Kathryn Knowles  00:06

Hi everyone. We are on season nine, episode 12, and today I have Matt back with me. Hi Mads, good morning to you. How are you? I’m very good. Thank you. How are you? Yes, yes. Kicking along

 

Matt Rann  00:16

bravely, you’ll be glad to know I’m wearing holiday to Turkey next week, absolutely, our podcast would do not be the same without me telling you where I’m going on holiday. So it would

 

Kathryn Knowles  00:25

not, it would not. I feel like we need to maybe start doing some kind of, like, some kind of, like a lottery yourself, like, where’s Matt going to be, you know, kind of,

 

Matt Rann  00:33

what can I say? It’s a mystery. It is

 

Kathryn Knowles  00:37

always a mystery. Always a mystery. Well, today, everybody, we’re going to be talking about fibromyalgia and what can be available when people are applying for protection insurance. This is the practical protection podcast.

 

Kathryn Knowles  00:56

So very, very quick little snippets on some sorry, initial things to do with fibromyalgia before we go straight into Matt giving us lots and lots of information. And so we’ve got about roughly one in 20 people are affected by Fibromyalgia in the UK, according to the NHS, it’s something that my mum has, something she’s had for many, many years. And I can certainly test the fact that it’s, it’s a condition that’s really focused upon, in a sense, many pain and, you know, increased sensitivity to pain as well, and brain fog, so where there can be a bit more confusion at times over things and memory and stuff like that, and and what I would say, you know, with my mom, it’s one of the things I give as an example when I’m doing my vulnerable client training, is that we do have things like, obviously, we’ve all got social norms and and stuff. It’s like a sciency thing. That’s what we what we expect people to do, in terms of languages, or the way that we look at people, or that our mannerisms are the way our body moves, and things like that. One of the things I like to try and show people, it’s like the vulnerable clients, is, you know, you might meet somebody for the first time in person. And I get this from, obviously, from knowing my mom so well. Is that, you know, it’s kind of quite normal for us to, like, shake hands, or was it, certainly, before COVID, it was very normal to shake hands. I think people are quite back to shaking hands now, now. So my mum, with fibromyalgia, she really tries not to shake hands, and it’s something really difficult for her as well, because she is Catholic, and she goes to mass, and one of the things that people, yeah, might be very familiar with, is that there is a moment where your peace be with you and you all you basically with every single person around you within our reach. You shake hands with and she feels awful because she has two choices. She either doesn’t shake people’s hands, and then she feels like she’s doing this socially normative bad thing. And people around her can be like, yeah, up, you kind of thing, or she shakes their hands. And then that means that for at least a few hours, possibly days, sometimes weeks, she will have shooting pains up her arms, her wrists, her elbows, just from the fact that she shook someone’s hands. So I do like to say, I say to advisers and the people is that if you go to shake someone’s hands and they don’t shake hands with you, it can be for a number of reasons, not just fibromyalgia, but it’s really, really hard, because our initial instinct is to go, this person’s rude. It’s like, it’s like, you know, people not holding doors open and stuff like that, you kind of seem to think, well, that’s rude. And it’s trying to sort of go to yourself, like, hang on a minute. This might not be rudeness. This might be that this person needs to communicate in a different way. So it could be to do with pain, something like fibromyalgia. It could be a number of different things. It could be like OCD. So they maybe don’t like germs and are worried about touching hands. They could be neurodiverse and, you know, not be a toucher, or they might just be someone who’s not touchy. You know, there’s plenty and plenty of things about it, but anyway, a bit of a side tangent there, but also five myalgia as well, another aspect of it that would come into a lot of our considerations is that it can often be linked with mental health, because it can be, you know, very, very difficult to live with the condition, very difficult to continue working, at times, not everybody, but for some people, it can be, and that can, obviously, it can be a huge change to someone’s life and and it’s quite a huge thing as well, because at the moment, Maybe Matt, you will, um, correct me if I’m wrong. But I don’t believe that Fibromyalgia is something that typically stops, you don’t recover from it. As far as I’m aware, it is something that is there, and that’s quite a lot to sort of accept. You know, if you are, if you have a condition, you’ve got a lot of pain from it. The fact that you know that, yes, it can, obviously the symptoms, to an extent, can be managed, but that there’s going to be pretty much pain going forward, that’s that’s not easy to sort of get your mind around. So hopefully Matt everything about that just matches, sorry, similarly, hopefully what you’re going to be. Saying, and what you know from your underwriting mind, absolutely, oh, largely, so maybe something’s gonna be slightly different, interesting, interesting. Okay, then so, can you take us through fibromyalgia, please, how it’s affecting the body and things like that? Yeah,

 

Matt Rann  05:14

absolutely. Thanks for that.

 

Matt Rann  05:17

Interesting. As always, do I do a little bit of research before I come on the podcast, just primarily, I hope to refresh my old brain of

 

Matt Rann  05:32

the condition itself and the symptoms and so on and so forth that I used many years ago now and in terms of my underwriting, but not, not so often these days in certainly in terms of fibromyalgia. But I’ll, I’ll endeavor to do my best. First of all, fiber. Fiber. Fibromyalgia is a, is a medical syndrome? What does medical syndrome. And effectively, the syndrome is a collection of symptoms or signs that are grouped together and given a name. And Fibromyalgia is is Ace is an example of a syndrome. And I can go through that you’ve touched on already, of course, but go through the main symptoms and signs that together and collectively, will become fibromyalgia. Now, interestingly, and I’m glad I do do a little bit of prep, fibromyalgia was a is a term. The term itself, fibromyalgia only came into mainstream medicine in 1976 and that probably sounds, you know, for me, a lot of our listeners were nowhere near as old as 1976 but certainly I was in my teenage years then. And therefore 1976 to me, thinks, good grace. That’s only kind of like yesterday, almost. I wish it was, but there you go,

 

Kathryn Knowles  07:02

just slightly before my time. Of course, I never doubted

 

Matt Rann  07:06

it for a minute, but I thought that was quite interesting. The actual term is relatively recent now, all of the symptoms, we talked syndrome and some group of symptoms, all the symptoms have been previously recognized, many since the the 19th century. But some fiber Fibromyalgia is is quite is quite recent, as you said, is typically associated nobody talking symptoms and a collection of different symptoms very much associated with pain. And pain can be all over the body. It’s very it is, I would say it is very difficult to actually come up with a firm diagnosis of fibromyalgia, because there are so many overlaps with other medical conditions, medical disorders, and it’s safe to say that the symptoms themselves vary very much from person to person. Those symptoms can be, as we’ve already talked about, widespread pain, and it can be throughout your body or just in particular areas of your body, and that pain, the pain can be different. It can be, I’m sure everybody can has had one has had some kind of physical pain in their lifetime for one reason or another. But pain can be described as simply an ache, a burning sensation, or a sharp stabbing pain. Now I know do tend to suffer from a little bit of osteoarthritis through far too many days playing sport in my youth, I probably had all three of those. But so the pain itself, it can be of different types, but importantly and sadly, can be throughout the body or in particular areas. Also, another symptoms is extreme sensitivity. So the slightest touch on somebody’s body can be very, very painful. Slightest touch node or the pet, the pain from a touch can last much longer than it would normally. Yes. So we’re not, we’re not, we’re talking quite a nasty sensation, nasty disorder here. Stiffness is another one, albeit, I must admit, many other types of disorders that you can go down with stiffness as well. However, it is one. Fatigue is another. This could range from general tiredness right up to feeling exhausted to the extent that you can’t get out of bed. That’s often described as a kind of a flu, like symptom, poor sleep quality, so you wake up tired and don’t sleep deeply enough to refresh properly. There’s another symptom, and there’s one that I think you touched on a. Earlier cognitive problems, so yes, effectively as it relates to mental processes, so you’re going to have trouble remembering or problems with attention and concentration, and you can have slow or confused sleep. Now, as I say, those symptoms vary from person to person, so you can have various degrees of all of these symptoms, but together, can be classified by the medics as fibromyalgia. Yeah. Now, does that? Does I think that probably covers a lot of what you’ve just or you, you said, Yeah, does that? Does anything kind of stick out there at all?

 

Kathryn Knowles  10:38

Yeah? I mean, it’s just the fact, as you say, there’s so many different symptoms, and, you know, I imagine that all of them kind of feed in and in some ways, can feed and amplify each other in many ways. You know, I’m thinking like the stiffness, you know, the stiffness aspect of it. I’m thinking, well, that if move, if, if you’re in pain, and if movement and if being touched hurts, then you’re probably not going to move as much, which will inherently then make stiffness. Make stiffness worse, because you’re not moving as you know. So it’s, but I think I remember rightly as well. It’s, it’s been something with five miles, because I remember when I’m showing I started in the industry, because I’ve obviously, I know that in shows obviously work for decades of data. And like with you saying about being 1976 is that when, when it first I’m sure when it first, I’m sure when I first started doing industry fibromyalgia, there was a lot of, I think, hesitancy, I want to say, in terms of underwriting, because, and it, from what you said about how, like it, obviously it can be so similar to other conditions as well. Because I remember at the time, there’s some people going, we, well, we’ve even had this before where, you know, I think people had said, and this is, I say, many years ago. So, so we’re not talking right now, but people saying, but there’s no such thing as fibromyalgia, and have people say that, just like until recently, we have quite, you know, we’ve had it where people say there’s no such thing as functional neurological disorder, yeah, and I think it’s that thing, isn’t it? Where? Because it’s because it’s not necessarily, I mean, I was gonna say not widely known. Obviously, fibromyalgia is very widely known now, so we have seen a lot of developments, and it is seen as, like, you know, a lot of insurance questions. We do see fibromyalgia or other kind of musculoskeletal conditions, but I suppose that could be quite interesting, just to cover there, Matt, is that, where would Fibromyalgia sit in the usual application set with insurers? Because, like we say, we’ve got we’ve got pain so and we’ve got stiffness, so that’d be musculoskeletal, but then we’ve also got a bit of cognitive side of things as well. We’ve got maybe some mental health. So where would you be suggesting that this would sit

 

Matt Rann  12:40

you mean, which answer to which question? Yeah, because

 

Kathryn Knowles  12:44

I find that some people, I mean, obviously, with with my team, I train them. I’m just thinking for listeners who maybe don’t come across as often. So I know where I would put it, but I think some people would get a bit like, oh, well, where do I put it? Because actually, they’ve got fibromyalgia, and it causes this, and it causes this. So they then go to, like, symptoms Exactly. So, you know, if it’s, you know, if it’s causing some sort of, like anxiety or stress, you know, and the client may even be saying, but it’s, it’s not anxiety stress, it’s the fibromyalgia doing it. Then sometimes I’ve seen it where I think people have gone into the mental health question and said, Yes, and what’s the condition fibromyalgia, in the mental health question, because they’re saying that’s the cause of it. So it’s a bit of a strange one. So where would you be putting it?

 

Matt Rann  13:29

I think, to be honest with you, it would probably be either where the main symptom is. I hope that making sense by that, yeah, you mentioned depression. I would just, you know, with the the world of drop down boxes these days on application forms, it could well be that Fibromyalgia doesn’t come up yeah on as an answer to some of the questions. But I think the that wonderful catch all question around, have you? Have you, is there something else you’ve not already mentioned that you should tell us about? Then you can get it in there? Yeah, is, you know, at the end of the day, I mean, my, my take, and I think a lot of advisors have been bulk of what I would I’m about to say, but it’s always good to over disclose and under disclose,

 

Kathryn Knowles  14:25

and then that’ll be contentious with advisors, absolutely,

 

Matt Rann  14:29

absolutely, but I can absolutely assure you, because, as you know, I have a lot of experience with claims as well, and particularly on. I’ll come into what fibromyalgia means for underwriting a little bit later on, but particularly in the in the realms of living benefits. So criticalness to an extent, but I’m thinking more of TPD waiver and income protection. Yeah, these the conditions which. Think a lot of people would say, you know, you know, on your experienced person, Kathryn, but things are like anxiety, stress, pain, shoulder, goodness knows, what else people would think. What am I disclosing those for? But in fact, they’re incredibly important, yeah, and I think when you you do have a when you got when there is something that may not be obvious to a an applicant, or necessarily the advisor as well, it’s always worth getting it down on the application so that, and I do appreciate it, may mean that the system says, rather than acceptance, it says, refer to underwriting. Yeah, better to be safe than sorry. Oh, absolutely.

 

Kathryn Knowles  15:50

I want to risk. We don’t know risk non disclosure. I mean, I was going to say, I think, with for me, I think when I do the application, because, like we said, you know, most people with fibromyalgia will be experiencing pain, yeah, in the body. So I would usually put it like with where the musculoskeletal questions are, but if it doesn’t fit in there, and it might not do, depending upon the symptoms and different things, that if it doesn’t fit in there, then are you saying, Matt, you know, there’s, there’ll often be one that says, you know, in the last couple of years, have you seen someone other than your GP in regards to anything like this, or for any reason, in a sense,

 

Matt Rann  16:31

I would look to get it down somewhere. Yes, that on the application form, and let put the underwriter on warning. Therefore it is their job to make due inquiry thereafter. But you know, people with diagnosis of fibromyalgia will often be on a drug treatment. Yes, so again, you’re going to potentially will have questions around that, have you

 

Kathryn Knowles  16:59

taken any regular medication for more than four weeks, things like that. So it should fall in somewhere. And I think what as an advisor as well, just like what you’re saying there, is that, especially for things like critical illness and income protection, if you are going through an application and you’re not seeing anywhere to put in the fibromyalgia, it’s very I mean, obviously with any of them that the insurers are wanting to know. But you know, there are specific things, you know, for when we’re looking at these other rather than life insurance, we’re looking at the criticalness income protection, where there is much more, sort of like a desire from the insurers to know about fiber, my ultra being there, and especially on the income protection side, I might be, maybe disagree me on the kick, but especially the income protection side. So if you’re not seeing somewhere to put it, what I would be saying is, ring the insurer and say, you know, ring an underwriter and say, right, I’ve got somebody with this condition. Where do I disclose it? Because, you know, I’m not aware of any, I’m not aware of any insurer in the UK, on a full, I’m going to say full income protection policy, because there are some that you know, don’t ask. But if you were doing full income protection, who wouldn’t want to know if somebody had fibromyalgia, 100%

 

Matt Rann  18:11

agree with you, 100% and they should, you know, the treatment side of it, seeing doctors or a Fibromyalgia clinic, there should be an opportunity to to add that disclosure somewhere on the app, but you 100% important, particularly on income protection, waiver, total and permanent disability, you’re absolutely right on CI, although it rather depends these days on quite what’s covered.

 

Kathryn Knowles  18:38

Yes, oh, absolutely yeah. But wouldn’t

 

Matt Rann  18:41

be, as you know, it’s not a curriculum list, but

 

Kathryn Knowles  18:44

yeah, well, as you say, for total permanent disability, they would want to know so which sits in there anyway, so, but yeah, there are, I think it would mainly just be on to that, really, yeah,

 

Matt Rann  18:57

very, very valid point. It’s very difficult because when your point is very, very well made. And it’s not just fibromyalgia, because with fibromyalgia, as I said, it’s a medical syndrome, a syndrome, therefore, is a collection of symptoms, and really a proposal form is designed, not necessarily around symptoms, or I can think of chest pain being a classic. It’s around diagnoses, yes,

 

Kathryn Knowles  19:23

so that’s one that we sometimes have interesting things as well. So this is, yeah, another area where we find it really interesting. So we’ll sometimes have it in, like my team, obviously, as the training, they’ll come and chat to me. And I’ve certainly had it before where somebody has come to it, and again, with sirlot syndrome as well, where somebody will have come and said, Right, okay, I’ve been diagnosed with fibromyalgia, or, you know, I’ve been diagnosed with all Down syndrome, right? Okay, and so I’ll be chatting, you know, obviously, speaking to my advice, and I’ll go. So, so they saw a specialist. No, they’ve only seen the GP. And I’m like, they’ve not got the I was gonna say, No, basically, no, we need to have been. More than a GP to, sort of like, really confirm this. And I think that can cause quite a lot of difficulties as well. Because, I mean, I see it quite a lot on the Ellice Daniels side of things, that people can go to the GP and just be told you have Ellice down loss syndrome. And then that is it. There’s, there’s no, you know, there’s, there’s been nothing else. There’s been no filter rheumatologist. Because, again, with fibromyalgia, if I’m right, Matt, that will be going to rheumatologist as

 

Matt Rann  20:26

well, usually, well, it very much depends, I think, initially, on what symptom is presenting.

 

Kathryn Knowles  20:32

I suppose, yes, of course, to start with.

 

Matt Rann  20:36

And then then that entry point, if it is a rheumatologist, they will or, let’s be honest with you, Amy, aches, pains and so on and so forth. Often, people will think osteoarthritis or Ankylosing Spondylitis or something, yeah, but consultant or the or the, you know, the hospital specialists should explore every opportunity when presenting with a symptom. Yeah, you know, everybody starts off. I suppose every time they go to a doctor, then the doctor first thing. Well, you know what symptoms in plain or English, I’m sure. But what symptoms? What brings you to see me today? Everything starts off in the symptom is trilogy back down into the eventual diagnosis and treatment.

 

Kathryn Knowles  21:22

Absolutely. So I think it’s worth noting, for advisors and anybody who has Fibromyalgia is listening to this is that if you know, if it was just your GP that has said you have fibromyalgia, and there’s not been checks for other things as well, because, like you said, Matt, it can, it can mirror other things as well that can sometimes, the fact that there hasn’t been a specialist involved can sometimes cause difficulties in terms of getting policies underwritten because, you know, because obviously they’re then sort of like the underwriting. Well, I don’t have all the information, because I would usually expect this. I need to make sure that I can rule out x, y, z, that, you know, it could potentially be and, you know, and it’s certainly not easy, really, really not easy for people at all.

 

Matt Rann  22:08

No, it’s, I think it’s not easy for the applicant, the IFA, or the underwriter. Now, when you have incomplete information, and I think these days, certainly over the last 10 years, was 10 years or so in the in the underwriting world, when I was a baby underwriter all those years ago, particularly when, you know, I was 18 years in reinsurance, then we would often make decisions around symptoms, yeah, necessarily a diagnosis, but underwriters these days definitely like to work off a diagnosis, yes, which therefore can lead to cases being postponed or declined unfairly, maybe not unfairly, because that you Know the information isn’t there to be able to size up the actual risk that’s been presented. But in the world of trying to make accessibility to insurance and so on and so forth, maybe it’s something that insurers need to look at at some stage, very difficult with automated systems as well. Oh, absolutely.

 

Kathryn Knowles  23:20

I was gonna say, I mean, I know very so many people love automated systems, and I do definitely see the work of automated but that’s the thing. There’s like, obviously most of the people that I support. It’s just like, when people say to me, what do you think of the automated system? Are like my clients? It’s, it’s really, really tricky, you know, and obviously it means that it’s just not providing the best of, obviously client outcomes, which obviously we all want to to make sure that that is the key thing that we want to do. But, yeah, I just thought it was, I just suddenly popped into our mind the fact that, you know, at times we’ve had it where there’s not been that full process and, it’s just so, so important to know that it’s like with other ones, where we’ll, you know, we’ve done it before. We’ve said, right, if we’re going to be underwriting this, to do pre sales, we need X, Y, Z information with fibromyalgia. It is also that kind of thing of like, you know, we would expect that usually it would be more than a GP, and that’s not to say a GP doesn’t know fibromyalgia, and can’t say, I want to make sure. I’m going to caveat that as well. It’s just that that would be the usual process. And it does just make sure that that things have been ruled out that could also be there. And that’s also really important for the person you know. If somebody says, you know, you’ve got a fibromyalgia, but they’ve not checked anything else, it’s really important to make sure that the other things that it could be have been discounted. And so, so, yeah, so anyway, I’ve gone off. We’ve gone on a bit of a tangent there. I’ve taken myself again. I

 

Matt Rann  24:45

think it’s important stuff, because these the situations that you allude to. Obviously you’ve experienced them yourself and the client. I’ve seen them many, many times. But bear in mind, I’ve been around it many, many years. Myself, and they are very they are difficult to to quantify as a risk. When you don’t have all the information, the information you require, what you know, again, if you don’t bend your underwriters in a room, they will there will be arguments about, well, how much information you actually need to make a decision, you’ll have different saying it kind of argue in one side of it and an underwriter arguing the other side of it. And that’s really down to the the chief underwriter to dictate the underwriting philosophy, which the teams follow. But it is quite a debate with underwriting. How much information do you actually need it from when you take it from the applicant, or does it have to be evidenced by a GP or consultant? Another debate, either which way, potentially one for

 

Kathryn Knowles  25:57

another day. Talk about, yeah, going to like underwriting evidence and GP reports and, yeah,

 

Matt Rann  26:02

it’s, I mean, it’s fascinating. It’s writing, but it can be so difficult to explain. So can I got a little bit more to say about fiber Mojo? Is that okay? Yeah, absolutely.

 

Kathryn Knowles  26:16

I was going to take us to what do you want to know as an underwriter? But, but yeah, take us into

 

Matt Rann  26:22

just a little bit more. Yeah, we’ve highlighted it already. You’ve highlighted already. But Fibro, the lot of these symptoms can overlap with other conditions, and certainly depression is one of them, something that we’ve already talked about this morning, very common to see depression linked in with fibromyalgia, and looking at the symptoms, it’s possibly completely understandable causes. Sadly, it’s not clear what the exact cause is, but the pain itself, the main theory of the pain symptom is that there have been changes in the central nervous system and the way that it processes pain messages around the body going to a chemical imbalance. And really the way that the medics at the moment have to treat all of this is really trying to alleviate the symptoms that we’ve talked about, as best they can. There is a genetics is also thought to be, to be a link there, as with many things these days, to be fair. And I’ve read different articles on this. Some say, for instance, the NHS website says that genetics may play a small part, and their articles say that it does play a small part. Sorry, does play but up to 50% cases, there’s a genetic link. So obviously doctors not agreeing with each other in some in this particular instance, triggers of a fibromyalgia. Now, I should just say that my understanding reading around is that Fibromyalgia quite often, although there’s obviously going to be the exception now and again, actually has peaks and troughs. So you will get a peak in the symptoms, some of the symptoms that I’ve alluded to already, that you’ve spoken about, but those can drop off, and you can be relatively pain free and symptom free for a while, until you get a next flare up. So with fibromyalgia, even with that diagnosis, I think you know, it unlikely you’re going to be in severe pain all of the time, although you’re quite right in saying that there is no cure and it is likely to go on for your life, the rest of your life. Now, triggers, bear in mind, I’ve just said there about you kind of peaks and troughs. What triggers? Don’t know, the flare up, and it’s thought to be stress, physical or emotional, serious injury, which, again, I’m sure is going to be stressful and anxious and anxiety laden, a major operation. Again, we go back to stress there. And interestingly, it’s been seen with significant emotional trauma. And the example that I’ve read last few days was actually the Armed Forces during the war. Lot of cases came fiber fibrino Being diagnosed, cropping up with our armed forces, thought to be because of the emotional trauma. So it’s an interesting one, isn’t it, it has to be said, but let’s be honest here, when the exact cause of fibromyalgia is not known, clearly, these are educated guesses. Yeah, absolutely at the moment, but I’m sure a very good educated guess. I. Other associated conditions we talked about depression, but osteoarthritis, rheumatoid arthritis, an closing spondylitis, and something called a temporomandibular disorder, which is a which is where you get pain in your jaw and cheeks are easy, mandibular being the giveaway word there. Yeah, so all kind of pain and swelling and so on and so forth. But I think this builds a picture up here. And again, you did touch on it. You I didn’t think you went up on a tangent, tangent. And Kathryn, to be honest with you, I thought it’s very relevant, very relevant, to be honest with you, but you can see how difficult it is to actually come up with a diagnosis. Yes, and it’s unlikely that a GP will have the time order, the wherewithal to actually do it themselves. I don’t think they’d have the time to do it personally. So so you know, it’s more likely a specialist would have had a look and come up with a diagnosis, if indeed, why, bro, myalgia is the diagnosis, okay, sorry,

 

Kathryn Knowles  31:03

isn’t it? Sometimes I’m sure with my mum, that part of her diagnosis was to do with certain points being pressed on her back. I think there was, I want to I want to say 14. I could be making it one. It was such a long time ago, but I remember something to do with like, depending upon the certain places that were pressed on her back, her reaction, that was part of the assessments of her having fibromyalgia,

 

Matt Rann  31:29

right? Okay,

 

Kathryn Knowles  31:32

I can see, I can hear from your voice, that that means you’ve not come across that at all. Correct,

 

Matt Rann  31:39

correct. I wonder whether, if it was part of the actual diagnosis, or they were looking at testing for some, for something, no because, or some other spinal condition. Oh, maybe,

 

Kathryn Knowles  31:52

maybe I was. I mean, obviously I was a lot younger, so I think I’d have been. I don’t know, no, I’m gonna say, I want to say maybe mid teens, maybe even early teens. So it’s a good while ago. So a couple of years ago, Amy, oh, yeah, only a few years ago. Yeah, I was excellent. I did my doctorate when I was four.

 

Matt Rann  32:16

I always knew I was talking to a genius, either which way? No, I haven’t specifically heard of that. No doubt, say such a collection of symptoms here, and as I said, osteoarthritis and close in, spondylitis. Boy, appreciate your mom was relative is relatively older. It could have been down to a number of things, but no, it could well be, you know, it could well be a test just not just not have seen it, not seen it’s what I’m trying to say. So, as I say, diagnosis can be very difficult because there’s no specific test which says, when it comes out of laboratory, this person’s got fibromyalgia. Testing exists to say that, but blood tests are often used for inflammatory markers and so on and so forth, to actually try and exclude other diseases rather than anything else, which therefore leaves you with kind of a rather than 10 options before you have the blood test. It ends up with the doctor saying that’s only two things that are going on here, and possibly X rays and scans as well, with the kind of the links to what the various arthritic diseases. I’ve already said, symptoms can vary from person to person, similar, similar to several other conditions. I think I’m like a stuck record on that. But also, as we’ve all again, said, depression and anxiety often linked, but also things like IBS is another one. Yes, irritable bowel syndrome. Sorry to for those who are not aware of that, also, let’s not forget the wonderful. And I say wonderful rather, Tom in cheek is not the right expression to use, but the very the the areas where claims assessors think, oh my goodness, it’s one of these. But let’s not forget chronic fatigue syndrome and my encephalo myalgic encephalovitis as well. So me or CFS, and they’ve kind of very high profile. So you all of these things. So again, it’s just not easy. Treatment, very, very quickly. Exercise, not really a surprise, but goodness gracious, if you’re in Tom, if you’re in a lot of pain, that’s so difficult to do. Yeah, walking therapies, particularly CBT, cognitive therapy, medicines, can sometimes help relieve the actual pain. I think it was described somewhere as a turning down the pain volume in the CNS, which I thought was a rather nice way of putting it. Yes, we. So

 

Kathryn Knowles  35:00

it’s like a volume, a volume dial, in a sense, you turn trying to turn down the volume on it, in a sense, yeah, and it’s

 

Matt Rann  35:06

antidepressant, yeah, different, different, focus on the use of it.

 

Kathryn Knowles  35:12

I’m sure my mum was offered, I think my mum was offered a medication that’s usually used for epilepsy, yeah, as part of the treatment. Well, the name of it is, but the gabapentin, yes, there we go. Well done.

 

Matt Rann  35:25

You. Thank you. You sure you were born, you took your doctorate, either which way? Absolutely, yes. And it’s, again, that’s that drug is used for different loads of things. It really is. It’s a great help to a lot of people. Acupuncture, not really, not a surprise, maybe a loss around self help and self care these days as well. Exercise again, relaxation, practicing relaxation techniques, working on getting better sleeping habits and also support groups as well. Yes, because, as we’ve already said, this is not a nice condition to have, therefore, talking to people like a lot of lot of medical conditions, it’s good to do. So I think that’s probably me finished in terms of what I wanted to just say about fibromyalgia,

 

Kathryn Knowles  36:27

we’ve covered lots there. We’ve gone through lots, haven’t we? Well,

 

Matt Rann  36:29

we have, really, because it’s a symptom based disease, yeah, you know, and it overlaps with so many areas that it’s, it’s, it’s, I find it totally interesting to be honest with you. But it is, it is not the easiest thing to to underwrite for all the living benefits I would add. But also, you know, when you have overlaps with other conditions, and I would, I would just focus on on depression, the under isa for life insurance would be much more interested in the levels of depression and how the client is coping with that than actually the fibromyalgia itself. Yes. So in terms are you, I think I interrupted you in terms of your the next step for you was say, what underwriter? What should underwriters look out for?

 

Kathryn Knowles  37:23

Yeah, basically, what are you wanting to know? If I come to you with a client, what do you want to know? Okay,

 

Matt Rann  37:29

well, guess what? I’m going to go to the auto underwriting route straight away and say, diagnosis, yeah, if there is one, I would suspect, if somebody has been investigated for Fibro, myalgia, then they would be either yes, you have it, or you are likely to have it, or no, you haven’t, yeah, the and if they haven’t, then you’ll be looking at sorry in terms of the questions would Be, what’s what? What are the symptoms you are suffering from? And have they ever been investigated, and was a diagnosis ever made those? Those would be the key issues for me. Yeah, you would get depression coming out of it. You would get arthritis potentially coming out of it. But for life insurance, maybe, maybe so what? Maybe so it’s really, the questions would be quite simple ones really,

 

Kathryn Knowles  38:28

okay, so when, sorry, what you diagnosed? What were you diagnosed?

 

Matt Rann  38:33

If you were diagnosed, that’s right, you could almost, you could almost go, have you had any investigations for fibromyalgia? Yeah. And then you’re going to get a yes or a no. You probably, you could, well get because of the nature of the disorder, possible, fibromyalgia, yeah. And then you can, you can take it from there in turn. As I say, it’s probably some of the particularly depression. It’s the overlapping diseases which can be the result of something from fibromyalgia, or it could be depression that leads to, well meant, a mental health condition that can lead to fibromyalgia. But it’s often the associated, associated conditions that the underwriter will be most interested in. And I don’t want to leap forward, but I think we’ve already alluded to it in terms of a diagnosis of fibromyalgia with no other linked conditions than for life insurance and its standard rates. Yeah, had no impact on mortality. Now you do have to be careful with that comment. I do have to be careful where so you do need to just check out those, any associated condition, of

 

Kathryn Knowles  39:45

course, and obviously, the medications can have an influence as well. I believe, sometimes

 

Matt Rann  39:51

in the context of fibromyalgia, in terms of a lot,

 

Kathryn Knowles  39:55

in terms of the sorry, in terms of the fibromyalgia, yeah, I think depending upon the types. Of medications that could sometimes, I think, would that have an influence? Sometimes, don’t think so.

 

Matt Rann  40:07

Not, not okay. You put my audio on its own right. Please do correct me, you know, after the show, so to speak, or whatever, if I’ve got that wrong, but I don’t believe so. But I mean, if you’re on steroids or other very heavy duty treatment, then I’m not thinking probably be down to fibromyalgia in its own right, but I would imagine the doctor will look at one of the symptoms and does a particular treatment help with those? But I wouldn’t. I might, my gut feel, yes, is that? No, I don’t, I don’t think a treatment for literally, fibromyalgia on its own, relate would end up with a rating

 

Kathryn Knowles  40:47

okay for life, for life on its own, yeah, when it

 

Matt Rann  40:52

comes to the living benefits. And let me just take kick out there, because I think there are so many conditions within kick these days, and for instance, with mental health and so on and so forth. Severe mental health cover, it rather depends on what type of product that you’re advising on, but in terms of waiver, TPD, particularly in occupation, TPD and IP then you not be accepted, I’m afraid, for any of those benefits if you have a diagnosis of fibromyalgia, yes, I hope the reasons for that are obvious, like, maybe, maybe I’m just being an underwriter there.

 

Kathryn Knowles  41:39

Well, I think maybe a bit of a summary could help on that. So in terms of like, if we look at the income protection one, because obviously wavy premium TPD are obviously part of the other products, and can be part of income protection as well, but they are almost sometimes a bit of an add on. But income protection in itself is obviously, it’s a product in its own right. So I think just to recap, for everybody, that obviously mental health and musculoskeletal conditions, especially the back, are the biggest claim areas for income protection, and if somebody already has a condition or symptoms that are sorry leaning towards those areas, then you will tend to find that income protection can be quite difficult to get if you were to have both. So you know, if you do have back pain, you can often still get income protection, but there would be a back exclusion if you you can still get income protection if you’ve got mental health, but there would be a mental health exclusion for at least certain periods of time until you no longer experience those so the difficulty does come when there is a condition like five myalgia, where you have those things so entwined, or even if you don’t have fibromyalgia and you have mental health as well as back pain, that you do tend to find that income protection often isn’t available and and it might be that, and you’ll probably be able to Correct me if I get this wrong, Matt, is that it, let’s say, if somebody has fibromyalgia, and they’ve got the pain, but they don’t have the mental health side of things, and this is just in relation to income protection, I say, and a product in its own right. Yeah, that’s the that there’s maybe an assumption based upon the history and statistics that if there has been five miles, that it’s likely that at some stage there would be both mental health and back pain, so even though somebody might just have one symptom at the moment, that it’s likely that there’ll be multiple symptoms over time. Would I be correct in saying it in that context,

 

Matt Rann  43:46

I think you’re on the right lines. Yeah, absolutely. I suppose. Again, it’s I’m not going to be very helpful by saying that one of the things that I’ve mentioned right at the very beginning here, the symptoms vary from person to person, and it can be certainly that somebody has fibromyalgia, but they never have any mental health problems that keeps them off work. So it’s very difficult and the but what you say, even statistically based, would be enough. But I think more importantly for me, it is the variety of symptoms, not just mental health ones, and not just musculoskeletal ones, but the the pain. Yes, one, for instance, what is? What she causing the pain? Well, we talked about kind of they see it, the CNS processes going awry, that effectively you could claim for any of those and to try and exclude would be virtually impossible, because the well, the claim. Assessors will be and underestimate matter, will say, well, we can’t exclude absolutely everything here that may or may not be related to fibromyalgia. And bear in mind, the diagnosis isn’t easy to get anyway. It’s something that, from a risk perspective, an underwriting perspective, you just can’t quantify the risk. When you can’t quantify a risk, then I’m afraid the 99 times out of 100 it’s the risk is declined. Yeah, can’t put a price on it, and you can’t put a price on whether you can be reasonably certain that the exclusion will work

 

Kathryn Knowles  45:41

absolutely and, and I think those are the challenges

 

Matt Rann  45:44

that you see throughout IP, by the way. I have to say, well, this, this is a very good example of why

 

Kathryn Knowles  45:50

I think and protection can be so

 

Matt Rann  45:51

even within exclusion,

 

Kathryn Knowles  45:55

yeah, absolutely. I was going to say it’s the income protection side here that we’re speaking so specifically on on these things, because you can get life insurance, you can get critical illness cover. If you have fibromyalgia, obviously it does depend upon your symptoms. It does depend upon the medications for some things. And I’ll just say that, and obviously, and the linked conditions, potentially at times, because, you know, there can be some linked conditions that come with it. And, you know, so it might be that somebody’s concerned about, can they get insurance because they’ve got fibromyalgia, but it might be something else that they have that’s actually more of a concern to the insurer, rather than the fibromyalgia itself, even though, for that person, the fibromyalgia might feel like the big thing. It’s very, very difficult. And I have to say, I have to say, and always to I think it’s important to say that the underwriting and outlooks, at times for medical conditions from the insurance world can be different to how doctors and the medical professional professionals view and term things. So we often find, as always, you know, a lot of the medical professions, when they talk about conditions and outlooks, they are trying their hard as well to be as positive as possible for people, because you don’t want to tell somebody something, you know, really bad and you know, and then it’s and just leave them to have things really bad. Or we would hope that that wouldn’t be the case. So a lot of the time, you know things I’m thinking of other conditions that we’ve talked about before, Matt, where, you know, chronic kidney disease in somebody of certain ages, GPs are like, Ah, it’s fine, whereas underwriters are like, you know, kind of thing. And I think, you know, it’s fair to say the same, not necessarily just with fibromyalgia, but with all conditions potentially the the insurance and underwriting world, you know, they they don’t always have that same kind of view and perception that can be really, really hard for advisors as a middle person, but also hard for us to the underwriters, hard for the clients as well, to go, Well, hang on a bit, my doctor says I’m absolutely hunky dory, but the insurance is not necessarily going as straightforward as I thought it would be. So in terms of options for personal income protection in fibromyalgia, Most insurers, to my knowledge, very similar to what you’ve said, Matt, would be a no, just purely based on the fibromyalgia, as you say, because of all the you know, potential symptoms, but you know they’ve got to the insurers have to look at and go, What do we think is the likelihood that there’d maybe be a claim for this or a claim for that, and then, as you’ve said, Matt, you know, because there’s so many symptoms by the time that they would maybe go well, you can’t claim for this because you’ve already experienced this. It becomes really, really difficult to define you can get some style of income protection policies when you have fibromyalgia. But you know, they often, they often pay out for a short period of time if you are ill and unable to work. And they would very, very likely be excluding claims relating to the fibromyalgia. And there are some other options as well, but they get quite technical, and not everybody is eligible for those. I would say in terms of life insurance, critical illness cover, like you said, Matt, it really depends upon. From my experience, I’ve got two case studies to go through. It depends upon the connecting conditions, if there are any, sometimes I think I see things like, have your symptoms been similar for a certain period of time? Or, you know, have they gotten worse? Have they if they stay the same, they’ve gotten better, and sometimes that can influence the the options. And as you said before, it’s very likely that Fibromyalgia will come up somewhere in the question set. If it’s not seeming like that, then really have a very, very good, really good go through it. It could be, if the client has had this diagnosis, if they’ve not seen a specialist in a long time, they’re not taking medications. It might be that it doesn’t pop up in the question set, depending upon what they’re experiencing, but it is very likely that some of the symptoms somewhere will pop up somewhere as. Available either medication or appointments with people other than the GP critical illness cover, as you said, Matt, that the main thing there is the total permanent disability. And I would be expect, you know, expecting the same thing of saying waiver premium, total permanent disability would be something that wouldn’t be offered by the insurer, as always on the total permanent disability. I like to say to people out of let’s say the insurance contract for critical illness cover is 60 conditions. The total permanent disability is just one of those conditions you are still covered for the main things, the cancer, the heart attack, the stroke, they are your ultimate three that you want to be covered for. And whilst we do want to have everything. If you are told that you can’t have the total parent disability, it’s it’s unlikely that you would need to go down that route for a claim. You’re very if something’s going to happen, it’s very likely to be one of the named things, rather than something that’s kind of like left as a catch all in the total permanent disability side of things. It’s not particularly easy to make a claim on total permanent disability. I’ve been involved in a couple of them and and they weren’t the nicest of things to go through. I have to say, No, very, very, very difficult to do. Okay, right? Should I go through the case studies? Matter. Is there anything else you want to say in terms of potential outcomes?

 

Matt Rann  51:20

No, not really. I think one of the things that are a couple of kind of memory joggers for me when you were talking then, and I just think that one of the things just wanted to re emphasize was that the underwriting fraternity, with together with the actuarial fraternity, certainly have a lot of data on a lot of conditions. But at the end of the day, if the case that you’re looking at, and it’s going to you can apply it to all decline scenarios, if you can’t actually put a price on it, you’re guessing, yeah, the writer isn’t doing his job properly. Yeah. I think with with a condition, with with a fibromyalgia, which is a classic syndrome with so many different types of claim areas, I’m talking about income protection here, then it’s just it is virtually impossible, never, say never, but virtually impossible for an underwriter to say, Okay, right? You know, put an exclusion on this. But the reality is, we don’t know whether an exclusion will work at all in terms of actually trying to put a price on it. Then, you know, I’d be sat there, potentially, if I was looking at Fibromyalgia data, saying, Well, this could be anything between, let’s say, three times ordinary rates or 10 times ordinary rates. Therefore, you know, I couldn’t, I’m not prepared, therefore, to try and make a guess on that type of risk, because don’t have the data and data coming from with fibromyalgia, all of the different symptoms and interactions of those. So it’s it’s around, not we have data, a lot of data on some of the main areas, cancer, heart attack, stroke, things like that, diabetes. But when you get into these areas of syndromes, very, very difficult to quantify the risk. Hence why you often will get a decline from trying to say that if you can’t quantify it, then you aren’t going to be quoting for it. Absolutely. Sorry, esoteric, I don’t know, but I think advisors in particular, don’t you know, not quite sure the actual area of thinking, actual medical thinking, of why a case has declined. Oh, absolutely

 

Kathryn Knowles  53:48

no, completely sorry,

 

Matt Rann  53:51

your case studies. Yes,

 

Kathryn Knowles  53:52

absolutely yeah. Well, we’re getting to the end, everybody. So last thing is just a couple of case studies. So the first one is somebody in their early 40s, non smoker. They’d actually been diagnosed with fibromyalgia four months prior to the application, due to some aches and pains that they were experiencing, but it wasn’t affecting their ability to work at all. But they did have a connected, not connected. They did have another condition, which was Crohn’s, and so they had Crohn’s, and they had needed surgery, and they had to take regular, strong medication, so similar to what you were saying before, Matt, you know, the key focus on this was more the Crohn’s due to the medication and the symptoms of experience. But for this person, we arranged 200,000 level life insurance over 26 years for 29 pounds per month. For the second person, again, we do have, we have a linked condition, actually, this time, one of the ones we mentioned earlier. So somebody in the mid 50s, non smoker, fibromyalgia that they’d had diagnosed over 20 years did affect their ability to work at times, due to the brain fog, due to some tiredness, but they were in a position where they could move their hours. So in a sense. They needed to work so many hours a day. Well, if they had a moment where they needed an hour, they were they had that ability to just go right this hour is, you know, not happening, but I’ll do it later on, and that worked for them. And they also had irritable bowel syndrome, which is that link that you’re mentioning before, Matt. They’d had a knee operation due to a sporting injury, and they did have stress as well, and which sometimes caused the heartbeat to have a little bit of a moment at times. I believe it was ectopic heartbeats at times that were experienced. And so for this person, based upon their need, we arranged the increasing life and critical illness cover of 50,000 pounds over 11 years. And that was 83 pounds per month. So hopefully that shows that, you know, we can have something like fibromyalgia, we can have link conditions as well, and there are going to be options. I’ll say that for both of these, it wasn’t the standard terms there what had been an increase due to the mixture of medical histories, but even at that, you know, considering the client’s ages, considering the amount of cover we’re going for, I was very, very happy with those outcomes for the people that we’d supported. So that’s it. So thank you very much for listening everybody, and thank you, Matt, for joining me as always a pleasure to have you with us. No,

 

Matt Rann  56:19

my pleasure. It’s very, very syndromes. And talking about syndromes is, from my perspective, is very, very interesting. So, so, thank you.

 

Kathryn Knowles  56:28

Yeah, it’s been really, really good. Thank you. I like, I like that when, as well, I can, like, bring a bit of a personal sort of like aspect to it, you know, seem, knowing what my mom’s been through and things like that, and just being able to go, right, okay, I know a bit about this. I know, a bit hands on. So, so next time I’m going to be doing a little bit of an overview on group income protection, as always, you can visit the website practicalhinprotection.co.uk, to access all of our episodes, or you can do that on any podcast platform. But on the website, you can also access your CPD certificate. And thanks to our sponsors, the OPT members. Thank you very much, everybody. Bye,

 

Matt Rann  57:02

Max, take care. Bye.