Kathryn (00:05):

Hi everyone. We are on season eight, episode 10, and today I have Matt Rback with me. How are you doing, Matt?

Matt (00:11):

Very well, thank you very much indeed. And as I will always comment on the weather as you know me, so cold and wet. But yes, life is good. Thank you very much indeed.

Kathryn (00:22):

Absolutely, absolutely. And I was just thinking then by saying cold, I was thinking cold as well and then I’ve just gone back to my mind of thinking my sister’s been over with her family from Italy. So obviously for us our level of cold is one thing, but for them being here over Christmas, it was a completely different level of cold for them, which was entertaining to see in some ways. But I think there’s also of huddling around the fire, least your sister

Matt (00:47):

Knows what it’s like to be cold, let’s be honest.

Kathryn (00:49):

Yeah, I was going to say she has that experience. Bless her. So today we’re going to be talking about heart valve disease and what it can be and what it can mean when you’re applying for protection insurance. This is the Practical Protection Podcast.

(01:12):

So as always, when we’re going to be going down a little bit of a deep dive into a medical condition or situation, I will give a little bit of a background and then we’ll really get into the specifics with Matt who’ll go into it in far more detail than I can. So with heart valve disease it’s basically where one or more of the valves in the heart aren’t working as we would expect them to. It’s usually around things like they maybe don’t open or close exactly as we would want them to be doing, which can lead to some health complications and it can be caused by genetics, there can be injury to the heart, whether or not that’s like a physical injury, like a blow to the body or potentially an infection that’s causing it can also be something that is just for some people part and parcel of getting older. So Matt, can you start off please by explaining what classifies as heart valve disease? Because I’m sure there’s probably many, many different names and versions of this.

Matt (02:06):

Yeah, absolutely. I’ll leave immediately forward to confirm what you’ve just said. If you look at the ratings that the insurers, the insurance manuals apply to these various heart valve issues, then they are pretty complicated to say the least, particularly for life insurance. Not so much for income protection and critical illness because quite often can’t be given, but it is certainly quite complicated. So what I thought I would do very, very, very quickly is to return to is there such thing as an O level anymore? I don’t think there is.

Kathryn (02:48):

Do you know what we’ve, I was going to say we’ve actually reached a level, I mean I say I’m 38 and I don’t have any clue what’s going on with any of them anymore. Now obviously GSEs, GCSEs are completely different now, aren’t they? They’re not like a’s to ease, they’re numbers and that just completely throws me and it makes me feel incredibly old. Obviously if anybody does apply per job and it says numbers and I’m like I’m going to have to go search this, I’m so old. So let’s assume that yes, there is sort of the A levels are still a, levels are still going and O levels and everything, but sorry

Matt (03:21):

For all those people who are under 38. If there’s no level and immediately have to go and Google it, lemme put it back, but either which way to explain the heart valves and to ensure that I’m on the right path with everybody in terms of their understanding. I thought it just went back to the heart itself and just very, very quickly run through the structure and if I’m teaching anybody stuff that they already know, I do apologize, but I thought it would be useful for today.

Kathryn (03:56):

I think it’d be really good. Thank you Matt.

Matt (03:58):

No problems. So you’ve got the normal heart structure consists of four chambers and basically it is a hollow organ, no two ways about it and it’s divided into the left and right sides by a muscular wall called the septum. Now the right and left sides of the heart are further divided into two top chambers called atria. I must I always call them the right and left atrium which receive blood and then pump it into the bottom two bottom chambers called the ventricles. And I think people who look at ischemic heart disease will recall term ventricle, particularly the left ventricle, which is a big pumping chamber of the heart and these pump blood to the lungs and around the body. Now what I wanted just to make sure that people who are on board with that coronary arteries and coronary artery disease are not part of the internal structure of the heart. These are the great vessels that lie in terms of the muscle of the heart and keep the heart healthy and able to perform its function and coronary artery disease different. It’s certainly heart related, very much so I can’t deny that, but it is a different medical topic.

(05:30):

You’ve got the right coronary artery, which everybody I’m sure a lot of people would’ve heard of. And then the left main coronary artery, so basically the normal heart anatomy and physiology, the atria, so those are the top chambers and the ventricles, the bottom chambers to work at the same time sequentially contracting and relaxing to pump the blood out of the heart and then let the chambers refill with blood. When the blood leaves each chamber of the heart, it passes through a valve. This is what we’re talking about today specifically, they’re designed to prevent the backflow blood. So effectively it allows the blood to flow through the heart in the right direction. They should not, the healthy valves do not allow the blood to go from the ventricle and flow back into the atrium.

(06:29):

That’s important from a physical perspective. Important just to understand because then once you can understand that, then you can see what heart valve disease is all about. Okay, yeah. So you’ve got four heart valves, the mitral valve, which is one of the ones that certainly I see from an underwriting perspective the most. And it’s between left atrium, so the upper chamber and left ventricle. Again when you hear they’re all important, these vials and the chambers. However, if you go left ventricle again, major pumping chamber of the heart, very important. And the tricuspid valve is between the right atrium and the right ventricle. So it’s on the other side of the heart connecting the upper and lower chambers, the aortic valve, which is another one that certainly I see as an underwriter between the left ventricle and the aorta. So effectively on the left side of the heart, so this is the side of the heart that pumps blood around the body.

(07:41):

You’ve got the mitral valve that allows blood to flow from the upper chamber into the lower chamber and then you’ve got the aortic valve which flows out of the left ventricle into the aorta and that is the major artery of the human body. So that takes blood away from the heart and all around the body to allow it to act healthily. The fourth one is the palmy valve, which is between the right ventricle and the palmy artery. Okay. And that’s the one that feeds back to the respiratory system lungs. Today I’m just going to talk about, because we could go on forever, which is usual for me to be perfectly honest. Let’s just focus on the mitral valve and the aortic valve. So this is on the left side of the heart, right upper, sorry, the left side of the heart, the upper chamber, the lower chamber, and then pumping through into the great artery, put the A water Now as I hope people are following me okay with that one. Kathryn, are you okay at the moment? I’m absolutely fine with that.

(08:57):

So effectively the heart valves work in the same way as one way valves work in your home, so they prevent the blood flowing in the wrong direction. As I’ve already said, each valve has a set of flaps called leaflets or cusps, and this allows the blood, let’s go back to the left side of the heart. It allows the blood to flow through and then when that chamber, the lower chamber is filled up, they close, the blood can’t flow back, the blood can flow through and it pushes the pressure of the blood flowing through, pushes those little leaflets open. But when the chamber is full, the lower chamber is full, it starts to close those little cuffs so it can’t go back.

(09:51):

The mitral valve has two leaflets as they’re called and all the others have three. That’s just a little bit of a trick poke quiz question, that one, but I’m not entirely sure I said physiologically why the others have three and the mitral valve has two. However, that’s the way that works. I think I will probably finish there in terms of the, not the lecture, but me just talking about the anatomy, meaning of the heart, types of disease that you see are stenosis, heart valve stenosis and heart valve regurgitation as it’s called or incompetence. And effectively I think we’re all regular listeners to these podcasts. Medical podcasts will come across term stenosis and effectively that is the narrowing of the heart valve. So the blood can’t get through as quickly and efficiently as we would want. And

Kathryn (11:06):

I’m assuming that’s like cholesterol and things like that cause in that or is it something else?

Matt (11:11):

No, it’s generally can be a raft of things. I think you came that you mentioned right at the very, very beginning. There’s a congenital aspect to it. There is an ischemic. In other words, the leaflets become hardened if you like, through lack of blood themselves. And certainly in the old days when I was much younger than I’m today, much less, much less older than 38, I would’ve to say. I used to see quite a few mitral valve disease cases because of rheumatic fever. Rheumatic fever were very, very well known in the olden days to cause mitral valve disease. These days with the very rarely see instances or hear about sensory rheumatic fever, then the occurrence of ular disease caused by infection, if I can call it that, is far less. So that is a good thing, but it can becomes to nose the leaflets, the cusps themselves become hardened and they’re not as elastic, I suppose, as it is actually required.

(12:40):

So this is where of course, as I say, stenosis is where the blood can’t flow through as easily as it should through those all the heart valves. But the two we’re particularly talking today about, which is the mitral valve, neo valve, okay, they can’t push through and get around in terms of regurgitation. It’s an interesting term. That’s what makes me think of it won’t go into it, I’m thinking there, but incompetence, regurgitation or incompetence is where those leaflets don’t close as they should and it means that the blood leaks back into the other chamber and when the blood can’t get through properly, it can cause obvious issues from pumping blood around the heart and where it leaks back into the previous chamber, then obviously that impacts the flow of blood from the heart around the body. And the absolute worst case scenario in people say see it a lot in the older days, I say rather than old then makes me feel really old, where the surgical treatment of heart valve disease wasn’t where it is today by a long stretch.

(14:05):

People really just died of heart failure at the end of the day because the blood couldn’t be pushed through effectively. Their heart just was, sorry, not the heart. The body was starved of blood and the heart just packed in. At the end of the day, we’re now much better place and heart valve disease can be treated surgically. You can have minimally invasive treatment to the prolapses, those, sorry, not prolapses, the little cusps that allow the blood to flow through and not to flow the other way. Those can be sorted out and you can have your heart valve replaced as well.

Kathryn (14:53):

It’s fascinating what they can do. In fact, it’s really interesting.

Matt (14:55):

Well it’s fantastic to perfectly honest with you. It’s one of the reasons why I’m still doing this job after 40 odd years. I’m telling you it’s absolutely fantastic and I mean heart valve surgery has been around for a while that I’ll be honest with you, particularly the heart valve replacements. And these can be done by either a biological means and certainly my day. Always talk about pore sign replacements. So they used pig valves.

Kathryn (15:22):

Yes. Yeah, I was thinking pig valves when you said about that.

Matt (15:26):

Yeah, no, absolutely. Or more they had the mechanical replacements as well, which were, I can’t remember quite what they’re called, but it was basically little cage where a little ball was in it and the ball moved in and out to allow the blood to flow through. Okay. The thing, the challenge that people had with mechanical valves were that it kind of ground up the blood. If I can use that very untechnical term, which could cause blood clots, which would then zoom around the body and cause problems. The worst case scenario, obviously being everyone, all of this blood we’re talking goes back to either the brain through the carted artery or to the heart muscle itself through the arteries we just mentioned earlier and cause either heart attack or a stroke. So you often find people with those types of heart valve disease on blood thinners. Okay, yeah,

Kathryn (16:25):

That would make sense

Matt (16:26):

To help or reduce the risk of clots if you put it that way. So that’s where we are in terms of the anatomy. I hope that makes sense.

Kathryn (16:44):

It does,

Matt (16:45):

Absolutely. There are four valves, I’ve only talked about two of them in particular, but there are four, and you can get disease of all of them, you can get disease, certainly I’ve seen cases of aortic valve disease and mitral valve disease in the same person. Not necessarily, I can’t honestly remember seeing disease the right side of the heart in both of the valves. But you can also, I have to say, extend this debate, this chat into incidental heart murmurs. Heart murmurs are often the first thing that a doctor will notice if there is a heart valve problem.

(17:36):

And it is always a challenge for the clinicians, although of course with the clinician, sorry, the doctors in other words can do all types of tests, particularly MRI scans, et cetera to look at those heart valves. But in terms of underwriters, we often see one-off comments saying, oh, heart murmur. And an underwriter will say, okay, this what happened next, what did the GP do about it? Because often found blood pressure checks when people stick the stethoscopes on the heart, lemme put it that way. And of course heart murmurs are not just down to necessarily bowel disease that come down to a lot of things and often heart murmurs are completely innocent.

Kathryn (18:27):

Yeah, I was going to say I’ve definitely heard of the innocent heart murmurs as well, but it’s just something that I think underwriter, you do like to see what’s gone on in a sense and what’s being checked.

Matt (18:38):

You have to really, because otherwise you can’t make a judgment. Certainly I’ve seen historically heart murmurs uninvestigated that could attract a rating, which always seems very, very hard on the client personally life to be assure. But if that information is there, then you can have to assume that it could be a raft of things and if you took a hundred lives with a heart moment that’s not been followed up, you are going to get some in there that should be followed up and treated, but a lot that is completely normal for them. So yeah, the information and follow up would often be required if nothing else to be fair to the client fair to the life assures and as well as I do, sometimes heart murmurs are commented on and unfortunately are missed in follow-up, but let’s not go there on that one today, I don’t think.

Kathryn (19:42):

So when it comes to the heart valve disease as an advisor, so somebody’s telling me about their health or I’ve maybe even got a copy of some medical records or something, what are the words that would in a sense stand out to say that are commonly on those records to say this person has heart valve disease? So I know you’ve mentioned the mitral valve, some things like mitral valve regurgitation and stuff like that. Is there anything really specific terminology that we should be looking out for?

Matt (20:11):

Well certainly the valve itself. Okay. The name of the valve itself and the treatment that was recommended by the medical profession, that could be the fact that the heart valve is, I think in underwriting terminology or at least in terms of the manual terminology is split into slight mild, moderate and severe. But whether a will be aware of those classifications then some will, but the majority I would suggest will not be. So it’s important that you know what the name of the valve that’s impacted and what the doctors said or recommended to that life, to the life insured about what to do next. It could well be that it’s in the slight category and nothing ultimately is required. Dental prophylaxis and so on and so forth might be recommended, but more is required apart from the follow-up and therefore you could see it follow up in 12 months, maybe a bit longer depending. The doctors normally would want to at least start off with 12 monthly checks just to see any progress important. The progress of the disease, is it a congenital valve led defect that really certainly doesn’t impact the flow of the blood around the heart and it’s not progressing or is it something that is actually progressing getting worse, which will lead some intervention at some particular time in the future.

(22:06):

So where was I? We’re talking about the names of the heart valve disease. We’re talking about what the medics say in terms of follow-up and treatment if necessary. Within that you’ll get, you should get whether surgery has been performed and if surgery has been performed, it would be good to know what type of surgery has been performed. So you’ll hear, you may have heard something like a valvuloplasty, which effectively is something, it’s like a balloon angioplasty to one of the coronary arteries, to be honest with you. It’s that little balloon that’ll blow up to try and smooth out the art in the coronary arteries here. It’s a similar type of event if you want or procedure except they open up the little leaflets in the valve and hopefully that will sort things out at least for a good number of years. If they’re turf and thickened and stiff, pushing them out will help with that blood flow for at least a while anyway, so the client doesn’t have to go through any major surgery. So does that help at all? Follow up is important. If somebody had what can be turned as mild or moderate disease, particularly moderate, then you’d want to see a follow-up. Absolutely. You want to see them under regular follow-up and if they’re not, then there’s something gone wrong. Or conversely it was never moderate disease in the first place

Kathryn (23:49):

And it’s maybe just an error on the report that needs

Matt (23:51):

Error on the reports or a misunderstanding from the client. Yeah, so does that help in terms of the things that you need? If you get into kind of a pressure gradients and things like that, which is pretty technical stuff, but certainly doctors will look at that to see the performance. It sounds very technical expression, but

Kathryn (24:17):

I think it’s really, really helpful. Thank you. Obviously, and I know it, it’s important.

Matt (24:23):

It’s important because that tells you, gives you an absolute reading on how those heart valves are working in terms of the blood flow. That’s why it’s important, but whether a client will know that or not is another point. Sorry Kathryn.

Kathryn (24:35):

Absolutely. No, no, absolutely. I mean I think the other thing to just, sorry, moving on to that because I know you said that there’s some really technical stuff as well, and it can be that you do need to really look at medical reports. A lot of the time people, they don’t understand what those medical reports say. And it’s confusing even for myself sometimes when I’ll come across a new sort of reading of some sort and I think, well, what does that code mean or something. I have to obviously do some research and everything and I think a lot of the time it can be quite difficult as always is that difference between the medical professional and the insurance world. Because you will find, and we’ve said this before, chronic kidney disease, that for people when they reach a certain age that in a sense they’re automatically at times classed as having chronic kidney disease because their kidneys working at a certain marker, which is just completely normal as you get older that your kidney won’t work at the same level as it did in your twenties.

(25:28):

But compared to the insurer’s world, the insurers just, they see chronic kidney disease and they’re just like chronic kidney disease kind of thing and it can cause some concern. So I think there’s plenty of things that we need to know. There is a lot more technical stuff than what we’d be able to cover in this podcast because there’s just so much that can go on with the heart. But I think what would be really useful is, is there anything that as an underwriter, if you saw it in a medical report next to something that there’d been an indication, heart valve disease, you’re having a look through it, is there anything that would make you look at that and straight away think, I really need to see more about this? Or even instinctively be thinking, I’m not sure we’ll be able to ensure this person.

Matt (26:07):

I think it generally in the, you need always need cardio reports just like you would with a heart attack, sorry, heart disease, not a heart attack necessarily, but heart disease because you will get indications or you should get indications from the doctors, the cardiologists looking after the patient, the client about the extent of the valvular disease. Okay. Also the classification of it, is it mitral stenosis as an example, is it mitral stenosis or mitral regurgitation? Is it aortic stenosis, is it aortic regurgitation, stroke incompetence. And they will also give a view on the severity of the disease. So I’ll just whip back to my slight mild, moderate and severe here in these circumstances, sorry, these kind of scenarios, the slight, mild, moderate, severe are in cases where they have not been operated on by the way, sorry, maybe that absolutely clear. This is the journey to potential surgery. Once a person’s had surgery, then we change the ballpark. But with the ratings that appear here and the grading slight mild, moderate, severe, sorry, I’ve said that about six times in the last two minutes, gives you an indication of the underwriter and more importantly the clinician of where they are in their journey to potential surgery.

(27:51):

If you’re looking at severe, then really they should be on the waiting list for surgery by definition, because the blood is not getting through the pumping chambers of the heart in a good way, mild, moderate. Again, it is, they are really indications of, again, where they are in the journey, but noting that the categorizations of slight and mild, they don’t always say the same of course. And that’s where your follow-ups come in. Slight can become mild, mild, become moderate and moderate, become severe. So in the pre-surgery category, then it’s important to know where they are. And if you look at the ratings that are applied, really, as I say, they are pretty complicated and they’re also, you’ve got those four categories, but you also got an age element coming into this as well. You’ve got certainly the, in my opinion, any my personal opinion out there, by the way, 20 reassurers who are looking, or sorry, listening rather I should say the major reinsurance manual that is out there certainly looks at people under the age of 25.

(29:22):

They’ll age categorize it. So under 25, 29 to 25 to 39, 40, 50 to 65 and over 65 as an example. And anybody under the age of 25, for instance, for aortic and mitral valve disease disease, in fact one of them for a aortic stenosis, you’re looking at slight disease. So minimal disease under the age of 25 is rated at 75. But if you go mild or moderate or higher, and any of the mitral, not the wrong way around, I do apologize, but it doesn’t really make a lot of difference at the end of the day. And people under the age of 25 actually declined for life insurance.

Kathryn (30:17):

Right,

Matt (30:18):

Okay. If I can call it logic, it’s because the insurers, their underwriters want to see how that disease progresses.

Kathryn (30:31):

Yes.

Matt (30:33):

And whether that’s slight moves to mark to moderate and how quickly it does that, if indeed it ever does, let’s be honest about it. But your ratings tend to go down. If that category of slight, mild, moderate stays the same, then the ratings will come down with age. So if you have moderate mitral valve disease, then for instance 25 to 39, I did say moderate, didn’t I? Under the age of 25, it’s decline, 25 to 39 is 200, and then it comes down right down to plus 50 over the age of 65. So heart valve disease certainly can be catered for within life insurance. It very much depends on the category of slight, mild, moderate, et cetera, and the age of the client when they’re applying for their life insurance as well. But certainly as long as you’re over 25, you should be able to get life insurance. Unless really you are into the severe category, which is really, as I say, you probably should be on the waiting list for surgery at that stage. Or of course maybe the medical profession has decided that surgery cannot be performed for other reasons. Maybe the heart is damaged in a different way as C artery disease, for instance, and therefore surgery cannot be performed because of the catastrophic problems that can come from that.

Kathryn (32:07):

So basically this could be a bit too much for the,

Matt (32:10):

It could be too for the heart to take. Yeah, thank you. So does that help a little bit? I could go into it. Does mitral valve and ATA are subtly different in terms of the ratings? You’ve got the ratings for the right,

Kathryn (32:25):

Which one is seen as I was going to say, I know that there’s difference between right and left side of the heart. Cause I had something with somebody not long ago where they were getting, it was just everyone was just saying, this is just a decline and it didn’t feel right. And it wasn’t specifically heart valve disease. It’d been like some blocked arteries. And I’d had a chat to an underwriter that I know very well, and then they came out and said, I said to me, well actually, if it was the left side of the heart, then that actually could make it okay in some ways we would be able to look at it. So it was everywhere we’d been absolutely like that. And I think nobody was prepared to entertain it or anything. And then because we did establish it was the left side of the heart, I think that tends to be the more favorable, is it? I’ve got that the wrong way around.

Matt (33:12):

It very much depends on what’s, oh, well the thing is scenario you have with the valves on the right side of the heart. Yeah, we’re talking valves, not coronary artery disease. Remember just

Kathryn (33:22):

Yes, of course. Yeah.

Matt (33:23):

Very different.

Kathryn (33:25):

Very different. Well that was a good point, wasn’t it? Cause we were having a little bit of a chat before we did this because I wondered if it would come up at all in the family medical history, but you explained that things like cardiomyopathy, which can come up in the questions, it’s nothing to do with this, is it?

Matt (33:37):

No, not essentially. No. No. Cardiomyopathy is a disease of the heart muscle itself where, and you’ve got these valves allowing the blood to go through, but you’ve actually got the heart muscle pumping it.

(33:53):

So these heart valves allow the blood to come through into it. But really it’s that great B power chamber, the left ventricle, which is the major pumping changer, major pumping vessel chamber, and it’s the coronary arteries that feed particularly all that left side of the heart are the ones that caused major problems. That’s not to say the right side of the heart isn’t important, but we know the major issues that we see as underwriters in particular tend to concern the left side. I’ll just maybe whip back just very, very slightly for a couple of minutes and just say that you have the incidental heart murmur. You also get now a lot of stuff because of the scanning that they do these days, the scanners are so sophisticated A B, they do a lot more generally then you will get nearly always on an MRI, the specialist looking at it will comment on the heart valves as well as the functioning of the left ventricle. And sometimes you will get abnormalities of those heart valves that don’t produce a murmur and doesn’t cause, has never caused the life assure any problems whatsoever. And it’s complete incidental finding because they were looking at for something else. And that is also a challenge from an underwriting perspective, but you’ll normally get the cardiologist who’s looking after the patient saying, okay, you’ve got often in the slight category, there’s a slight abnormality of one of the valves, but ignore it

(35:53):

Or just go on dental prophylaxis. So that’s another challenge that you’ll get from underwriters. And also when the GP report comes in and you’ll get a reference to the cardiologist, let’s say they were looking at coronary artery disease, you’ll very, very rarely get the GP saying, oh and those incidental finding of heart valve disease,

Kathryn (36:20):

Right

Matt (36:22):

To complicate matters.

Kathryn (36:23):

Oh absolutely. Let’s just make it as complicated as possible. It’s always lovely when something just suddenly pops up and you’re like, where does that come from?

Matt (36:30):

Well, it’s a bit like the dreaded CKD, isn’t it? Let’s be perfect honest with you. What is normal for you? What’s normal for me? What’s normal for my grandparents? Completely different. Completely different. And this is where, and there’s subject for a very another day. I’m not even sure I could speak about it, but this is where genetic profiling really, really is coming in and making tailored drug treatments, particularly genetic drug treatments for that individual.

Kathryn (37:00):

Yeah, that’s happening quite a bit in the cancer space isn’t it? And quite a lot with things like the psoriatic arthritis and things like this. The biological treatments with some of the, I want to say some of the rheumatological, I dunno if that’s the right word, but it’s a word that made it if need be.

Matt (37:16):

No, no, no. I mean sickle cell disease, one that we’ve talked about historically I know is close to your heart. Gene editing, taking that rogue gene out of DNA, reimplant it back in the person with fantastic results.

Kathryn (37:27):

Yeah,

Matt (37:28):

That’d fantastic. It’s absolutely fantastic. Anyway.

Kathryn (37:32):

Brilliant. Okay, so in terms of life insurance, it depends, but the heart valve disease I think will depend upon the situation. We’re probably thinking small rating, severe situations. It might be through to a decline. Am I right in thinking?

Matt (37:45):

Yeah, yeah, that absolutely. It could be declining in worst case scenario you might get, as I say, an in severe that can be operated on. They’re on a waiting list and I think, I never think of those as declines. They’re more postponed until post-surgery and they’ve had a period of where the heart valve has settled down. If you’re sticking something foreign in the body, our immune system loves to attack it because it doesn’t understand what it’s actually trying to help you and all of that period, period has settled down then terms should be available.

Kathryn (38:20):

Yeah, absolutely. Critical illness. What we’re thinking,

Matt (38:24):

Again, you are looking really at heart valve disease replacement is a covered critical illness as you know, and therefore anything that’s more than maybe slight is either it is quite interesting, some actually rate, but most will exclude heart valve surgery.

Kathryn (38:50):

Yeah,

Matt (38:51):

Okay. For kick and IP is generally no can do for anything that’s more than slight. If slight, it’s usually maybe an exclusion, very highly dependent on the case, but its kick is pretty difficult.

Kathryn (39:08):

So with the IP side of it, is it because the knock on effects of having bowel disease, like the conditions that might develop from having had that, that’s what make it to, because in a sense, I can imagine some people and some advisors thinking, well, can we not just exclude claims relating to the heart, but obviously the heart is a big part of our body function and things like that, but it can just develop other things that aren’t. It then becomes maybe more gray, isn’t it? Well, is it because there’s the heart valve disease there? Is it not caused by that? Is that where we’re having the issue, do you think?

Matt (39:43):

I think you certainly wouldn’t want to exclude the heart, you wouldn’t do that, but you could exclude heart valve disease. When we think of heart, we need to be very clear. I need to be very clear with myself that we’re not talking coronary artery disease. We’re talking valve disease, very different beasts and the symptoms that you get with valvular disease because that blood isn’t being pressured through the body as it should, fatigue, tiredness. If the blood is not getting around the body, you’re going to get all other types of symptom that will make you feel generally pretty damn unwell and therefore not unable to do your job. Particularly one that has a manual element to it.

(40:34):

If your heart rate’s going because you’re a class four income protection heavy manual, then the last thing you need is heart valve disease. It’s going to make you feel continually tired to the extent as it either progresses, I might add, we’ve still got this kind of a known element of progression. You’re not going to be able to pick up your spade or your shovel or whatever else is heavy manual kind of in occupation category. So that’s why ultimately, I’m just looking at my notes here. I do see that actually for slight, some insurers for income protection would actually rate for ip. Sorry, I’ve just noticed that I was saying, oh no, it’s really, really tough to get it. Some insurers at the slight end of the category of those that’s slight mild and moderate. So sorry about that. But having said that, how many clients that we see with slight as opposed to mild, moderate, severe, you see maybe a very, very small amount, but at least there’s potentially an option. But they’d have to be right at a very slight end and not under the age of 25. I would add,

Kathryn (41:45):

And I was going to say as well, for all of us, I think it’s probably worth bearing in mind that probably being a smoker wouldn’t be seen as a favorable,

Matt (41:53):

It wouldn’t. But again, we’re not talking coronary artery disease here. You’re talking heart valve. But I mean you do get those little cusps, the leaflets that we’ve been talking about, they can become ischemic and I either they lack the blood and tissue that comes from oxygen. And my technical feel if you want, is that smoking won’t help.

Kathryn (42:22):

Yes, think it isn’t helping. Most situations does. It

Matt (42:26):

Doesn’t know,

Kathryn (42:27):

But I think it’s just people should just be really conscious that if somebody’s had a heart attack, I’m not saying this is the same as snap ies, but if someone’s had a heart attack,

Matt (42:35):

No,

Kathryn (42:35):

No, no, absolutely. Being a smoker does make it much more complicated to get insurance. And so just bear in mind when you’re doing your research, if you’re an advisor that it is really important to still discuss if there’s that. I think sometimes when we are doing research, it can be easy to, sorry, forget and go, oh right, we’ve got this condition, I’ve got all this information, but then forget all the extras that go with it.

Matt (42:59):

Yeah, absolutely. Absolutely. Lifestyle, there you go. It’s under the lifestyle, isn’t it? I don’t think drinking vast demand well is actually health, not valve disease particularly, but throughout. And we’re only familiar about metabolic health, weren’t we?

Kathryn (43:15):

Yes, we were.

Matt (43:17):

Which is absolutely fascinating subject beyond belief. So definitely

Kathryn (43:21):

It’s really

Matt (43:21):

A great big branch of lifestyle.

Kathryn (43:24):

Definitely. And I was going to say, and moving away from lifestyle site, but it’s another thing and it comes up in terms of potentially vulnerable customers for people to be aware of. But again as well with health conditions, I’ve had it, and I’ve seen it a few times with even in my team where they’ve got somebody who’s got a health condition, which can affect the outcomes, but they’ve looked through it all and I’m looking at what they’ve said because they’ve asked me for maybe some advice and it’s basically, it’s seeming like the condition’s really mild. But then when I’ve looked at the other parts of their fact finding in a sense it comes up that the person’s in receipt of pip, so that’s personal independence payments. Now being in receipt of PIP in itself doesn’t mean that you can’t get insurance. I was going to say, there’s nothing sort right to say this if you’ve got benefits that you can’t get insurance.

(44:08):

But what’s really important though is that if somebody is telling you that they’ve got a very mild version of a condition, but then they’re also saying that the receipt of PIP then from an advice point of view and just generally managing expectations, that doesn’t really, not always, but I’m not saying it’s every single situation, but that doesn’t really match up. So it’s very hard to be awarded pip, which is essentially the disability and benefit that the government will pay people in the uk. So it is really, really hard to get that and you have to be quite ill to get it. So if you are hearing someone say, oh, my condition isn’t very bad, I’m absolutely fine, I’ve not got any issues, but then they are received that benefit, then something isn’t matching up. And you might just need to with support from probably a compliance person, maybe somebody who’s specifically in your organization does speak and give training on vulnerable clients as to how you would approach that with the person. Because assuming Matt, that in my assumption is that as an underwriter, if I was an underwriter, I’m making an assumption here, but it wouldn’t make sense to me to think this person has this no problems whatsoever. But yes, still they’re in receipt of that.

Matt (45:21):

Absolutely. I mean, I suppose in a way the question needs to be asked in a very, very sensitive way, which you talk about there. It could well be the pip, I suppose it could be a musculoskeletal reason.

Kathryn (45:36):

Yeah,

Matt (45:36):

Absolutely. Which probably wouldn’t impact on your life insurance, but certainly would impact on your income protection insurance. But yeah, I mean there are a whole raft of other conditions that the dots need to be joined up. They

Kathryn (45:54):

Do. And I say as an advisor, this is on advisors to really look at that from the starting point. And it’s for your own time, it’s for your inefficiency, making sure you’re managing everyone’s expectations, the clients and your own, because benefits aren’t going to come up in the question set. Obviously I, insurers do tend to ask about occupation. So if the person isn’t able to work, that could come up. But sometimes people can work and still be in the receipt of these benefits. And again, just because somebody isn’t receipt of benefits or just because someone isn’t working doesn’t mean that they can’t get insurance. It’s just that if there is a medical condition there and they’re saying that they’re in receipt of benefits specifically for that medical condition, it’s very likely that you’re at a point where the insurer’s going to want to see A GPR.

(46:37):

So a report from the doctor. So again, it’s just making sure that we all have a really clear understanding of what the outcomes could be. So potentially, and whenever we do research, I’ll say you don’t necessarily, well, not necessarily. I’ll say, I would suggest that you don’t suddenly go, oh, I’ve got Angela Smith here, this is her date of birth, here’s her address and everything. We tend to do it with our research saying, we’ve got a person here in this situation, so it’s anonymized, so we’re not flying around these people’s data everywhere. So do it really anonymized. And then you can say, well, the obvious receipt benefits, and then the underwriters can help guide you as well. But it’s, as an advisor, it’s important for you to pick that up initially and make sure that when you’re doing your research that you are getting that over.

Matt (47:19):

Yeah, I think it’s incredibly important. It is really good to hear that the advisor community will take that extra step as well, because the absolute last that any of us want is for a claim to be turned down and that reinforces that practice. It actually really does reinforce the closest one of those loops that can occur in the advisor practice. So it’s incredibly important. Last thing we want to do is claims turn down, end

Kathryn (47:51):

Off Exactly, exactly. Or in a sense to build hopes up. So you’ve told somebody, oh, well I think this is going to be 15 pound a month. And then actually you in a sense, you had that information at the beginning, if you’d shared it with an underwriter, they’d have said, look, this isn’t matching up. I think you should speak a bit more and ask them a bit more about this and that to then go potentially months down the line with the gp, you’ve been chasing it, possibly your team’s been chasing it, the client’s just been sat there waiting. And ultimately it wouldn’t have been possible, but you could

Matt (48:24):

Have maybe

Kathryn (48:24):

Done something different from the start, which would’ve made it a more positive journey for the person rather than that dreaded to postpone or decline there. But anyway, we always finish off the podcast with a case study, so I’m pleased to share this one with everybody. So this was somebody, it was a male non-smoker, his early thirties, and he had mitral valve disease and about a year and a half before the policy was started, he’d had surgical repair. There’d been no ongoing complications, he was just taking aspirin. There had been a family history of heart attacks as well. And obviously that was all included, but really pleased to say that obviously we’ve got the insurance in place. It was a mixture of mortgage cover and then just some family protection within affordability for the client. So it was three 30,000 pounds of decreasing life insurance, 40,000 pounds of level life insurance, both over 34 years.

(49:18):

And the outcome was that the price was about 36 pounds per month. So it is to say that we can get covered. Obviously this person had what we would probably consider the, obviously you’ve said the surgical repairs, obviously we want to see that because it can sometimes mean that something stronger is happening, but it’s been repaired. He’s doing really, really well. There’s not huge amounts of medication or treatment that’s needed and everything’s just in a sense back to normal by needing to take the aspirin. And we’ve got the cover and it’s a good price as well. So very happy that we got that for the person.

Matt (49:51):

Yep. Congrats. Well done.

Kathryn (49:53):

Thank you. So we’re at the end. So thank you for listening everybody, and always, as always, thank you Matt for joining me next time. I’m thinking of doing a little bit of a mixup upon some things for a little while, Matt. So obviously me and you will keep doing our every other episode on underwriting. But then what I’m going to do is I’m going to start doing some little possibly mini episodes and the in-between ones where I’d take a bit of a deep dive into certain products. So I’m going to do a bit of overview of business property relief insurance next time. And I might at some point even have one of my team joining me to share their case studies where they’ve done things for people. So please feel free to visit the website, practical protection.co uk if you want to listen to the episode again or access your ccpd certificate on there, which you can get. Thanks to our sponsors, the Octo members. I did a bit of, lost my train of thought there, so I do apologize everybody. But thank you very much for listening everyone, and thank you again, Matt.

Matt (50:50):

Absolutely. No problem. And just two seconds to say Happy New Year to everybody and really the very, very best of luck with your businesses throughout this year and beyond that matter. So happy new Year.

Kathryn (51:03):

Thank you, Matt. Lovely. So yeah, thank you. Bye-Bye

Matt (51:08):

Bye.