Kathryn (00:07):

Hi everyone. We have Debbie Smith with us from Swiss Re. How are you doing today, Debbie?

Debbie (00:13):

I’m doing really well. I’m really looking forward to the Christmas period. It’s been a busy year. Just got through a really busy conference season, so all good here.

Kathryn (00:22):

Fantastic. I was going to say it’s pretty intense this time of year on the conference isn’t the awards and everything like that as well. Well, everybody, we are here today season eight episode days, and we’re going to be talking about income protection claims, the trends that we are seeing in terms of long-term income protection claims and what the industry can be doing to help people. This is the Practical Protection Podcast. So Debbie, you were just saying that there’s been quite a lot of conferences and we actually met at a conference earlier this year. We met at Lucid. We

Debbie (00:59):

Did. We met at Lucid. Yeah, it was an excellent conference.

Kathryn (01:02):

It was brilliant. It’s the first time I’ve ever done one like that and we are always trying to, in my company, we work so specifically with people who do have risks, so we’re always trying to get better underwriting outcomes or understandings and everything. And when there was one that was an hour away from where we live and obviously we’re in the middle of the north absolutely away from anyone and everything, it was just too good an opportunity and it was just so lovely to be there and see anything. There’s some ones on there that were really, really quite emotive for me as well because there was the professor who was speaking about the Parkinson’s and everything, my dad has Parkinson’s, so it was really quite emotive and it was really interesting to see what they were saying in terms of the treatments and everything like that, and gave me lots of new ideas.

(01:44):

And I have to say as well also, and I think this can happen as well with underwriting, isn’t it? You can end up in a really bad cycle of self-diagnosis and suddenly getting really worried. So I remember that we were there and somebody was talking about familial hypercholesterolemia and they were talking about those little bumps that you can get on your eyes and everything. And I’ve sat there, I’m thinking, I’m sure my mom has them, I’m sure my mom has them. And I got home and everything and I looked at my mom’s eyes, I was like, right. I was like, you’ve got these lumps. It might be, it might be. She was just like, oh, I have been told this could be my cholesterol. And I just looked at her completely deadpan night, are you serious mom? And I was like, and my granddad had had a quadruple heart bypass.

(02:26):

He’d always had high cholesterol. But I knew from my insurances, because I do have medical things that I get with my insurances each year that my cholesterol is always very, very low, which I’m always very proud of and I have to say is a competition between me and Alan, my husband who has lowest cholesterol. So we do definitely do that. And I have to say as well that I went for full on genetic testing. I was like, I’m not messing about with this. We’re going to get this tested. And obviously touch wood and very, very gratefully, we do not have familial hypercholesterolemia, but that’s definitely an example of where you can get a little bit in the terminology and different things that can happen. So anyway, that was quite a random offshoot and a side tangent there, but so Debbie, it’d be really good to hear from you a little bit about yourself. What is it that you are doing? Where is it that your career has been?

Debbie (03:14):

Oh gosh, yes. There’s a lot to unpack there. Wow, it’s a busy year. I’m chief medical Officer for the part of Swiss Re that covers Europe, middle Eastern Africa, so a big patch. And as a reinsurance company, we take a share of the insured risks that insurance companies take on individual lives to their cover or groups of lives and across all of the life and the health product lines, I’m really privileged actually in the work that I do. I really enjoy it. We spot medical trends. We do a bit of horizon scanning for medical trends that are coming over in terms of treatments or diagnoses, finding better ways to identify health risks. Also identifying rehabilitation options for people if they’ve gone off sick from work, trying to help them get back. So I’ve always described myself actually over many years as the advocate that sits between the insurance company interests and that the patient body and trying to make sure that fair play takes place in that bit in the middle, that the products do what we intended them to do. And we interpret those definitions in a really fair way.

Kathryn (04:21):

I say it’s a really lovely space to be in actually that I think, and I think there has to be somebody in that space so difficult at times because the matter what I think sometimes it is hard for people to understand that insurance and insurance companies, it’s a commercial business. It has to have certain targets, it has to have certain rules, it has to be able to uphold its promises to existing clients and everything like that. And it can be really hard as an advisor sometimes because you sat there and you’re looking at it and you’re like, oh, come on here, kind of thing. Let’s do this better. Let’s get this right for this person. And you’re wanting to challenge things and it can be really hard. But I think what’s important is to know that there are people like you there who are making sure that things remain fair and seeing it from both sides, as you say, probably straddling it.

(05:09):

And I think it’s probably worthwhile just for anybody who’s quite possibly a newer advisor to the market or somebody who isn’t even in our industry wanting to listen to this, is that when we’re talking about reinsurers, reinsurers are, well, they are the insurers of the insurers in many ways. So all the big brand names that people associate with insurance that you’ll see, usually people tend to think of the people who do their car insurance and their travel insurance and things like that is the big brand names they generally have. They take on the insurance, they take on the policies and the risks of UR people, but it’s reinsurers like where used to it with Swiss, who then ensure part of that risk. So it is always a very, very strange dynamic I think to sort of think of it as insurers ensuring insurers, but that is how it works and it’s that lovely kind of play with the interests of everybody involved to sort of make sure that everything’s going to be right. But we are here for the income protection, so I’ll stop going off on tangents. So I’m terrible for that, Debbie, so I do apologize. So it’s a good idea to probably just jump straight into the data. I know that obviously I’ve seen you at Lucid, I saw you at IAG recently and it was quite a lot in there about the data, the statistics, what they’re showing, what you’re seeing, what you’re able to see from that. So what are the key things that you are noticing about income protection claims?

Debbie (06:32):

Well, as we know, the main sources of income protection claims are usually mental health disorders and musculoskeletal ones. So things there like bad backs, knee operations, that kind of thing. We noticed a trend though, going back over many months that we were seeing a lot of obesity related claims coming through.

Kathryn (06:50):

So I remember that coming up quite specifically. And it was one of those things where when you don’t sit there and research the data yourself, and obviously for myself as well, I wouldn’t understand all those numbers and everything in front of me. It’s not what I do. But sorry, when that first came up I thought, oh, I wonder what it was just that thing, obesity, you would think you understand with certain things that it might lead to longer claims on insurance, but I don’t think people would necessarily think of obesity because obesity is such a, it’s so hard in some ways because in some ways it’s such a gray area because of the fact that BMI tables are not necessarily always the greatest thing and clients that can get quite frustrated when we’re doing BMI tables and things like that. And it is that thing of I think if it’s not perfect, but it’s probably the easiest way at the moment for insurers to get quite a broad idea as to somebody’s how healthy they are, their lifestyle by looking at those BMI trends.

(07:48):

Obviously it makes it very, very difficult if you do have somebody who’s very fit and active and quite muscular. But I know that we talked about that actually, I think in one of the breaks we were saying it is really hard because you can get somebody who’s incredibly muscular who is maybe very fit and active like a rugby player or somebody who’s doing lots of weights, but then there is that and obviously they will naturally have a higher BMI and that is something that we can talk to insurers about and you can get potentially more favorable outcomes if you explain the reason why the BMI is so much higher because it’s due with weight mass rather than carrying and sense extra weight, excess weight. But then we said, but the problem is the same point, isn’t it? Is that when somebody stops being a rugby player or stops training, that the body’s still kind of left with to a certain degree, some of that mass. So it was a really interesting sidetrack to have with you, but when we’re looking at the data and the things that are saying about the obesity, about the high BMI, sorry, linking to those long-term claims, I remember you saying that there’s quite an issue actually with trying to get that data in the first place and specifically as well to do with people’s medical records.

Debbie (08:56):

That’s right. So the team of doctors that work in my team, we all really spotted a trend that obesity was really underpinning. It was driving lots of conditions that were actually impacting on people’s ability to work, but that wasn’t really identified by their healthcare provider as being something that was there to be supported to help with. I think I’ve worked in the NHS for a fair while and I think everybody’s read the newspapers. We know that the NHS is struggling a bit right now and we did a deep dive into claims data and looked through all of the medical reports. We found that only one in five people with diabetes or metabolic syndrome, and I’ll explain a bit about what that is, would get the support they needed. And when we looked and said, well actually, do we do anything on this in the insurance space, are we doing something to help this in terms of maybe coaching nutritional advice, there wasn’t very much there either.

(09:51):

So really quite a big gap. So metabolic syndrome is something that occurs when so we eat, our body responds to eating particularly carbohydrate or sugary things. And the more often we do that, if we snack between meals for instance, we kind of maintain quite a high glucose level over time and the body responds to that by the amount of insulin it produces. And over time, if it has to produce more and more insulin to try and get the body back to where it should naturally be, then we see development of diseases. So I think it’s entirely fair to say that obesity just on its own without any other downstream effects and illnesses, it’s quite difficult to sell that as a rating to somebody who feels pretty well from an underwriter’s perspective. It’s about what it gives you a risk for in the future. The risk is really of that, of this developing this metabolic ill health metabolic syndrome, which is where you see all the downstream effects of having this raised insulin state and insulin resistance and the body is really struggling to cope with all of those sugar carbohydrate based intake and that can give all those downstream effects of high blood pressure in some cases, high cholesterol, heart disease, stroke, even cancer.

(11:15):

And so that’s the kind of cause and effect thing that we look at.

Kathryn (11:19):

Okay, that’s what I was going to say. You’ve kind of triggered a side tangent in me again, so I do apologize because, so I have my BMI is well within normal ranges, but I do have an underactive thyroid and it is hard sometimes it feels like an unending slog of sort of trying to exercise and it doesn’t really do anything. And obviously if I’m wanting to, and it is not to say that I certainly don’t need to lose weight, but it’s just that thing sometimes you’re just like, I want to be a bit more toned and you’re struggling to get a bit more toned in that. And my thyroid didn’t help, but I came across something and obviously I know you’re a doctor, so I just want to be very clear, I’m not asking for your opinion on this or anything like that. We’re not going to be saying, oh, Debbie says you should do this or anything like that.

(12:02):

But it was really interesting. I’ve actually found it helps me and it really specifically feeds into that sugar as well. And this was done by somebody who did a lot of the, I want to say the blood glucose monitoring, like those patches that people can wear on their arms. And she did this and she’s a mathematician and she did all this charting and everything and it’s all about the order that you eat your food. So you eat all your fiber first, then your protein, then your carbs, and then your sweetss. And it’s all to do with if you layer it like that, this is when you probably say it all just goes in your tummy and it’s all just doing the same thing. And I’m just like, oh, well that’s a few months down the drain. But actually it seems to have really helped and it’s really helped in terms of if you’re getting the sweet stuff, it breaks it down. It has even longer to break down in your tummy before it actually starts really getting absorbed. So if anybody is really struggling, obviously I’m not saying that you do this, this is not a medical point of view. Again, I’m a doctor but not that kind of doctor. So I certainly don’t have any kind of backing to it or anything. But it’s just something that I’ve tested myself personally and I thought it was quite good. But again, that’s me going on a side tangent, so forget,

Debbie (13:08):

I’m going to respond to that side tangent actually by saying brilliant. I think the whole science of nutrition has changed dramatically. We’ve had at Lucid, I talked about the obesity prevalence, how many people in the population are overweight or obese And we know that actually ever since we saw the guidance about what to eat in terms of low fat, high fiber in the seventies and eighties since then as populations across the world we’ve just got bigger and bigger and less and less healthy. And now we’re seeing a growing body of scientific evidence that actually shows that what we eat and the proportions of what we eat is really important. How often we eat is really important. We were never evolved to eat constantly. My children are always being told, you must have a snack, you’re getting hangry, you must have a snack. But this is completely counterintuitive to how we evolved over the centuries, but the order in which we eat is actually equally true. There’s clear evidence now that the order of how you eat your different food groups is incredibly important too. So I think even if you’ve decided that mathematically or intuitively, there is now an evidence basis for that. So I’m actually quite keen to move away from just looking at BMI as a marker of health or future health and actually think about metabolic health instead. So it’s exactly the point you’re talking about.

Kathryn (14:35):

Oh absolutely. That sounds really good. I was going to say when he said hangley, I was thinking that’s probably Alan approaching me from a very safe distance going, you’ve got a bit hangry. Here’s a carrot, get your fiber in. But no, that’s really good. So just as an idea is that how would we check the metabolic health side of things? Because I’m thinking if it’s body fat percentage, I’m voting that we stick A BMI because I’m a typical kind of, I definitely don’t. I say I do have a low BMI, but I think somebody said once it’s a skinny large person because inside on the body fat side of things, it is higher than possibly what I want it to be.

Debbie (15:14):

You can look at it from all sorts of ways you look about. So it’s possible to have somebody that’s normal BMI that’s metabolically looks quite unwell. So we can test for that. We can look at lipid profiles, we can look at where the body fat is stored. So if it’s stored centrally, we know that’s more of a risk. So the kind of apple shaped of us, but also it is over time we can change. So I think the idea that a diet is something that works has pretty much been abolished now we see lots and lots of studies that just show that the more you try and think of something as a temporary nutritional change, the long-term improvements are vanishingly rare. And so trying to think about something from a lifestyle perspective, the ability to have a test that looks at where you carry your, if you have excess pounds where you carry them, if it’s central or not, what your lipid profile looks like, just all the markers of health really.

(16:13):

So you can have a high BMI for several years, many years even for some and never develop those downstream effects of poor metabolic health. But you have to know, don’t you? And I think that’s the worry and that’s the worry for the government and for the health system is that we’ve got lots of people wandering around of a normal BMI or not and we don’t really know because we don’t test so much which of those will be developing significant health conditions down the line. And I think that’s where there’s some opportunity really for insurance companies to do something quite positive actually and something quite educational, catch people early and then we get a bit of a win-win. But I hope to talk a bit more about that in a minute.

Kathryn (16:56):

Yeah, yeah, absolutely. I was going to say, I think it’s really interesting as that as well because I think there is always certain assumptions when we speak about high BMI or potentially some diabetes. I think people, because of the way that the media and the way that TV shows and films, they always tend to go to an extreme of a situation rather than just looking at the people who are just in the middle range. And I always think that when you do think of high BMI, you’ve got a specific image in your mind. If you sort think, oh, if somebody has a high BM I, they’re probably going to look like this. And it’s not being mean, it’s just obviously it’s what our learned experience. But then I know, so my husband does well, he is done. Is it half triathlons? I better not say fall on triathlons because Ill probably say to me, don’t say that I’ve not done that much.

(17:38):

People think I’m super intense, but he’s done. I think it’s half tries and there’s been people that I’ve seen doing them and I’ve looked at them sometimes and if you look at them you think, oh, you’re quite big actually. And not necessarily looking muscular big, looking more like they’re just carrying weight, I thought. And I thought, but they’re so healthy, they must be so healthy to be doing what they’re doing in terms of fitness levels. So it’s going to be really interesting to see how we can do that. So that probably takes us really nice into the next bit. So what can the insurance industry do to sort of help prevent and also be positive in a reactive way for people when it comes to these long-term claims, especially if we are seeing this thing to the high BMI side of things?

Debbie (18:20):

Yeah, I mean I think sometimes it’s just really good to step back and take a really objective view of something. I mean it seems crazy to me that if we know somebody’s got A BMI 50 say when they apply for insurance, that we take the cover, let it run for 20 or 30 years and basically leave them to become more and more unwell over time for the vast majority then they claim. But is it easy? No, it’s definitely not. To be honest, no country’s public health system has fixed this over the last 20 or 30 years. So I can definitely see why we are where we are. But we do know now though that science has evolved enough for us to understand that the root of so many of these conditions is metabolic ill health or metabolic syndrome. But the fact that somebody’s a beast really isn’t the issue per se. It’s what it’s doing to the function of the bodies. Whether this in insulin resistance is developing and there’s lots of good books that I can point you to read up a bit more about this because a really exciting kind of area of science,

Kathryn (19:23):

I would love that. I would say I would really love that,

Debbie (19:26):

Happy to. So if your body’s permanently on kind of sugar or carbohydrate high, then it keeps being produced but it’s being less effective to try and control and keep that sugar down. It develops something called insulin resistance. And insulin resistance is the thing that’s the root cause of so many of the diseases that we see being suffered from in the country. High blood pressure, heart disease, high cholesterol, any number of conditions. Even now we’re seeing a growing body of nutritional psychiatry talking about BMI being correlated, poor metabolic health being correlated with mental health disorder. So we learned from the deep dive that obesity and poor metabolic health is largely left alone by the NHS and that as an industry we don’t offer any largely very little help or guidance or counseling when we know somebody goes on risk when they’ve got their cover and then we don’t have very much to offer later when they go off sick.

(20:22):

And I think it’s really exciting that there’s possible to change that now. And we are at Swiss Re, we’re piloting a claims rehab project to see if we can do some combined nutritional kind of learnings and then some counseling psychology type stuff because if you don’t handle both of those things then it’s not going to be as successful as it could be. So that’s what we really want to do. We want to try and get to something that’s a win-win so that you get potentially people much healthier so they feel able functionally capable to go back to work. You’ve got people that are engaging with their social life again, their work friends, healthier, happier customers and it’s a win for us as well because they’re living healthier, longer working lives and just spending more time with their families, which is essentially what we’re all hoping that they will do.

Kathryn (21:16):

Absolutely. And I think as you say, it is certainly a win-win. So I know obviously we’ve been there through a lot of the things that you’re seeing, the trends and everything, but I would have to ask you about underwriting one. I’ve got you here with me. There’s no way that I can avoid it for my listeners off just me for just generally picking your brains. But we’re saying all this, we’re saying about how we’re going to be helping people, especially once they are making a claim, how can we engage with them, as you say, possibly from a physical but a psychological aspect of things as well. But it’s also getting people to get income protection as well. And obviously lots of people can get income protection and it just goes through very straightforward and no issues whatsoever. No premium increases, no exclusions or anything like that.

(22:01):

But we are seeing, and I think what’s really interesting is that as medical science is evolving all the time, obviously we’re getting diagnoses of things all the time and on the run-up to things. Whereas before things would only be caught once they were quite in an extreme situation. They’re getting caught quite early on. Newer things are being identified all the time and especially as well post pandemic, the amount of people who do have a statement where it says obviously, have you ever experienced anxiety? It’s very unusual for people to not have experienced. And I know that this is completely not for here, but there is a very, very confusing kind of moment for clients, for advisors, and I’m sure from underwriters as well where we go, but what kind of anxiety, because anxiety is a natural human process as well in certain situations, but it that’s not for here. But what do you think in terms of underwriting now that we’re seeing more and more people being diagnosed with things like mental health as well as doing all this stuff to help people in that reactive space and obviously trying to help prevent it. What can we do to try and open up more for people who do have these existing conditions?

Debbie (23:12):

Oh, that’s a big question. I have a go.

Kathryn (23:16):

Thank you.

Debbie (23:16):

Firstly, I think, well I think it’s interesting isn’t it? I think we’ve moved to have lots of automation, which is great because you want the vast majority of things to go through really, really rapidly, get ’em on cover as fast as you possibly can. But there’s different companies with different processes that can tailor to a greater or a smaller degree around the kind of disclosures you want to give for your clients. So for me, the basis of this is really the underwriting questions have to ask the right things in the way that gets enough of a disclosure to make the fairest possible decision. So I think it’s actually quite a good idea to offer the applicant the chance to make medical disclosures sometimes on their own or online because not everyone can feel able to share their whole medical history perhaps with their life partner.

(24:05):

So if they have one. So that’s quite important I think, to have the space to be honest about things. I know some people know their advisors socially and it can be sometimes a difficult conversation for some not all to be able to talk about their mental health struggles, whether current or historical. But I think as an industry we really need to try and facilitate disclosures if the applicant feels that they’re particularly sensitive. But over time, I’m absolutely sure that you’re right. We see more and more disclosures now around mental health because stigma is reducing or that the people perceive as there and that people are much more accepting and able to talk about that. I think it’s really important that we use evidence-based systems. So we provide a kind of guidance framework for the insurers that we take some of the risk for to try and make sure that there’s consistency so that people should get a fair decision across the board.

(25:03):

But within that, the underwriter’s role really is to kind of liberally use common sense to try and look at the context. And context is everything, isn’t it? Some applicants will suffer with mental health issues throughout their life but cope really well take the help that’s there. Counseling medication may never take a day off work. Some people may need time off in the face of significant life events. And this is something I commonly see at claim stage. You can see a series of life events where someone’s been really kind of resilient and able to cope with it until the fifth or sixth or seventh thing happens and then it all falls over. And then we can provide some really valuable cover to give them some time and space to get the help they need and then hopefully get them back to their workspace. So underwriting income protection is really no different.

(25:54):

Some other products for an underwriter really it is about those kind of base principles, really understanding, asking the right questions, understanding the context, using data to assess the kind of risk of time off work and then trying to be quite consistent about that because it, I would hope you try and get a consistent decision from many different places so that we’re treating people in a similar way. I think the key thing for me is the risk of a health event of any sort just gets more as you get older, the chance of having a rating or having a cover with exclusions goes up as you get older, as life events and illnesses happen. So the chance of get in early and start your income protection cover at younger ages is really a great opportunity. That’s a really good conversation to have to get that protection before life events start.

(26:41):

Some people they would’ve had an illness from childhood, so that’s a bit more difficult. But really the opportunity to get in there early and get cover before some of those later life events happen is really important. And the value of this is so important. I look at claims on a daily basis and I see daily how valuable this is when crises strike, when people are diagnosed with terrible illnesses or just life gets in the way and it’s really nice that the product steps up and really makes a difficult time more tolerable. And that really is what keeps me jumping out of bed in the morning and drives the enthusiasm I have to kind of do what I do in insurance. Oh,

Kathryn (27:23):

I’m glad that you are there to be able to do that. And as you say, you’re seeing, you are just firsthand seeing it, Tom. We just need to make sure as always as an industry that we’re getting it out there. I have to say as well about getting the IP as young as possible. Pretty much as soon as my kids start working, I’m just going to get them ip, I’ll pay for it myself. I’m just like, we’re not messing it out. It’s going to happen as soon as they can get critical illness cover, you’re getting that as well. I’ll pay for. It’s just that kind of thing of let’s just like you say, it’s just so, so important. And I think as with anything, it’s so tough, isn’t it? Because it’s always that what if situation. I know sometimes that can be quite hard when I’m speaking to clients.

(27:58):

Cause the case of I was like, in some ways it’s like, right, I hope to never hear from you or your family again in some ways because if there is, it means you’ve made a claim. But it’s just there as that just in case. And the devastation from it when it’s not there is just obviously really, really horrible. And I always try and say to my team and my advisors that sometimes people think of protection as kind of like I’ve said this before, it’s a bit of the annoying little sister in the insurance world when it comes to advice when we’re thinking investments and pensions and everything like that. And I’m allowed to say that cause I’m the annoying little sister. And what for me though is the fact is that it’s like, yes, pensions and investments are essential, but literally what we’re doing with the income protection and everything like that, well the pensions reliant upon the income, the investments reliant upon the income and bringing that back in.

(28:46):

So we don’t need to draw into them quickly and we have people’s financial futures in our hands and we really should make sure that we take that just as seriously as we should be doing. Well, thank you so much for coming, Debbie. It’s been really, really lovely to speak to you and to just see and hear all of this again because just each time I feel like I’m just learning something new about the way that the medical side of things is working with it all, I’m going to be back next time everybody with Matt ran and we’re going to be looking at heart valve disease and what a diagnosis can mean in getting your protection insurance. As always, you can go to the website practical protection.co uk to listen to this episode or you can hear it from all of the major podcast platforms. And on there you can also access the link to be able to get your CPD on the website too. Thanks to our sponsors, the Okta members, thank you so much for joining me, Debbie.

Debbie (29:36):

You’re very welcome. Nice to see you

Kathryn (29:37):

Today. Thank you. Bye

Speaker 3 (29:40):

Bye.