Kathryn Knowles (00:00:05):

Hi everybody. It is season seven, episode three, and we have Matt ran back with us for the first time this season. How are you doing, Matt?

Matt Rann (00:00:13):

Good morning. Yeah. Not too bad at all. Thank you very much. Uh, I’ve certainly got over my, uh, my Christmas bug, which laid me down for the best part of three weeks or so. Oh. Feeling, feeling very grotty and missing all of Christmas. I knew you. Mm-hmm. <affirmative>. Um, but yeah, not too bad. Really, really good to see, uh, the world becoming a lighter place. Absolutely disappearing. Slowly but surely. I must admit, I think I’m, I must be one of those, um, you know, not greatly I would say, but, uh, one of those sad people. Those seasonal effective.

Kathryn Knowles (00:00:44):

Yes. Yes. I’m, I’m, I think I might be somebody who experiences that as well. Alan’s always trying to sort of like, suggest things to help me want to wake up in the morning. Cause essentially once I’m asleep, I don’t wanna be waking back up. Obviously, I do want to wake back up, but generally I want to stay asleep. And, um, and was just like, well, why don’t we do this? Why don’t I play some nice morning music for you? And I’m sure you can imagine the glare that he gets in the thought, <laugh> doing some music, morning music to wake me up. He’s just like, no, I have a five-year-old that’ll wake me up. That’s, that’s

Matt Rann (00:01:14):

Sufficient.

Kathryn Knowles (00:01:15):

No, absolutely not. Well, today everybody, we’re gonna be talking about family medical history and how it can and cannot affect protection insurance applications. This is the Practical Protection Podcast. So Matt, let’s start off, if it’s okay with you, with why is, why, why does family medical history before the age of 60 or 65, depending upon the insurer, why is it so important for insurers when we’re looking at things like personal and business protection insurance?

Matt Rann (00:01:51):

Okay. Well, I think, uh, it, it’ll be, um, a relatively, it’s relatively common knowledge that, um, from time in Memorial, um, people used to say, uh, you know, your own mortality, look at your own genes if you want to get an idea of, um, you know, how long you’re gonna live, and so on and so forth. And that was around a few hundred years ago. Um, but obviously science and, and particularly data collection, uh, has moved on and with actually shadow doubt, um, genetics, your family history, um, does count an awful lot. Um, what is better understood now, of course, that it is not purely, um, your genetic maker or, or to be honest, the faults that, um, appear, uh, while you’re developing an wound. Um, or you could ask you, okay, right to the very point of ization, to be perfectly honest with you.

(00:02:48):

Um, you know, the, the, some of them are faulty and that can, can cause not always I might ask, can cause uh, problems later on in life. But what is, what is better understood is it’s, it’s purely not just those genetic, um, um, I dunno what you call them, just mistakes, I suppose. Um, but environmental factors as well. Uh, and also lifestyle factors do come into it. Um, you can go through with a faulty, um, diabetes gene, for instance, a type one diabetes gene for, for all your life and never developed diabetes type one diabetes. Um, but, uh, it, it’s now known that, uh, those who do develop, um, it’s triggered by, uh, it can be trigger by environmental factors such as, such as a virus, simple virus. So I’m afraid to say, not particularly technical comment, but it’s a bit of a look of the draw on on some occasions.

(00:03:49):

The one us wanted to specifically talk about, given that we have a limited amount of time, um, was, was, was in fact diabetes. That’s, uh, one of the very common ones, family histories. That is that, that the crops up, um, when, uh, underwriters look at protection, both, uh, both live critical and income protection for that matter. Um, and it’s interesting really when I was, uh, reminding myself of these from the old days, that’s really, uh, type one diabetes. So that’s really the, what people will understand is the severe type of diabetes that does need in, in, um, injections of insulin, uh, to help with the disease, the control of the disease. Um, but it is very much a combination of, of, of genetics and, uh, environmentals are just, uh, just mentioned. And really, if you do have the, um, genetic, uh, mistake, can I call this that, um, you, you are only at slightly higher risk of actually developing diabetes itself.

(00:04:53):

So that’s type one, that’s the severe one. Now, if you’re looking at type two than the, uh, predisposition, um, the genetic condition, um, certainly impacted by lifestyle and environmental factors as well is much higher. Um, for instance, if a an individual has one parent that suffers from diabetes, then there’s a 40% chance of them developing the disorder. If both parents have type two diabetes, then there’s a 70%. So to use that example, I thought that might be a good example of, of, um, where family history is important to underwriters and, and why it is as well. Uh,

Kathryn Knowles (00:05:38):

I think that’s a really good example. Cause as you say, I mean there’s, there’s so much so bundle in there. So as you said, there is the genetics that could potentially do it, but there is obviously as well those, those lifestyle factors as well. And you know, I think that when we probably, I think probably when we’re looking at it from an advice point of view, I think probably initially we’re thinking of it as more of a genetic rather than lifestyle factor. And, and I don’t think that we don’t see that and we ignore it or anything, but when we, when we’re generally looking at it and you see sort of the list of conditions, cause diabetes doesn’t always come up in the question step, does it for family medical history? It, it can do, but doesn’t always. Yes. Um, you know, and we’ll see things like heart attack cancer, and I think you automatically, I don’t know, I I think you automatically think, oh, that’s probably more of like a genetic link.

(00:06:21):

But you are right though there is, there’s a huge influence in terms of, of lifestyle and especially, I mean, even if we think it’s like a probably quite a, a broad, um, sideways jump in a sense is if you were looking at someone like Australia, obviously the, the likelihood of skin cancers I imagine is far higher than say, somewhere in the uk. So that you could quite well have parents and children and siblings and everybody experiencing that. But that comes from an environmental factor rather than necessarily genetics. So it’s, um, there’s definitely a lots of things to be thinking about about it.

Matt Rann (00:06:55):

No, a absolutely, and I think it’s, it’s, it’s one of those, if, if we take it back to the actuarial underwriting science behind all this, it’s, it, it’s, I think it’s fair to say that really the, the data that is used to come up with ratings generally will include all of that. Um, now that if, if some, if somebody thinks about that or if I think about it, I’m thinking, well done. Lifestyle factors, that’s a variable. Environmental factors could be a variable. Um, is that really fair to to, to, um, rate people with those two big variables there? But the, the reality is, and it’s, it’s something that, that we continue, we as underwriters actually continue to work on whereby breaking down that data to try and be more specific and to be more in, um, to, to try and better understand what a family history and all of the types of conditions that matter, positive family history, um, how we can break that down for the individual and try and move away from categorizing people in great big groups.

(00:08:11):

It’s a very difficult thing to do because the data, the, the very detailed data isn’t there. And, um, but nevertheless, you know, the, the, the world of underwriting continues to work with the, uh, the great and the good in the medical world with our actuarial colleagues to try and do that and provide much more tailored ratings for, um, for our clients. For your clients. So I always think family history ratings are, um, uh, uh, an interesting one. And I’ve spoken about it before, Katherine, you and I have spoken about it, but, um, I’m not sure if I’ve ever said to you personally, but because I had, um, colon cancer stage three actually doesn’t matter, I don’t think from memory, but, uh, colon cancer at the age of 48 below 50.

Kathryn Knowles (00:09:03):

Yeah.

Matt Rann (00:09:04):

Then both of my children are, how do I say it, lumbered with a plus 50 loading for critical illness for the rest of their lives.

Kathryn Knowles (00:09:12):

Right.

Matt Rann (00:09:13):

Um, and I, I know for a fact that other, um, you know, IFAs often or distributors full stop will, will get a comment, oh, this is so unfair that my sister had X and Y and why am I being loaded? You know, it’s nothing to do with me. She, she did this or did that. So you then get into the lifestyle environmental stuff. Um, but reality is where we are, the interpretation of the data at the moment, then, um, you know, that that is the additional risk that my kids will bring to the, to, to the critical illness fund. Uh, it’s okay for life insurance. Purely death only covered by the way. But, um, now I’ve got those. There is absolutely, and because I’m a, a great family history buff, um, I can absolutely say to you that, um, there is, and to everybody, that there is absolutely no history of colon cancer far beyond my, my mum and dad, brother, sister, which course the people we’re generally, uh, we, we are applicants for, uh, does had cancer.

Kathryn Knowles (00:10:19):

Right. So

Matt Rann (00:10:20):

You do ask yourself quite <laugh>.

Kathryn Knowles (00:10:22):

Well, it’s interesting. It’s, it’s really interesting that, and it kind of takes us a little bit onto the next question I was gonna chat to you about, which is all about genetic testing. Yeah. So I was gonna talk, and I think we again, have a little bit of a, a sideway thing here on this, but, so I was gonna talk, and I think we should talk about like the genetic testing for say Huntington’s disease and the BR gene, which do come quite sign, you know, significantly at times. Cuz the brackine is something that a lot of women, um, are tested for on Huntington’s is a specific question on a lot of the insurer’s question sets. But in terms of the colon cancer, I can’t remember the name of it, but there is a genetic test, isn’t there? There’s a certain test that you can potentially do.

Matt Rann (00:11:00):

Yeah. Familial polyposis I think is probably what you are, what you’re particularly thinking about where, where thousands of polyps, uh, form in the colon and they, they, and they tend to be, I can’t say every single one of those thousands, but they, a lot of them tend to be pre-cancerous.

Kathryn Knowles (00:11:16):

Right.

Matt Rann (00:11:17):

The condition is untreated then, then, uh, you’ll get, uh, cancer, um, appearing, um, through, throughout various parts of the colon. Um, right. And so, so that’s a particular one you’re thinking about? Absolutely. Now I could, it would be un uh, I’m just trying to think here about confidentiality, but certainly members of my family have had, uh, genetic testing because of me and they’re all clear.

Kathryn Knowles (00:11:44):

Yeah. Well that’s good cause I, I think sometimes this is one of the things I was gonna talk about in the BR gene when we, we do talk about that is, um,

Matt Rann (00:11:52):

Is social negative tests maybe.

Kathryn Knowles (00:11:53):

Yeah. Disclosure of negative tests, basically, you know, you don’t have to volunteer, you know? No, you know, nobody has to volunteer things, but if you can disclose negative tests, then that can sometimes, not always, but it can sometimes make the outcomes more favorable insurance-wise.

Matt Rann (00:12:08):

Yeah, no, no, absolutely. Can I just nick back just for a second? Yeah, of course. We do like to do sideways, don’t we? Yeah.

Kathryn Knowles (00:12:14):

<laugh>. So

Matt Rann (00:12:15):

I was just, I was just gonna go to and highlight something else really, just in terms of family history. Again, I seem to be like a living wreck I have to say. But my brother, um, developed skin cancer, uh, melanoma, I always had to clarify that was skin cancer when he was 32 that he died at 38. Yes. And again, absolutely no family history at all. Now you might, some of the, some oncologists sat there or, or, or whis on cancer might say, well, hold on, you’ve had colon cancer, he’s had skin cancer, where, how, how does that work out? But either which way? No, no family history of skin cancer then or now historically he died a while ago now. Yeah. But the one thing that we thought about was that he spent three or four years in Singapore when he was a, a, a young child.

Kathryn Knowles (00:13:06):

Yes.

Matt Rann (00:13:07):

And would’ve, well, whatever my mom and dad tried to do, he would’ve got burnt with a son. And the, the, the, the, the tumor actually pulled on his side side of his back, well side his back area. And uh, you know, we wonder whether at the end of the day it was probably sun damage that then manifested itself some 25, 30 years later. So I mentioned that purely not to, not to get any sympathy obviously, but just to say environmental factors you pointed out Australia. Yes. Um, which is a good one. Although I must admit, I always tend to think Australians these days, they look after themselves so much on those beaches. Yes. Um,

Kathryn Knowles (00:13:48):

I think it’s more historically kind of,

Matt Rann (00:13:51):

Yeah. Yeah. The first skins, uh, people from, uh, from Western Europe, Ireland, Scotland, that went over to over to Australia and immigrated then Yeah. A lot of, um, problems there historically, but either which sway, I’m sorry, k I was just trying to bring out the environment.

Kathryn Knowles (00:14:07):

No, of course. Well, I was gonna say, you know, in terms of the, it’s so important. Cause I mean, I think I’ve said it before on the podcast I did with my dad who has Parkinson’s. Yeah. You know, we, we think his is possibly environmental because, you know, he, he works on the farm and um, you know, there was a thing where he looked after the turkeys and the farmer would say, pull those chemicals together, shut the cupboard and went out of there as fast as you can. And you know, there’s now obviously quite few studies that have linked, you know, potentially some chemicals to, to potential diagnostic Parkinson’s. I can’t see for definite, you know, my granddad, so my dad’s dad, he was, he really, he never had a tremor, but he sort of seemed to, as he got older, he seemed to have similar traits to my dad.

(00:14:48):

But then I’m just thinking, is that just that my dad’s now becoming my granddad kind of thing, <laugh> and you know, you just, you never know with these things. But again, with the Parkinson’s, there’s been nothing in the family in terms of Parkinson’s. So, you know, but it’s a bit of a, you know, every now and then I get a little bit worried because I think, is this something that’s, you know, gonna happen to me? And obviously it’s, it’s not a pleasant condition and, um, and it is something to obviously, you know, think about every now and then. But, but yeah. So if we, if we go, as you said, the environmental aspect is, is so, so important. But if we look at the genetic testing side of things, so Gotcha. In terms of the Huntington’s and the BR gene, can you take us through why these are so important to insurers? And then I’ll probably start to give a little bit of a, uh, a summary in terms of advisors as to what to, to look out for and what they need to know.

Matt Rann (00:15:39):

Yeah, sure. I, I dunno if it’s worth going back just for a couple of minutes just to, um, remind everybody that the insurance code

Kathryn Knowles (00:15:47):

Yeah, absolutely.

Matt Rann (00:15:48):

It’s, um, there’s doesn’t should a code of practice, and this is an agreement between the, the government, um, and the ABI and its members. Now, the ABI doesn’t cover all of the major protection insurers in the uk Yeah. Um, but certainly ones that I’m aware of who are not members, and you can count them on one hand still very much, um, uh, follow this dis code of practice. And, uh, having been involved, I think in the first ever code of practice myself with the A B I, um, it was, it was quite, um, quite hard to believe that that as far back as 2018, then there was, the sixth agreement is quite in quite incredible mm-hmm. <affirmative>, um, with a review in fact last year, um, looking at the, the kind of the, the, the genetic landscape if you like. And importantly, and this is really why I wanted just cover this, it’s, it, it outlined the action around the industry, getting expert opinion to show that the code remained relevant to consumer and industry.

(00:16:56):

So it goes back to the point I made very early in the podcast about the insurance industry. You’re always looking to move forward with genetics, family history. The huge, the, the huge variable, I hope I can use the term huge is around that environmental, in particular lifestyle to an extent. But anyway, there is, there is, as I say, um, just to remind everybody, there is this code of practice and I believe it’s worked pretty well. Catherine, I don’t know if you’ve had any, uh, I know, I know you’ve historically you’ve, you’ve kind of questioned the Huntington’s disease limit of 500,000. But generally, do you think it’s going well for advisors, I think and and your clients?

Kathryn Knowles (00:17:37):

Yeah, I think it does generally work quite well. I mean, I think a key thing for me in terms of the Huntington’s, um, disease and the disclosure of genetic testing is that in terms of when Huntington’s disease dis is diagnosed, even if someone doesn’t need to say that they’ve had, uh, like, um, a Huntington’s, um, genetic test, correct, yeah. It’s very, very likely that in the family medical history that there will be the disclosure of Huntington’s, um, disease by an immediate family member, which then does mean that the underwriters, that in a sense, it doesn’t matter if we’re disclosing the genetic test or, or not in some, in some ways it doesn’t matter because the underwriters then know that there’s that family medical history. So then the underwriting is gonna go down that route of, there’s a potential, it may be a 50 50 chance of Huntington’s disease here, so they’re gonna rate it on that basis.

(00:18:29):

But what we were saying before about the volunteering of, um, negative, um, genetic tests, that’s quite important for somebody, um, with the Huntington’s, um, disease. If, what I would say though, from an advisor point of view is don’t just jump on this thing of saying to someone, get the genetic test done. You know, because then if it’s negative, we can get you the insurance without this rating. It’s an incredibly emotional decision and psychological decision to decide if you want to have that test or not. It’s it, Huntington’s disease, if people aren’t familiar with it, it is something that will lead to somebody dying. Um, relatively, I’d say relatively quickly from probably diagnosis. I think it’s probably between five and 10 years usually. Um, from diagnosis, full

Matt Rann (00:19:13):

Diagnosis. Yeah. Yeah.

Kathryn Knowles (00:19:15):

Um, so, you know, it is something that people will face. It’s not a pleasant, obviously Dying’s never pleasant, but it’s, it’s not a pleasant, um, condition to have and the what will happen over time. So, you know, it’s certainly not something, you know, when we’re speaking to someone, if they say that there’s family medical history, we can ask as an advisor and say, have you had a genetic test? Or the insurer’s not gonna ask. But if you happen to have had a negative test, that can sometimes change the options. Um, but we wouldn’t ever encourage somebody, or I certainly wouldn’t advocate someone to encourage someone to get the test done purely for the purpose of the insurance. It could save money, it could potentially open up some options. But the, the other side of that is, is that someone has the test. They’ve, they’ve already gone through all of this advice in terms of counseling, of do you want the test, all this kind of stuff.

(00:20:01):

They’ve made a decision not to have it done. And then if you then encourage ’em to have it done, and it is positive, that is a huge, huge thing, emotional thing for that person. And, and ultimately you’re not gonna be in any better position in terms of what insurances are and aren’t available. So, you know, there, there’s a lot to consider about that from an advisor point of view. But yeah, so, so my, my query about it, my, you know, obviously I think, you know, I, insurers asking about it and saying, oh, we don’t need to ask up to a certain level. Brilliant. I just think it kind of, I kind of feel like it cancels itself out when we get to the family medical Hi, uh, hi. Medical history questions. So that’s, that’s just my take on it in some ways. But, but it might not always be the case.

Matt Rann (00:20:42):

No, I don’t think it’s, it is always the case, but you know, you, you, you, you, right. Um, I think the way that our understanding is under ISIS and actuaries, uh, let’s be honest with you, the, the medical Ws out there as well on this type thing, in terms of data, we’re still, yeah. You know, uh, we still haven’t, we’re not in a position yet to be able to kind of really delve down into the r to the, the wises and Weres. Yes. Um, Huntington’s, as you quite rightly said, is, is an awful disease. Um, and, and you know, I hope you don’t mind, bear in mind this podcast goes, goes under Kira then, but I would say absolute red flag, do not advise somebody to get a genetic test. Yes. You know, that would be my absolute statement there. Um, you know, your, your, your website covers this, I think very well.

Kathryn Knowles (00:21:35):

Yes, yes, it does.

Matt Rann (00:21:37):

<laugh> and, uh, that, that’s, that’s 10 pounds by the way, for that plug <laugh>.

(00:21:42):

And, uh, I think you’re absolutely right. It covers it and, uh, particularly Huntington’s, but I would say every single genetic test, yes. They just stay, they’ll say well aware, just to reiterate under, uh, uh, insurers cannot ask or insist on you going for a genetic test. Yeah. They cannot insist for a test result. So do two different things there. One is actually going, attending for a genetic test. Insurers simply won’t do it in terms of asking for the results. That is, that is as, as, as Catherine’s highlighted only for Huntington’s over really large sums assured. Yeah. Which really well, well above what the average sum assured of, uh, is, is in, is in the marketplace.

Kathryn Knowles (00:22:23):

Absolutely. And that’s a cross insurers as well. So people do need to be, you know, make sure you’re watching out for advisors United States. Watch out for any questions. Cause if you suddenly think, oh, well they ask if it’s over 500,000 pounds for life insurance, well I’ll place 500,000 here when I’ll do 500,000 over there. Just be very, very careful because, you know, in terms the grand scheme of things is the questions. Make sure the questions in a sense, don’t stop you from doing that. But also as well, bear in mind that, you know, each insurer has reinsurers, the reinsurers fulfill different policies with different people, different in insurers everywhere. And you don’t want to get in a situation where you’ve done something trying to be smart and trying to try and get the person more cover when actually it’s gonna end up that potentially one of the policies will be voided. Um,

Matt Rann (00:23:09):

To Totally, yeah, totally agree with you Catherine. Um, it, that happens more often than I’d like to say, to be perfectly honest with you.

Kathryn Knowles (00:23:17):

Yeah. There are reasons to split cover across insurers at times. You know, there are certainly, you know, times that advisors will do that. Very

Matt Rann (00:23:23):

Valid reasons,

Kathryn Knowles (00:23:24):

The very, very valid reasons. But again, it’s that all whole thing. If, you know, especially protection isn’t your go-to thing all the time, just be incredibly careful, you know, seek advice from somebody as well if need be. You know, as always, I know people don’t always wanna speak to them, but, you know, speak to a compliance person, double check what they say, um, because you know, they are putting not only the client’s best interest at heart, but you, the advisor, the firm as well at the heart of what’s being done. And then we’ve got, we’ve got the Huntington’s, I know we’ve just spoken about there. Um, but then the br gene cause that obviously, so this is a really interesting one, and I know we’ve spoken about this previously in another podcast, but maybe just a really quick recap, Matt, on the difference, and it, it applies for hunting, it applies for any genetic condition as well. But the difference between diagnostic and predictive testing,

Matt Rann (00:24:09):

Well, predictive is, is, is literally what it says on the packet, is the chance of something happening in the future. Diagnostic is what is, what is the position now, um, you know, a custody example of a of, of, um, another diagnostic test is a blood test. It is, it’s saying what the position is now predictive, literally predicting what is likely to happen given current, um, uh, statistics, um, will happen in the future. So that’s really the classic between the difference. And we are, we’re primarily talking about, um, in terms of this podcast, predictive testing in the future. Um,

Kathryn Knowles (00:24:49):

Absolutely.

Matt Rann (00:24:50):

Can I, I just like to add just one other thing on before we disappear on, um, on genetic testing. So I think it’s quite important, um, occasionally, um, now GPS are specifically asked not to give the results to intergenic tests, um, uh, unless they are negative from memory. Okay. Uh, if we do get one, if we as insurers, sorry, do get one as underwriters, um, we have to ignore it. Yes. So something happens, one mistake, we must actually ignore it. And of course, do remember that a negative test could help you out. So you have a negative genetic test as Catherine’s already said a couple of times. Then please do let the insurer know. Cause that can help enormously in, in, um, when, when looking at family history amongst other things. So, sorry Catherine.

Kathryn Knowles (00:25:41):

No, absolutely

Matt Rann (00:25:43):

As well. Particularly because I think sometimes the, you know, you get blow mistake, um, whatever you should use it, use it, um, on rather sneakily, if I can use that, then the answer is absolutely no hold, hold the calls if they tried to do that.

Kathryn Knowles (00:25:59):

Absolutely. And in terms of, um, just for the advisors as well that are listening in terms of the predictive and the diagnostic test, we can sometimes be asked as advises by people you might say, have you’ve ever been, you know, have you ever had cancer or anything like that? And people start going, oh well I had some tests done. And then people can get really confused as to what it is. Yeah. So one of the things that we tend to say to people is, you know, along the lines of, right, did you know in terms of what you’ve had done testing wise, is it that you’ve had a family member with, if we taught the brack imaging, cause that is one that does come up quite a bit. Have you had a family member with breast cancer? Okay. Did they say to you have this test to just see whether or not you might have this cancer, you’ve got a higher chance of having this cancer in the future?

(00:26:38):

Or was it that you were having some symptoms, um, you may be found a lump or you had some other symptoms of the breast and the gp, all the specialists had said, look, we should do some tests just to double check if anything is, is happening cancer wise, that will then help you to determine whether or not it was a predictive test or the diagnostic test. And that can sometimes just really help people, sorry to tweak in their mind as to which one it is. And, and we can only ever do as an advisor, we can only ever do based upon what we’ve been told and the information we’ve been forgi we’ve been given by people. Um, so to go to some broader things now, Matt, cause we’ve done, sorry, this bit about genetic testing and family history and we are gonna go into this now.

(00:27:15):

So I, I have posed this question a few times and I have had some answers and um, and I’d really like to obviously hear your thoughts on it and everything. Cause you know, we’ve had quite a lot in terms of, you know, there’s quite a bit at the moment in terms of our women maybe not getting as fairer terms as men. Um, and could that be because there’s just been a lack of, um, like you said, data, it’s always down data, you know, and then typically with data it’s possible, possibly been more, it’s hard, isn’t it? Cause you kind of think is data more male led because we’ve, you know, it’s

Matt Rann (00:27:50):

Being contribution.

Kathryn Knowles (00:27:52):

I know, I know, I’m sure I’m truly know not to be. But you know, in, in terms of like things, you know, there’s been like said that in times that in, in times, let’s say that way, that maybe it was more focus in terms of male health conditions. There’s been given more informa, there’s been more studies done, there’s been more, um, medications, more treatments focused upon possibly upon the, the male generation, male aspects of society than women. But then at the same point I’m thinking, but women talk up more than men generating if there’s something coming on. So there’s probably more data that way. So I, I really don’t know each which way, but this question that has so Right. Popped up in my mind, you know, cause there are different things, and I know I’ve spoken before about how we say like menopause, you know, that’s something obviously, so women’s condition, we can sometimes get some, not negative terms, but in the sense of, you know, we can sometimes get, some of the treatments can lead to some exclusions, which you can kind of understand, but also kind of seem unfair because it’s just a natural progress that women have to go through.

(00:28:49):

But anyway, I’m going off on lots of tangents here, but, so my, my question to you, Matt, is just so we can sort of have this out and sort of like, you know, have a really good open discussion about is it say like if we have, um, a woman, she might get a breast cancer exclusion on critical illness cover due to family history of, um, of breast cancer, but we don’t get testicular or prostate cancer exclusions for men. And I imagine there’s a genetic aspect to that. I imagine there’s a data aspect to it, but it is just a question that it really fascinates me. So I’d be really, um, I’d really like to see your, hear your thoughts on that.

Matt Rann (00:29:26):

Right. Could you just repeat the, um, did, did you say testicular and prostate? Yes. Those new conditions. Okay. Um, for a start in, in terms of, I’m just trying to think this through really in terms of those particular two. I’ll go, I’ll go prostate first. I think, um, with prostate cancer, there is actually no reason why if a family member has been diagnosed with prostate cancer to relatively young age, particularly for critical illness here, um, they, the why they should not have a, uh, a, a cancer exclusion if they, if the family member remain, uh, diagnosed at a young age. Um, we were talking about BRCA, um, a minute ago. Yes. And BRCA is certain the mutations of brca, uh, one and two that matter are linked to increase, uh, levels of prostate cancer.

Kathryn Knowles (00:30:28):

Oh, right.

Matt Rann (00:30:29):

So I think a lot of people think maybe when we talk brca, bear in mind that BRCA is BRCA breast cancer, you think immediately think, well we we’re just talking about the, um, uh, breast cancer here. Yeah. You think <laugh>

Kathryn Knowles (00:30:49):

Absolutely.

Matt Rann (00:30:50):

It’s called. But, but you’ve got, you know, as you, as many people know, especially in your, there’s, there’s BRCA ones and BRCA twos and, um, different types of mutation and you know, again, the, uh, our listeners will, will put to breast, but you’ve also got ovarian as well, which I think a lot of people will Yeah. Know about, um, ovarian, but pancreatic cancer and prostate cancer for both BRCA one and BRCA two, if you carry that gene, there is a higher likelihood of, um, or prostate cancer itself.

Kathryn Knowles (00:31:24):

Okay. So that’s breast, prostate, pancreatic, and ovarian cancer all potentially linked to the BRCA gene.

Matt Rann (00:31:30):

Yeah.

Kathryn Knowles (00:31:31):

Right. I don’t know all that. That’s really fascinating to be

Matt Rann (00:31:34):

Perfectly honest with you. Um, there are a lot more as well cancers. Yeah. Um, but I mean, effectively what, what we’re talking about with, with BRCA is, is is the, the, the gene is actually a tumor suppressor. So it, it suppresses the genes and it stops tumors forming.

Kathryn Knowles (00:31:56):

Okay.

Matt Rann (00:31:57):

So that’s what it is, um, the name for it. Okay. And you can, and if just take the very high generalization stop tumors forming, you can see that it, the logical question is, well, why would that just be breast?

Kathryn Knowles (00:32:12):

Yes, absolutely.

Matt Rann (00:32:13):

It’s, it’s not. Now the, the the, and I have to say interesting, excuse me, for what I do for a living, but the, um, the, the, the BRCA one gene is very much linked to the triple neg breast cancer. Triple,

Kathryn Knowles (00:32:27):

Okay. Yeah. That’s a, that’s quite an intense one, isn’t it? The triple negative isn’t that more younger women and it’s quite, it’s, it’s quite aggressive.

Matt Rann (00:32:35):

Um, not always younger women. Oh no, no. More common. More common in younger women. Nice. Um, but, uh, absolutely it’s aggressive and, um, although great strides have been made in the last few years in terms of the treatments of it, then, um, it is, it is still the, uh, most frightening of all the breast cancers, um, that, that there is at the moment making great strides. But, um, what I was saying there is that’s very specific BRCA one.

Kathryn Knowles (00:33:08):

Yeah.

Matt Rann (00:33:09):

Okay. So as I say, I’ve kind of, again, I’ve deviated off the que question that you were asking, and that’s around exclusions for prostate. And, uh, I, I will, I’ll plan my opinion out there. Okay.

Kathryn Knowles (00:33:22):

If

Matt Rann (00:33:22):

Somebody has had prostate cancer, uh, a family member has had it under, uh, under the age of 50, then we should look at rating. If that person is taking out the insurance is obviously the b below the age of 50, stroke, maybe even 60.

Kathryn Knowles (00:33:38):

Yeah. Okay. So treat them in a similar way to, in a sense, what happens when breast cancers, um, thing eat as well disclosed. I can’t think of the word disclosed then <laugh>. No, no,

Matt Rann (00:33:49):

That’s alright. Yeah. I, I mean it, I don’t have, I don’t have the data sets in front of me, unfortunately to have a look at the prevalence.

Kathryn Knowles (00:33:57):

Yeah. I think we’re now one in eight people with prostate cancer.

Matt Rann (00:34:01):

Right. Well, of course an eight. It’s not necessarily going down to the BRCA gene

Kathryn Knowles (00:34:06):

<laugh>. Yes. No, of course. No, of course. Yeah.

Matt Rann (00:34:07):

I’ve got this environmental and lifestyle and goodness knows what else is,

Kathryn Knowles (00:34:10):

Oh, it’s going far too complicated. I’m just looking at the top levels <laugh>. So,

Matt Rann (00:34:16):

Well, what, what I suppose the point of my, what I was trying to say there was really, um, you know, people will, uh, advisors, clients will get mystified by that family history and what insurers do, but it’s not as simple,

Kathryn Knowles (00:34:28):

Not simple as it certainly isn’t. It’s,

Matt Rann (00:34:30):

Um, genetics is not simple, um, without any shadow of a doubt. So, so all I can really say is it’s no great help, just leave it with us and we will get there. There’s no ways about it. And we are, we are, um, you know, obliged to the government and the agreements that we’ve made to look at genetics and get the world’s experts on this. So, so just bear with us in terms of testicular cancer. I’m sure there is a very good answer to that. Um, but I, I haven’t seen one, uh, testicular cancer, which, which is really where you are coming from. And again, I, I would just fall back on, I can only assume that the numbers don’t, don’t stack up. Um, I’ve not heard of test. I’m there going to be some form. I, you know, I always think I go back to that comment and those right at the very beginning, two or 300 years ago, you know, just look at your parents to see on average, see how long you’re gonna live. Mm. Um, there must be some genetic component component in, in testicular cancer. Um, but I can only assume that the numbers don’t, um, add up to a a, an increased risk, which would worry an underwriter her.

Kathryn Knowles (00:35:39):

Yeah.

Matt Rann (00:35:40):

Um, in terms of the, in terms of the male female thing, then, then that’s a a, a different debate altogether.

Kathryn Knowles (00:35:49):

Yeah. I, I’m certainly not bringing it up as a, um, obviously I am quite feminist, you know, obviously, um, absolute girl power, but, you know, it’s, it’s just that kind of thing of, cause obviously I understand and you know, as, as you said, you know, it’s so complicated. We’ve got all the underwriters, the actuaries, you know, from reinsurers and insurers doing all this incredible number work, which I can’t even begin to fathom how it’s all calculated. I’d love to sit down with somebody at some point and just like shadow them, fly a week and figure out how they do it all. Um, it’s, it would be, it would be lovely. But, um, you know, I, I think it’s just that thing of, you know, because it’s the, the data, it’s usually, I mean, we’re using decades worth of data around me. I mean, we have the recent data which shows the changes in, in modern population, modern society, but it is based upon, especially side it’s decades worth absolutely.

(00:36:39):

Decades worth of data. And, and I think probably what’s, so, you know, I think some of the questions that have come out is sort like, well, is the, is the data, you know, in a sense, is it just more male dominating? Has there been as many records in terms of women and stuff like that? Has it been as easy, you know, and things like that. And, and, you know, I am clearly like I’m a feminist thingy <laugh>, but, um, it’d be interesting to know. I mean, I, it could be completely wrong, you know, it’s just, it’s just the questions that sort of like come up every now and then, and I start going, well, how come women are just getting slightly different on this bit compared to this and that? And, uh, I

Matt Rann (00:37:12):

Think population, population data will be, um, should be split between male and female, um, in, in the same portion as the population. Okay. So that’s population data, insurance data is going to be different. Cause it’ll be skewed by the difference between how many men take out insurance and women take out insurance.

Kathryn Knowles (00:37:32):

And it would’ve been very male dominated versus women

Matt Rann (00:37:36):

I would think so when women Yeah. Yeah, yeah. I mean, we know the, the historical

Kathryn Knowles (00:37:40):

Yes. When we were not seen as, as important, Matt, let’s just be honest, we weren’t as important

Matt Rann (00:37:46):

Tell you that, bear in mind that most women have at least six jobs. Yeah. That’s why I six jobs then. Um, I, I’m afraid I can’t, I can’t go along with that one. Exactly.

Kathryn Knowles (00:37:57):

I know, I know. I, I com I completely agree. I completely agree. And

Matt Rann (00:38:01):

I think, I think that’s when we, when you taught statistics, I think we have to be a bit careful between population statistics and insurer statistics. Yes. In fact, and underwriter in fact, look at both.

Kathryn Knowles (00:38:10):

Yes.

Matt Rann (00:38:11):

Okay. Um, and, and, but I think that’s probably why you’re gonna get more male than female on the insurance side of it.

Kathryn Knowles (00:38:19):

Yeah. Which, you know, in, in terms of society, it’s, it’s not a criticism at all to No, we know to insurers or anybody actually, it’s not an, it’s, it’s just circumstances, isn’t it? We’re still, you know, we are at a point now where we’re getting more and more women insured, and I’m really happy actually at Cure that, you know, I’ve been going through our recent and stuff for like our, um, consumer duty report and things. And actually we’ve, in the last year we’ve insured more women than men, you know, and it’s, it’s, it’s very, very close. But, you know, it, it’s, it’s lovely to see that, that we’ve got that really good balance of, of, you know, making sure that we’re ensuring everybody. Um, okay. Next question. Then we’ve got the last two thing. Well, is the last question for you, and then I have a comment probably, which I’m, I’m not gonna expect you to, to, um, to talk about that.

(00:39:01):

But it is something that I’ve, I’ve mentioned before, I don’t think I’ve mentioned it before on the episodes and the episodes I might have done, um, but it is something I’m just saying every now and then, because I think it’s important to talk about, um, you know, this community within society and, and how genetics and different things work. But, um, okay, our next question is, um, on the very first episode of season seven, we had our guest host, uh, which was Settle Meta. And he asked us to chat about what are the most common family medical history disclosures that we would think that will not think, but that we, we know will lead probably to a premium rating or exclusion.

Matt Rann (00:39:36):

Okay. Um, so by definition, the question really is going to have, I’m going to take my answer from what I probably used to see rather than today, um, on insurance forms whereby it’s, it’s a little bit of a red flag. Yeah. In the words what, but have a look at that quite, what does, uh, what, what does that mean? Yeah. And, um, don’t, I don’t think it’ll be any surprise really, that it diff Well, the industry differs hugely between life insurance and critical illness. Uh, absolutely. Um, exclusions are pretty damn rare on life, to say the least in terms of critical illness. Um, we only have to look at the product and the nature of the product and what are the main causes of, uh, claims on the product. Mm-hmm. And so therefore, you are gonna be looking at, um, cardiovascular disease, cerebral vascular disease, in other words, strokes to, uh, to see frenzi and ischemic, um, episodes attacks. Um, you’re gonna look at, uh, cancer, um, now Yeah. Look at cancer. You would also look at multiple sclerosis.

Kathryn Knowles (00:40:52):

Yeah.

Matt Rann (00:40:52):

And

Kathryn Knowles (00:40:53):

Would that be more towards the female side of things, or would that

Matt Rann (00:40:57):

Be, you tend, you tend to see more in feme. Uh, well, remember that if you, you, these are, I’m just talking about here disclosures.

Kathryn Knowles (00:41:03):

Yeah. Okay. Sorry. Yeah. Yeah.

Matt Rann (00:41:05):

So, so, you know, bl blokes have mums and sisters and things like that. So you, you’ll get that coming out from, from that side. Um, yeah, it’s, you certainly, if, if you took all the disclosures from family members, then yes, you would see it more in the ladies, uh, without an issue over doubt. Um, and again, you know, when underwriters will look, they’ll certainly take the age of the applicant at the time of the diagnosis, which is, I always think an interesting one. Um, but usually under 50 is when people will start, underwriter will start to think. Now, I always think it’s one of those questions where you think, well, do people re can people really remember the age when the parent, if they’re still alive, remember, can still, still has ever had, when they ever had a heart attack or a cancer,

Kathryn Knowles (00:41:58):

Or, it’s quite hard for people to remember how to say that. It’s, it, they don’t always find it easy.

Matt Rann (00:42:04):

I would, I would totally say that. And it’s a, it’s, it’s a difficult one. Um, I, I was reading, um, as you do bras, the great, the great Dr. Breckenridge’s book

Kathryn Knowles (00:42:15):

Oh, right.

Matt Rann (00:42:16):

You know, several years ago and, uh, some interesting points on family history there. And all those years ago they were actually saying the medical examiner should question the, uh, an applicant if he says that a family member died in an accident.

Kathryn Knowles (00:42:31):

Right. What,

Matt Rann (00:42:32):

What is the accident? Is it suicide? Is it, uh, showing up an alcohol problem? Is it showing, you know, so we’ve moved on <laugh>. That’s what I’m really trying to say that

Kathryn Knowles (00:42:42):

Absolutely.

Matt Rann (00:42:43):

Um, and I, and I think partly that is the, cuz we have to remember that, that people aren’t automatically geared up to remember the exact age of some of a, of a, of a sibling. I just Hampton to know, cause I’m an underwriter and I’m family history. Um,

Kathryn Knowles (00:43:02):

My mom has a spreadsheet I have to say, oh,

Matt Rann (00:43:04):

There you go.

Kathryn Knowles (00:43:06):

<laugh> there spreadsheet.

Matt Rann (00:43:08):

But, you know, it’s quite, it is quite difficult. And, you know, let’s, let’s be completely through it out there. Now what, what happens when somebody says, oh, they were, my, my father or whatever family member was 48, sorry, no, 52.

Kathryn Knowles (00:43:21):

Mm-hmm.

Matt Rann (00:43:22):

And in fact they were 48 when differentiates the age breaches, the age 50, um, and so on and so forth. And that’s a very difficult one for,

Kathryn Knowles (00:43:32):

For

Matt Rann (00:43:33):

A claims person to deal with.

Kathryn Knowles (00:43:34):

I was gonna say, cuz then you’re gonna have to go into innocent disclosure, innocent non-disclosures, deliberate non-disclosure, all this kind of stuff, aren you,

Matt Rann (00:43:42):

It won’t, it won’t be fraud. I can actually guarantee you that. But, um, yeah, yeah, yeah. So it’s, it’s, it’s an interesting one and it just shows you the practical problems. I’ll asking the question in my opinion. Yeah. So I’m not entirely sure whether I’ve, um, I’ve, I’ve answered settle’s, uh, question really. Um, but if we, if we, if we are looking at critical illness primarily, and in income protection, critical illness, look at the way that the, the, the, um, quest, the what, the, what the product pays out on. Therefore, what are the risks that the underwriter is covering and therefore signs of heart disease, signs of, uh, signs, even even signs of heart disease, um, uh, cerebrovascular disease, um, uh, multiple sclerosis, um, hypertension, you know, things, things like this will be of interest.

Kathryn Knowles (00:44:32):

Yeah.

Matt Rann (00:44:33):

Um, and you know, I won’t bore everybody with, because people can really generally look at the question, but remember, uh, on, on everybody’s proposal form. Um, what I would say is if you’re doing a kind of a fact find and you’re not necessarily that used to asking about family history, remember that a lot of insurers will ask if, if your, um, family member is still alive these days. Yes. And that’s in perspective of age now. They could be 86, 88, and so on and so forth. And again, this is really all around data gathering, trying to, trying to build a picture around how important family history is. As I say, for years and years and years. Family history is important, we all know that. But we need to break it down a little bit more, hopefully, as we will on many, many, um, writing issues into an, into more precise ha solution. So just, uh, Catherine, I do like to waffle as you were <laugh>. No. And, and Cecil, if you’re out there, please, please, please, um, in contact with Catherine or me and, um, you know, I can answer any, any other questions that you’ve got or indeed, I haven’t answered that one very well.

Kathryn Knowles (00:45:46):

No, absolutely. I think that’s, I think you’ve answered it well. I mean, I, I think for me, I probably would imagine that the, it’s exactly what you’ve said. You know, if, if we look at the, the top claim areas for critical illness is cancer, heart attack, stroke, and multiple sclerosis. Um, so that’s got to be, if, you know, if there’s any, like you say, if there’s any potential genetic link, you know, obviously we’ve got environmental effects, but if there’s a genetic link there potentially, then these shows are going to, to want to know about it. Um, I mean there’s obviously a lot of questions that, um, the insurers will ask in terms of family medical history and we do often get a list of things. And so they’re obviously the ones that the insurers do want to know about and are concerning. But I would say quite a lot of them aren’t necessarily particularly, um, common. I mean obviously Parkinson’s, it’s love of mine that is becoming more and more common. Um, it’s, it’s actually being, it’s a fastest growing neurological condition to be diagnosed, um, in the world at the moment. It’s being diagnosed an incredible amount. Um, and uh, it’s, it’s certainly a variant of interest. But, um, I think another one to just bear in mind is try and get it out the first time saying it rightly is familial hypercholesterolemia. There we go. Got it. That’s a

Matt Rann (00:46:54):

Big one.

Kathryn Knowles (00:46:55):

<laugh>. <laugh>. That’s, um, a really big one. Advisors to just be aware of. So generally, I mean, when I speak to people and this, you obviously different advisors work in different ways, but I’ll generally when I’m speaking to someone about their family, their own history or with the history, I’ll just say to them, mate, do you have, or have you had ever had any medical conditions? Tell me anything and everything, because then I know what the insurer does and doesn’t need to know in terms of things. And then in terms of the family medical history, I’ll just say before the age of 65, age of 60, or I usually say before the age of 65 Yeah. Family members, have they had any serious health conditions. And I just kind of leave it open and if someone says, no, no nothing, I’ll maybe go, all right, you know, that’s, that’s really positive.

(00:47:36):

It’s obviously no cancer’s, heart attack, stroke, nothing of that. So just to try and help people trigger what they might have forgotten potentially. And you might get told some, I get told things where I’m just like, okay, you know, thank you very much. Um, you know, obviously the good news is, is that actually that I won’t typically come up in the question set. So it’s really, really helpful that you’ve said it to me, but we don’t need to, to necessarily put that in the application and then it just means that we’re really covering our bases as to what we, um, what we need to do in terms of the, the research. So hopefully that helps people in that. Now there is a final thing for me to just mention, and this is probably just a comment to the industry, Matt, so I’m not gonna put you on the spot and expect you to, to say anything.

(00:48:14):

And I’m sure that there’s, um, I can imagine some people that we know will possibly have a, a comment or a query or two on the way that I’m, what I’m saying. Um, so gender identity, and this is really important. We do have a transgender episode that is out, so please do go and listen to that as well. But this is more of a, an observation that I’ve made and I I, I don’t think there is a right answer. And I imagine that some people are probably thinking, not now, Catherine, not, not something else <laugh> please, just no stop kind of thing. And the thing is, I and I do get, and I’m not saying that we need to necessarily make, you know, significant calls to action right at this moment, but I think it’s something that needs to be out there in the open for thought and that needs to be addressed at some stage.

(00:48:57):

So, so in terms of gender identity, we’re all doing as best as we can to try and support people. We’re now at stage where shows don’t ask for a specific gender reassignment certificates. Um, we don’t need to go into a lot of the information that we used to do. They will ask about things like any recent surgeries, which is, um, just they ask that of anybody. It’s not specifically to do with any kind of gender reassignment at all. It is just have you had a surgery in this amount of time? Yes. No. And that kind of a thing. Um, sometimes medications can potentially come up in the question set, but that does come down to each insurer. But in terms of pulmon replacement therapy, that should have absolutely no influence in the, um, exclusions or premiums for a policy. So something that stands out for me then is when we are talking about gender ream.

(00:49:43):

So let’s just assume that we’re in a situation where somebody has, um, they are now their actual gender. They were born a different physical gender, but they are now their actual gender. They have had the surgery, but it falls outside of insurer’s timeframes. And it’s, you know, it’s, there’s nothing in the insurance set that is going to bring up that this person has transitioned. It’s, we’re outside of those timeframes of talking about those surgery times. So let’s say that we have a woman that was born physically a man, but she’s a woman and she has, her mother had breast cancer age 37 and there could be a breast cancer exclusion on the critical illness policy, but the woman was physically born a man. Now the reason I say is I know we’ve spoken about the BR gene and different things and you know, potentially how they are, some of those genes are more likely if you are a female, potentially develop breast cancer or, or different ones or ovarian cancer.

(00:50:45):

Um, but my point is with that is that if this person had applied for the insurance when they were still physically a male, they wouldn’t have the breast cancer exclusion. The breast cancer exclusion is only gonna apply to women. It’s not gonna apply to men. Um, so that’s another thing in terms of when I was saying about the difference between men and female and what we have, it would be a woman that would’ve a breast cancer exclusion. We wouldn’t typically see a man have a breast cancer exclusion, even with a, um, a, a parent who’s had a, a mother who’s had breast cancer. And then we’ve got the other way around as well is that you could have somebody who was born physically a woman, but is a man, they are a man, they apply, they don’t see the breast cancer exclusion, but they were originally and they were physically born a woman.

(00:51:40):

So if they were still physically a woman, there would be a breast cancer exclusion. And I don’t know the answer for any of this, and I think it is an incredibly complex set of circumstances that I, I can’t imagine a computer system and an underwriting engine could necessarily compute. Um, there is also as well the, the thing that we are obviously trying to be in society much, um, much more open to, to modern, um, communities, modern societies to say, like for ourselves at Kyowa, you know, we, we have specific things in there where we don’t necessarily need to put in male or female in our systems so that we can make sure that we’re using the correct pronouns when we’re speaking to people. But we always have to have that conversation as well, which is, is really awkward. Um, but I’ll be honest, you know, in terms of saying that we’ll turn around and say, look in our systems and everything, we’re not putting down male female.

(00:52:36):

It’s all that. But unfortunately the insurer’s system still require us to put male or female. And, and obviously that can pause, uh, cause a lot of, um, it’s, some people are absolutely fine. I’d say a lot of people are absolutely fine. So please don’t make it anybody listening, don’t think that I’m saying that. We’ve had lots of people come to us like this and they’re really angry and upset at insurers. There are some people who aren’t particularly pleased that they can’t put down that they don’t have a gender or their specific gender that isn’t male or female. But it is just something that we need to, it’s that next step of trying to make sure that we embrace everybody in society as much as possible, make sure that people feel that the insurance world is designed for them, is, um, supportive of them, does understand their, um, circumstances, their situation.

(00:53:21):

But very much specifically for me in terms of what sort of putting out there at the moment is that I do think that with the insurers have made incredible steps to try and support people who are transgender who you know and stuff like taking off all these barriers that we used to have in terms of, well if they want to be down as female then they need to provide x, y, Z documents and all this kind of stuff. And that’s fantastic. But we are, I think at a stage now where, because we are doing things like that, which is, is brilliant, we then need to make sure that in terms of the terms that are being issued to different people in different situations, that everything’s as transparent as possible and that it does actually make sense in terms of being equal to everybody. So that would be people who have transitioned and also people who haven’t transitioned and who are the gender that they were born at physically at birth as well. So I know that’s a very, very long bit there, but so matters say, I’m not gonna put you on the spot to, to comment on any of that. Cause I imagine that’s a, a very unusual, um, situation to talk about. But, um, I hope that I made sense in what I was trying to get across. I hope I’ve not said anything that seems, um, as something boggled the mind too much hopefully.

Matt Rann (00:54:38):

No, I, I’m, I’m happy to comment to a degree cause I think, I think that you’ve raise, uh, a lot of fundamental issues there. I think my, my one comment would be that from an underwriting engines not something I tend to get involved with a lot these days. Obviously I was once upon a time, but not these days. Are we saying that, um, a transgender person, lemme lemme just say person for the moment, mented by that, um, let’s say, let’s say somebody’s gone from female to male and he’s saying that the underwriters would not, I think this is what you’re saying, they would not be able to identify that individual and therefore, therefore an exclusion

Kathryn Knowles (00:55:28):

Wouldn’t take place.

Matt Rann (00:55:29):

Right. Well, in that, in my, my take on this and please anybody out there shoot will not shoot me cause I’m, you know, I can’t run fast enough these days. But, um, if, if, if the underwriting engine has been built in such a way they can’t gather that information, then that that individual will, will either get the exclusion or not based on their current Yeah. Uh, identity.

Kathryn Knowles (00:55:54):

So, yeah. So in, in

Matt Rann (00:55:54):

That’s, there should not be a problem with claim. Oh, not absolutely question, isn’t it <laugh>?

Kathryn Knowles (00:56:00):

No. Well the thing is, it’s, the thing is it’s absolutely, you know, it’s, it’s absolutely right and, you know, there shouldn’t be an issue. And cause I think a key thing here as well is that in these situations it wouldn’t even necessarily go to an underwriter. So this could just be straight through online application. Um, so I think, so like part of my comment to that is, and you know, certainly don’t wanna go backwards or make anything worse and I, I worry that I’ll probably say something and people will just go, oh, well it’s too whiskey, I’ll just make it worse for everybody. Um, but my, my point of view is if somebody was born a female and has, um, transitioned to be a male, they wouldn’t have an exclusion for breast cancer. But at the same point then I kind of think of that is that in some ways is that fair to the woman who hasn’t transitioned and to someone who has been born female who is gonna see that exclusion, I certainly don’t want that male to have an exclusion put on, you know, and, and, and I do understand that this is a situation where I, I I, I say I don’t think, there’s certainly not a quick answer.

(00:56:56):

I don’t think there’s an easy answer and I don’t think, you know, there should be a question added on saying you are mailed by any chance if you transitioned or you are female by, you know, you know, we wouldn’t want girl down Exactly. We wouldn’t want girl down any of those routes. But I think it’s important to make sure that, and and, and obviously there’s vice versa as well in terms of a male, someone who’s born male and who is female has transitioned, they would have the exclusion. Whereas if they were a male, they wouldn’t, you know, I know it’s, it’s, I know it’s not huge numbers of people and you know, it’s certainly not the huge number of people that we see with the disclosures, but, you know, it just things in terms of equality for everybody involved, it just, you know, it just feels like there’s probably something at the moment that just needs to be, you know, I I can just imagine at some point there’s gonna be someone that turns around and says, well, hang on a minute. You know, I’ve, you know, I’ve been in this situation, I have transitioned and I suddenly have this exclusion, but that actually doesn’t genetically really apply to me. So how is this player? And, and I think there needs to be some kind of a, a framework or answer of some sort to explain the, the way that it works. And

Matt Rann (00:58:06):

Sorry, KA wouldn’t surprise me if that, that that answer could be given by insurers to be perfectly honest with you. Um, I think my comments were at least initially were more around systems capabilities.

Kathryn Knowles (00:58:22):

Yes. Uh, systems I can’t imagine could do cope with this at all. I dunno that thing they could do spotting

Matt Rann (00:58:27):

These things. I mean, one, you’re absolutely right and I think it’s important with insurance is, is, is one numbers are currently very, very small. And, and number two, there was always this fundamental thing with insurance, um, around anti-selection. Yes. Somebody knowing that, um, there is a condition or a likely event which the insurers aren’t aware about. And really I can’t see, um, an individual, let’s say I was gonna get your, um, uh, female transition into a male so they wouldn’t get an exclusion. I, I’d be incredibly surprised of that would ever happen.

Kathryn Knowles (00:59:03):

I was gonna say it would be, I mean, you might have it that if I, I doubt it, but you could have a male, someone who’s physically born male who doesn’t, who gets them insurance before this all happens. But you would imagine that somebody who’s in that situation would have spoken quite significantly at times to, um, to people who have to be involved, medical professionals in, in terms of the transition process. Um, so again, it, it doesn’t, I don’t think, I think be very unusual, very, very un unlikely to have a situation where someone deliberately sets the claim insurance or doesn’t set up their insurance until certain times to avoid these kinds of exclusions. Cause I think a lot of the time in our fairness when we are talking to people and it’s in terms of insurance and transgender and there’s that kind of big debate about sort of like what the insurance is gonna do, a lot of the time that comes down to people wanting potentially private medical insurance to cover the cost of transition.

(00:59:53):

Yeah. Um, so that’s where, you know, a lot of the time it’s just very, very straightforward. Um, in terms of, you know, you, you just put the application forward like you would do for anybody and just if the surgery’s in timeframe, you just mention it and as I say, shouldn’t have any influence, but it, the gender can have an influence in terms of some of these, um, family medical history exclusions. Uh, so it’s, it’s an interesting one. It’s certainly not, as I say, I, I dunno the answer, but I can just envisage at some point that somebody, somebody’s gonna come up with that que well like I am <laugh>. Um, but you know, obviously from a place where it’s maybe been a negative for them and um, and they really do want an answer. So it could just be something that there’s some, uh, some discussions somewhere just to, to clarify it all. But yes, underwriting engines, I can’t imagine that there’s any way of, uh, doing this unless you did specifically ask the question of, you know, is this your born gender? Which would just be horrific and we certainly don’t want that to be, um,

Matt Rann (01:00:55):

No. And

Kathryn Knowles (01:00:56):

It’d be physical gender as well. There’s, there’s so many ways that the wording can be so offensive. Um, and so we certainly wouldn’t wanna do that

Matt Rann (01:01:04):

Fly against modern society, um, every which way. Um, yeah. End of really, I’m not, you know, the, the reality is I said I think there will be an answer to that question out there. I have a feeling I know the answer to your question, but, um, I’m not close enough to it now to, uh, to, to, to want to say what I think of the others.

Kathryn Knowles (01:01:24):

Absolutely. That’s why I said I wouldn’t put you on the spot to give any kind of real insurance insight cause it’s so new as well. It’s so, so new.

Matt Rann (01:01:30):

The gender identity, uh, transitioning thing. Yeah. It, it’s has been a one for a while to be honest with you, isn’t it? Cause the gender recognition certificate, so I don’t,

Kathryn Knowles (01:01:40):

It has, but in terms insurance wise it’s so new.

Matt Rann (01:01:45):

The data again,

Kathryn Knowles (01:01:46):

Yeah, it’s the data. You know, there’s, you know, and I know probably some people say, well this has been happening for this many and you know, obviously it can go back a long time. But in terms of the amount of people and in terms like, you always say the data and you know, you know, we, I think, you know, there’s somewhere it’s even sort like really early, probably 19 hundreds where there’s even been things of people going through, uh, gender reassignment surgery. But that wouldn’t have been lots of people in the data isn’t there for the actuaries and the underwriters to look at it and really sort like, figure it all outs. Whereas now we are seeing that it’s obviously happening more than more. And so we are getting those, those numbers there eventually. But, um, but it just unfortunately it takes a bit of time. Cause you insurer have to see the risk over a timeframe to be able to say what doesn’t doesn’t happen.

Matt Rann (01:02:30):

Yeah. Yeah. I mean it’s, it’s, you know, yes, absolutely. I mean, we, we’ve kind of talked about that as a theme throughout, throughout, but you know, as I’ve always said about all our podcasts and any question that’s been asked of me over the years, it’s, it’s, it’s great to ask the questions

Kathryn Knowles (01:02:46):

Yes.

Matt Rann (01:02:47):

And throw them out there. Um, so, so well done you for doing that. As I said, I think there might be an answer, but I don’t want to, uh, throw my poor penny within just at this moment in time.

Kathryn Knowles (01:02:57):

No, absolutely. Well, thank you everybody for listening and thank you as always for your insights, Matt. Next, next time I’m gonna be back and I’m gonna be talking through the most recent money and mental health report that talks about how insurance is working, but maybe not necessarily working in the best of ways for people living with mental health conditions. If you’d like a reminder of the next episode, please drop me a message on social media or visit the website, practical hyphen protection dot code uk. And as always, don’t forget that if you’ve listened to this as part of your work, you can claim a CPD certificate on the website too. Thanks to our sponsors, the Octa members. Thank you, Matt.

Matt Rann (01:03:30):

Thank

Kathryn Knowles (01:03:30):

You. Thank you. Bye.