should be to it.

And obviously being a big advocate for mental health, I expected, I expected to be involved and everything like that, but I actually found that I became really involved and I was sharing quite a lot of my own experiences and sharing things that I don't generally share with people. But it felt like quite a safe group. It was very, very draining but just so incredibly important. And it was, there was so many fantastic techniques that we learned from that as well. And hopefully we are now that first line of kind of help if somebody really does - if they’re struggling possibly with some symptoms that they’re not really sure how to manage. But yes, on a hopefully on a more jollier note, you’ve had a bit of a better last week and a half than me?

Andrew
I did something for the first time this weekend, which is always good, at the ripe old age of 41. So I've always lived around London, but this was the first time we went to Madame Tussauds. Basically we’re at the end of our family year of Merlin passes (laughter). So picking off the dregs, and it’s fair to say as a good underwriter I definitely preferred the bodyworks exhibition, which we've done before, to kind of seeing Ed Sheeran in wax, which is slightly less impressive. But as always with these days, it looked very good on social media and let everyone else think that we're a perfect family and have great weekends! So we ticked that box anyway.

Kathryn
Fantastic. So yeah, yay us! So back to the facts of the day job now. So yes, here we go.

Well we did, I was going to say, we did Madame Tussauds once and I have to say I’m to sharing this because I’m going to be shaming Alan here and I will shame him well and truly.

It was when, I think it was one of our first anniversaries, so probably about 15 years ago now and we went to Madame Tussauds and they had this feature floor, which was like, a terror, horror house type thing and we decided to go through it and I, quick thinking that I am, thought right we’re in a set of four, there’s two girls in front of me. They’re really giggly and hysterical and the actors will swarm for them. Alan was just like in his head, was like hang on Kay’s rushing through this, she’s not enjoying this experience. I’m going to hold her back, so she can kind of just enjoy it a bit more and inside I was like no and I’m shouting at him what are you doing. And he was just saying like, you’re not enjoying it and I was like, I’m clearly getting through this as quickly as I can. And he was like, but we’re not enjoying it. And so obviously the actors then deliberately swarmed for me and I’m screaming at the top of my voice ‘I’m really sorry but if you jump in my face I’m going to punch you, I’m so sorry it’s an instinct!’.

Anyway, let’s focus on epilepsy.

One in every 100 people are diagnosed with epilepsy in the UK and the stat I actually found really quite surprising is that one in every 220 children are diagnosed with epilepsy and that just seems like - I feel like everybody knows about epilepsy, but I don’t feel like everyone – that just seems like a lot of people that I would potentially come into contact with.

Andrew
Yes I agree, so well, the one in 220 I guess is a powerful number for me because my children go to a one form entry school with 30 children in each year, primary school. So you quite quickly do the maths and go, that probably means that there’s a child there who has epilepsy. I will confess, or if I need to confess at the start of this, I’ve never seen anyone knowingly have an epileptic attack. I know people who have epilepsy, I agree it’s one of those conditions that I think if you do see, then it’s obviously memorable. The frequency of it is probably underestimated and for me that’s quite interesting in itself, because I don’t think it’s ever almost been a really hot topic for underwriters or insurance.

Kathryn
Another thing as well with epilepsy is that there’s just been a recent change in the name of it. Which I think some people aren’t necessarily aware of and I know sometimes, even when we’ve spoken to people. I think there’s still that kind of change of dynamic of which version of the term that people are using. So previously I think a lot of us are familiar with the term ‘grand mal’ and ‘petit mal’ epilepsy. That would have been like what it’s been referred to for quite a number of years. Whereas now they’re now they’re called tonic-clonic and absent seizures. But there are, and again this really surprised me, there are around 60 different types of know seizures.

Andrew
If you look to the future of medicine the reality is there is just going to be more and more of these subgroupings, so whether it’s heart attacks or cancer or whatever. I guess the labelling that goes on with these things is quite broad and then gradually, as with epilepsy, you figure that even though the attacks might look quite similar, what’s going on inside someone can be really quite different and the consequences of that be really quite different. It would have only been a couple of generations ago where, you know, you wouldn’t have had six different types, let alone 60.

Kathryn
Does that make it just - one of the things I’ve always had a query about in regards to underwriting - is the fact that we’re able to diagnose so many more conditions and we can identify them so much earlier – could sound a bit daft, but is that in a sense kind of being counterproductive to us being able to arrange these policies and do these applications. Because, whereas before somebody may not have been classed as having epilepsy because they didn’t fit specifically into the criteria or any other condition or something. But now that we know that there’s so many different types and different types of seizures, they now need to say well I actually do have epilepsy and it’s this type.

Andrew
It’s important to remember, sad as it is though, sad as it is at times, that underwriting isn’t the most important thing in medical advancements and you can sit there going oh this just makes my life harder, but there’s a few more important things to go on in that journey. That it is an ongoing challenge, so you kind of have, I guess simple things like relabelling a condition which ought to be a relatively straightforward mapping. But yes, the progress is really difficult, where so for life insurance, to say this for the first but no doubt the last time, for life or critical illness or income protection, you are underwriting today, for typically for the next 25 years.

And so to do that you’re generally looking at research that isn’t, you’re not looking at the latest medical advancements, you’re looking at what’s happened, let’s say 10 years ago. So that you know that the side-effects of that wonder new drug don’t, nothing terrible happens etc. So almost the modern research that in most cases, unless it’s absolutely certain, would be taken in, would be probably 2000’s research and then you kind of try to overlay that to all the changes you’ve just described. Which can absolutely create some difficult situations and some situations where you are into those individual considerations and actually, needing to get full disclose to get medical records potentially and to walk an underwriter through that process to get the fair decision.

Kathryn
Going back to some of the stats that I’ve looked at recently, I’m not saying that this negates how many people at all died, but I suppose from a risk side point of view, it’s around 1,000 people that die in the UK every year due to epilepsy. Now obviously, I mean those 1,000 people would have meant a significant amount to their families, but from a business point of view, from an insurance point of view, that’s really quite a low figure I imagine statistically for the amount of people that are in the UK. And I think it’s about half of those that are actually due to sudden unexpected death in epilepsy and I know that that’s had quite a lot of resurgence in attention at the moment, because there was this story recently of Amelia Roberts and her order of service was found by a women called Hari Miller in her new office drawer. And another thing that really shocked me is that when were chatting about this in the office - and obviously we’ve got about 15 – 17 people in our office - and out of those people two of them had actually known people who had unfortunately died due the sudden unexpected death in epilepsy. And that really obviously shocked me that even in that small group that we have that there were two people that had obviously had that with people who were in a sense close to them.

Andrew
I think the physical nature of attacks probably means that people have an almost primal understanding of the dangers of this condition and then the very modern kind of overlay with the DVLA - once people have seizures or attacks if you’re of adult age then your doctor will say that you need to send a letter to the DVLA and it could typically be 12 months from your last seizure or until there’s a diagnosis confirmed before you can drive.

So I think almost those two separate things create quite a, I guess, a realistic conversation around this condition and around the risk of this condition. And as you say, the numbers - so from an underwriting perspective the primary decision here for most cases is whether it’s acceptable at standard rates at the same rates that any healthy life without any medical condition would pay or whether there would be a small extra applied. But those are the two most common decisions for people with epilepsy and we’ll come onto when those don’t apply in more detail as I guess we talk through.

Are you saying there’s something wrong with me? There’s nothing different from me? I kind of think people with epilepsy, there’s, as I say that physicality of it makes them aware of it and there are, you know, as you would imagine, plenty of medical studies that will estimate that the increase risk from having epilepsy is kind of between about 1.5 and 4 times depending on the type of epilepsy and how well it’s being controlled at the time. As I say, it’s those kind of numbers.

Kathryn
I think this is time for you to get your absolute underwriting cap on Andrew and tell us all. I’ll just let you loose and see if - I’ll time you, if you go for too long (laughter).

Andrew
Well, I guess the aim, to flag what I or we are trying to do here, it’s certainly not to explain in great detail what epilepsy is - I mean it’s fair to say that the nervous revision course for me on a Sunday night is likely to be going to NHS websites and charity websites and I think those are a good resource for anyone listening to these. Sort of prognosis and decisions that come out of underwriting for these are the classic rubbish underwriting guide of standard decline or standard to postpone certainly.

So to kind of go through that journey, I think the bit - often the most difficult bit for underwriters and let’s be clear, the person who’s in the middle of all this - is through that period of diagnosis. But through that process typically most insurers would give a postpone decision and there’s pretty logical reasons for that, because it may be epilepsy it may be something else. You’re about to go and have scans of your brain etc, so there could be a very early claim either for life, critical illness or income protection potentially depending on what’s appeared. So that’s a tricky 12 months, once you’re in to a point where either a trigger has been found or the condition is controlled through medication or through any other way, then as I’ve said in most cases there, the decision would be standard rates. You ought to be able to get standard rates and there the only sort of ratings will be if there’s still a trigger present, if the medication isn’t working i.e. you’re still having a lot of attacks or still having very serious attacks when you do have them.

Kathryn
So could I just quickly jump in with that? So say like if, just as an idea then, so say if someone that is on medication and they were having more clonic seizures, so the stronger ones. But say they’ve not had them for a couple of years or something, but they’re still having really regular absent seizures - I know what would be the experience from our clients and I’ll come onto some case studies in a bit - but would you expect kind of a consistent approach across the market or would you imagine there is going to be quite a varying response depending upon the different insurers’ view points over it.

Andrew
I think there can definitely still be variants, I mean the I guess lifting the veil off what insurers are doing and seeing here, epilepsy is quite a table driven ratings approach. So what the underwriters are looking at, and in fairness, why this is a condition that tends to be heavily underwritten by systems, programmed by underwriters, rather than probably physically seen by underwriters, is that is does tend to end up being a table which is applied. You are diagnosed by epilepsy, number of attacks in the last year and type of epilepsy, almost then within the spreadsheet, depending on what the latest research that that insurer or reinsurer has used, then you may well get different outcomes. Again in the specific situation that you’ve highlighted there, there potentially is some underwriter judgment going on as well in terms of whether the grand mal epilepsy or the tonic-clonic epilepsy is still, whether you can take the view that that is effectively cured or whether that’s still there and the seizures are kind of minor, less frequent versions of those. So I think that’s where you can get very different decisions, where people are almost diagnosing the condition differently.

Kathryn
Ok, so I mean one of the things I was thinking as well, so as an advisor I have a lot of people come to us and chat about epilepsy and the different situations. Now we get a range of different reasons, it could be that it’s a genetic factor that’s caused it, a brain injury, a tumour. It could be the result of possibly quite heavy alcoholism, so I know because it’s what I do, is that I’ll need to know what type of seizures they have, the type of epilepsy, when they were diagnosed, what medications are in use. So that cause behind it, and obviously the regularity of the seizures as well, so say if I we are an advisor and we’re coming to an insurers or speaking to an underwriter or something - obviously I appreciate that you say that quite a lot of it is automated now, so sometimes it’s going to go through those systems - but is there any kind of specific things that would possibly throw an application out of the automation, what are the flags that would typically go, well actually that medication has now reached this dosage or actually they’ve gone from 10 seizures a month to 12 seizures a month, so now that it’s at the 12 we’re going to have to have somebody physically look at it.

Andrew
Rules in those systems are still being actively written by human underwriters and the data that comes out of them is being analysed by human underwriters, so we’re certainly nowhere near AI in any form or life insurance as yet. So I guess the more complicated the case, the more likely it is to get referred and I’ll try and explain what I mean by complicated.

What an underwriter would view as a simple case is someone who’s had epilepsy for a relatively long time, who may have had a very traumatic start to their life with epilepsy, has now not necessarily experienced no symptoms or is on no medication, but has a controlled pattern. And a predictable pattern, that’s the good, that’s probably going to go through a system of standard rates. Opposite to that is the further you deviate from that the more likely is to get referred, so those would typically be either newer cases which are just outside of this postpone period, where you’re still changing medication, where there’s still more attacks, but there’s a story that’s saying this is being controlled quite quickly or there’s a trigger, probably a trigger has been identified and there’s some question marks about whether it’s truly epilepsy or not. Because I think one of the challenges around this is, and in the long term for people with epilepsy and their health, is that epilepsy can mask other conditions.

Kathryn
One of the things as well, is that I know, because there’s something that I’m always trying to explain to my clients, is that we all see one in a sense level of the insurers, but then obviously I try to explain, there’s the reinsurers in the background, the names that people aren’t necessarily going to think of straight away when they think of insurers. And how does it work then, given your background, how does it work in regards to the reinsure to the front line insurer and how those epilepsy guidelines get washed together and that?

Andrew
Reinsurance in 60 seconds or less or trying to explain to my mum what I did for a job (laughter)!

Reinsurers insure insurers. In the UK life market there are typically, there are roughly two year contracts, so an insurer which is the name of the company who you would buy your policy from, would then give about, well between 50% - 90% of the risk to their reinsurer and in return the reinsure gives them promises to pay that much of the claim and helps them make sensible decisions based on lots of medical evidence.

So in practice - back to practical - there are reinsurance underwriting manuals which have lots of global medical research behind them and really do drive underwriting in the UK market, so insurers can choose to do their own thing, but they have to explain to the people who are actually going to pay the majority of the risk why they are taking it. To materially change things it is those reinsurance underwriting manuals which, where most decisions originate from.

Kathryn
Is it subjective I imagine as well as an underwriting? There are times we’ll even speak to the same insurer twice and we’ll get completely different indications and I think that’s obviously not the right scenario, in a sense that shouldn’t really be happening, but I think it is that thing as well that sometimes it comes down to underwriters are human too and, you know, sometimes they are going to have different opinions or maybe they’ve just learnt it in a slightly different way for that condition to potentially someone else, it’s difficult sometimes to know what to do.

Obviously we in our company in Cura we have built our rate and our business model to work alongside that and we know if someone gives us an indication for someone with epilepsy and we know it’s not right then we will, double check it it’s a case of well hang on a minute. We had one, not for epilepsy, we had one last week where someone had spoken to an insurer and they were indicated standard and immediately obviously one of the senior advisors said that’s not, that’s completely untrue. Not untrue, that’s just not going to happen in a sense, and the other advisor immediately ran back and was going through the underwriting and again and then we’re told that at the very least it was plus 150.

Andrew
It depends on the case right, there are going to be some decisions which are simply wrong or unreasonable or you know, unfair or whatever label you want to put on them. I think the vast majority of times when there are differences though, they are going to be just like if you see two different doctors and they take a different view of your symptoms and your treatment and don’t you know, actually know which one is, in inverted commas right or wrong. It’s really hard.

Kathryn
We don’t necessarily have it with epilepsy, and it could well happen with epilepsy, people who’ve been recently diagnosed with HIV where they do come to us and they’ll say things like I’ve got life insurance, but they’ll say I’ve been diagnosed with HIV, I need to get new life insurance. And you immediately go, hang on, let’s not get rid of the original pre-diagnosis thing. I can’t think of that specifically happening with epilepsy, but I think it possibly could happen at some stage, especially when you’re looking at things like critical illness cover maybe even income protection. People possibly start to get maybe a little bit confused and I don’t know, I wonder if that’s maybe, that’s people doing things directly and not having things explained to them or if it’s kind of insurers documents or even though I can’t think, I don’t think there needs to be any more explanations in insurers documents, because they’re already so hefty (laughter). Compliance people please do not add any more jargon to these documents you know!

Andrew
Yes I agree, it happened to my - so my brother in law got diagnosed with rheumatoid arthritis earlier this year and he was absolutely half way through cancelling his policy by the time, you know.

Kathryn
You suddenly got there and went nooo!

Andrew
Yes I did that kind of slow motion run to a computer to kind of. I don’t know in the same way you’ll try not to tell me how to do your job, I’ll try not to tell you how to do yours. But I guess it must get kind of not emphasised enough through some sales journeys that this truly is guaranteed, you know in the same way that, that classic kind of well if you chose, if you genuinely chose after taking up the policy to take up this hobby or to go travelling to this place that would be fine you would still be covered. Exactly the same for these conditions. Whatever you do, don’t cancel policies just because you’re diagnosed with a medical condition. And I guess as well, there’s lots of things that you can get access to if you have these medical conditions. Which you may have experience of?

Kathryn
Oh yes, absolutely, I mean I obviously, I’m sure everyone probably knows. For anyone who’s listening to this and knows me on social media will know, that I have obviously a few difference insurance policies, as you can imagine I’m insured quite well even though I do have medical conditions, I still manage to get the insurance. But I have a lot of the value added services now, so you know I’ve used Square Health, I’ve used Red Arc Nurses, I’ve used sort of like the on demand GP services that are available with some of the insurers and they are incredible.

When I’m chatting to people, well what I think of as a brilliant example, I was doing a policy for somebody and it comes down to that whole thing of being able to having been advised and give somebody that advice and not just doing for the cheapest policy. Because I had this option for this person, I was like right I’ve got two options for you this one’s 30p cheaper, but before you think yes I want to go for the 30p cheaper option, you know the cheapest option gives you the insurance policy, the one that’s 30p more per month, so £3.60 per year is going to give you, your family and your children access to on demand GP services, nutrition support, you know counselling, emotional support. All these things that I was like really to have an on demand, not private, GP service. Especially, I mean the NHS is fantastic, but I don’t think there’s anyone, who has, I don’t hear anybody say they can get an appointment in a couple of weeks, unless it’s really more of an emergency appointment. You know where we are it’s easily that you could be waiting four weeks before you can get a GP appointment, so to have that on hand is just absolutely fantastic and I think when we’re looking at those policies it does come down to – for a lot of my clients, in all fairness and I do say this, for all my clients the support services aren’t the deciding factor.

If I had people who were going straight through online applications, then yes support services would probably be one of the most or the most important thing when I was advising my clients. But for me it’s not a case of it often having that luxury of a good 10 – 15 insurers to look at or whatever or whatever comes up on the comparison sites and everything, well the advisor comparison sites not your general comparison sites that you would just use as a general consumer. But you know, I usually have to pick from a very small pool, maybe two or three insurers or it could even just be one insurer, at which point my hands are tied in regard to the support services. But I do think there are things that if an advisor that is sort of on the bench as to whether or not they see it as something important for their client or not, I would say just really do look at those kinds of experiences or even if you want to give me a shout, there’s myself, there’s Alan, there’s a number of people in my organisation who’ve used these services and have seen practically how useful they are.

But I just want to jump back for a second as well Andrew if it’s ok, because you were saying, sorry go on.

Andrew
Yes from that, I think, someone I know at the moment is six months in from first going to a GP for epileptic seizures and is now a month away from a sleep deprived EEG, which she is mainly annoyed about because she’s too boring to have fun all night, but she has to stay up all night! Which in her 20’s would have been fine, but in her 30’s she’s like I can’t even do anything, I just have to stay awake.

But, I think in terms of support services you look at that journey and almost for epilepsy specifically, so she’s falls into that classic, dare I say it, and again hugely positive stuff about the NHS, but her seizures are mild nocturnal seizures, but there are enough that she can’t drive, she can’t drive her kids around and all that. If there was any way for speeding up that process, even by a week or a month, by having a slightly earlier GP appointment, you know all these different things, that would be life changing to her.

K – Oh, absolutely.

Andrew
So I think yes, there are many practical examples where that comes to the fore.

Kathryn
I was going to say one of the things from what you were saying triggered something in my mind in a sense, is that you were saying if someone takes that policy and if they suddenly start taking up a dangerous sport or something later in life – they hadn’t had the original intention in a sense, that in a sense it’s ok. So another thing is, it’s that kind of, it’s difficult as an advisor – and if it’s difficult for an advisor, it’s definitely difficult for a consumer if they’re doing it direct - is that kind of fine balance about what is an intention.

I’ve spoken to people before and they’ll say, you know what in a few years’ time I’m going to go and live in Spain, I just want to go and live in the sun. And then it’s a case as an advisor, that you have to stand back and go, well ok, so what do you mean by intention? You know and then it’s a case of well what do the insures mean by intention and what do I class in my head as intention, because you know is it the fact that they’re saying, in three years’ time I’m going to go and live in Spain. Well is that actually disclosable, it would be interesting to hear your point of view, because well it’s something that may happen in three years’ time and I’ve got this vision and I know someone who would definitely like to go and live in Australia. You know, is that actually going to happen or is that kind of just like a dream that you have, that says I’m going to go and do this in a few years’ time or whatever. Is it more a case of if somebody actually has the plane tickets booked and they’ve got their accommodation being built or you know, they’ve already started looking for jobs and everything like that. When does that line between intention and actually doing, when does that come into play?

Andrew
So yes, it’s kind of timely to talk about this. So the start of Feb 2020, so just after Brexit. And I guess this podcast is two people from different sides coming together and in the spirit of that, I think I genuinely think that there’s so many people who would around that time have said, well if Brexit happened then I’m, or if Brexit doesn’t happen, then I’m leaving the country or whatever. And you would say that semi-flippantly and almost work back from there.

I think the practicality and most practical answer is, that an underwriter or probably in reality a claim assessor looking for mis-representation, non-disclosure you know, whether the claim is ultimately valid, is going to be looking for some kind of hard evidence that some steps had been taken. So, you would definitely need to tell us if there is a contract of employment or I would say if you are going for interviews for jobs in other countries. Because frankly that is evidencable and would be discovered, whether that’s you’re going to work on an oil rig in a different place or whatever. I think the looking at websites of other countries and wishing you were in Australia in February, is quite realistic and again if you weren’t doing that I’d probably worry more about you! So it is, I think it’s, whether you have started to take actions towards that happening, would be my rule of thumb for it. I’ll do the first small print of these – it is worth checking with your individual insurer, but often having sat there - probably more the proper tone of this podcast, sat there as an underwriter, you do often wish that people had never told you things.

Kathryn
I was going to say, I’m going to edit that out (laughter). I’m going to say check with the underwriter – I wish as an underwriter you’d just not told me anything. Because wow – Andrew’s said it now, that’s it!

Andrew
I think now I have to deal with this kind of ‘oh well I might possibly do this, that or the other’ and yes you end up with some pretty harsh decisions right, if you’re including everything I’ve ever thought of doing.

Kathryn
Absolutely. Well if it’s ok with you, I wanted to give a couple of case studies, obviously from an advisor side of things and also as seeing these decisions, I’m not saying that I’m maybe going to revolutionise and spark something in all the insurers in the land, but it could just be, I think it’s healthy for insurers to hear other insurers offerings as well. You know which can be good sometimes. But mainly for advisors, just to sort of give that detail out there, that you may have somebody who’s maybe sort of an extreme situation of epilepsy that you may be a bit, you may think I’m not sure if I’m going to get anywhere with this. And I just want to use these examples to show don’t give up, that there are options.

So the first one I wanted to talk about is, it was a 36 year old male that we know and we know him personally he has epilepsy, so 15 years prior to come to see us for his life insurance and critical illness cover he’d been shot in the head twice whilst he was on tour in Iraq. Incredible guy, now has a family, has children and considering he was a paratrooper he’s one of the softest people you could ever see or meet, he’s just incredible I think I completely demasculinised him the other week when I spoke to him, by saying I can’t imagine you as a big burly paratrooper and I’m thinking afterwards, shouldn’t have said that!

But anyway, so he was left with epilepsy, he’d been in a coma for a bit as well, for four weeks. But he has the nocturnal seizures, he’d not had any for five years, he was on steady medication. At first he was paralyzed on one side, but now he’s only left with slight weakness on one side, but he’s really active, he likes to do kick-boxing. So when we originally did the research - I’m not sure, people are probably assuming, when they hear that - we did have some insurers which were saying it would have to be referred to the chief medical officer, we also had some people who said he was potentially standard to a 50% rating, possibly with a paralysis exclusion. So that’s obviously a massive difference in the types of offering that are out there. But I’m really pleased to say that we actually did manage to get him the life and critical illness cover arranged both at standard terms, which I don’t think many people who would have started hearing that story and would have thought that would have been the outcome. You can’t judge what one experience of epilepsy is compared to another.

So as an example, I’ve got another person to just explain to everyone. So we had here a 40 year old male with epilepsy, so 20 years prior to us he had been drinking quite heavily around 160 units per week and it went up to 240 units per week. So he had stopped nine years ago and he had developed temporal lobe epilepsy, he was on medication and he was still having quite regular seizures. I think there was more that absent seizures, there was none of the tonic-clonic seizures or grand mal seizures for over 10 years. He had been as I say sober for 9 years and very, very strictly sober to the point where he wouldn’t even eat food if it had been cooked in alcohol or anything, he was absolutely adamant he wasn’t going to touch a drop of it ever again. His liver function tests had been consistently normal for a while and again we did research, all your standards in a sense standard names, everybody declined, they wouldn’t touch it at all.

I think primarily as well because of the amount of alcohol that had been used in the past, even though the liver function was now ok. I think that had been a concern and the amount of seizures. We were able to find an insurer that was able to offer him the insurance at a plus 250% on life. Again I think a lot of people would probably have listened and thought – when I said declined, everyone thought yer it’s going to be probably declined most places. But it is having that kind of knowledge and ability to go around and speak to different insurers and also I have to say, and we always do it in a very respectful way, I will say this, but we do challenge decisions as well. Because sometimes, I wouldn’t say if it’s a new condition that we have come across that we’ve never know about, we’re not exactly going to go in guns blazing challenging insurers. But if it’s something that we are very aware of and we know of the general decisions that are going to be available on the market and different things. If somebody is giving us quite a high indication then we’ll probably ask why is that with you, compared to XYZ over there, who are obviously potentially looking at a much more favourable option. Even if just for information purposes, can you just in a sense educate me and let me know why because then in the future I’ll know why that this is essentially your stance and to possibly know what to expect. So even though I may come back again and ask in the future in case the background manuals have changed at all.

Andrew
A relatively easy thing about epilepsy to underwrite specifically and obviously, there’s other factors in that second one. But it is the symptoms are so physical, that there’s less risk of there still being something underlying. And I think that’s what enables us to get quite good decisions for epilepsy, whereas maybe for other conditions you would still be thinking, you take coronary decisions or things could still be building up inside. I think with epilepsy you can get more confident that that has at least stopped.

Kathryn
was going to say as well, you say that 10 years ago everyone would have declined. Well that’s what Cura is there for.

Andrew
I’s the difference between declining and postponing somewhat, which I’ve probably been guilty of being quite lazy about in the past, but you know in both of those cases, I think wind the clock back let’s say 10 years ago. All insurers would have declined them because of where they were at that point.

Kathryn
Well that depends, I was going to say that’s what Cura is there for.

I’m being very conscious that people may come back and listen to this a few months down the line, they may catch up whenever. But I believe that Andrew you would like to talk about something that’s quite topical at the moment.

Andrew
We are aware, so this is as I think I’ve said before, this is being recorded February 2020. So at the moment, the news is all Brexit and Coronavirus. We are a topical podcast around all issues underwriting and risk, that it would be worth at least mentioning what insurers do about things like that. The short answer as of today, nothing has changed. The insurers choose to ask questions and when we set those application forms and when insurers set their prices, they know there will be even more widespread or increases in severity of mutation severity to something different. Then I think it’s realistic to expect, potentially different questions to be added to applications or different approaches to be taken. But at the moment, all you need to do as an application is to answer the questions as an advisor or anyone in that part of the process, to ask the questions and that shouldn’t result in any different decision being made.

Kathryn
So as an advisor then, just thinking. Say I have a client come to me and they have just spent the last three months in China and they’ve come back the last week or so, obviously the likelihood is very unlikely, but just as an example. They come to me and they say, right I want life insurance. So when I’m detailing the application, I will need to say that they’ve been in China for the last three months or so, is that, do you think there’s a potential that all of a sudden that maybe kind of triggering some kind of a flag, that I’ll then have to answer more questions about the exact region they were staying in?

Andrew
I’s always in theory a reason to have automated application, rather than rely on paper applications. So in the old days, about five years’ ago, it was very, very hard in these examples because to change a paper application would take about 24 months, as of today, potentially companies could re-programme and change questions. I don’t think that anyone will be doing that urgently today, but I imagine there will be some discussions about checking, you know those risk.

Kathryn
We’re obviously coming towards the end of the podcast. So please do keep listening everyone, because we have a little bit of a teaser. So we wanted to try and think of something to entice you all to come back. I’m assuming that you’re doing to want to do that anyway, seeing as this has been absolutely fabulous!

We are going to do a truth or lie feature, now myself and Andrew – one of us is going to say a truth and one of us is going to say a lie and we may even do a social medial poll to see if you guess which one of us lying and which one of us is telling the truth. This is going to be really interesting actually, underwriter voice and advisor voice (laughter) – who’s the deviant?

Andrew
Who’s the most trustworthy?

Kathryn
Absolutely. So Andrew, would you like to go first with yours?

Andrew
Yes ok. So my interest in all things medical begin when I was five years old and I chopped my middle finger off in a deckchair that was being used to hold up my mini snooker table.

Kathryn
I love the cough you did at the beginning, it sounded like you were really preparing for it. Right so, my thing is that - I’ve got to try and pronounce it now - I have thalassophobia, which is a fear of dark water and I’ve never been on a boat.

Andrew
Good pronunciation. I don’t know whether it’s true of not (laughter)!

Kathryn
I feel like I was trying to read a Pokémon name or something, that my kids have brought to me.

Andrew
This is just a service for any underwriters who you ever phone up, describing a presales enquiry to. They can monitor your voice, if they take two of these they’ll know which ones you’re lying on.

Kathryn
The inflection in my voice! ‘Are you telling us everything Kathryn?’ ‘Yes!’ (laughter)

Andrew
So as Kathryn says, we will reveal all, or at least the answers to those at the start of the next podcast, which should be with you in a couple of weeks. But, for today thank you all so much for listening, I hope that you’ve made it this far and we really hope that you’ve found it useful. If you have any questions that you want to discuss or if you want to disagree with us or any comments at all, please please do contact us.

Kathryn
And I think Andrew you said you’re quite happy for people to disagree with you if I remember from the pilot episode. So if anybody wants to disagree with Andrew do send those in. Please don’t disagree with me! I’ll just ignore them. I won’t really. (laughter).

We will be back in two weeks and if you would like a reminder of the next episode, when we’re going to be chatting about rare diseases please do drop us a message on social media or this is our website, which is www.practical-protection.co.uk and yes I’ll get all that out to you on social media and get out our poll as to which one of us is lying and which one of us is telling the truth. So there we go!

 

Thank you very much everybody.

Andrew
Cheers all, bye bye.

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