Kathryn (00:04):

Hi everybody. We’re on season seven, episode 10 and today I have Matt Ram back with me. Hi Matt. How are you doing?

Matt (00:12):

Very well, thank you. Very well indeed. Just back from the holidays, so if I’m a little bit vague or my mind is still in there, I beha, please bear with me. I underst. Having said that, I’m going to have to announce my retirement publicly from going to the San Antonio nightclubs. Okay.

Kathryn (00:35):

Was it just too much for you this time?

Matt (00:36):

Just too much for me. Yeah, we did go to, I’m going to say amnesia but that’s probably advertising on your podcast so I don’t, but yeah, we couldn’t take it anymore so we’ve decided to hang up our techno clothes and just retire to cocoa and slippers I think. But anyway, you had a great time but thank you.

Kathryn (00:59):

That’s good. I was going to say you’re doing better than me because even for the last 20 years I’d been that cup of tea and in bed before everyone else kind of thing. So good on you for still going and with your technical things right. Then everybody today we’re going to be talking about arranging protection insurance when somebody has had lung cancer. This is the Practical Protection podcast.

(01:28):

So to give everybody a little bit of a background about lung cancer, so I always like to give a few statistics and then we’ll get into the real information side of things with Matt in terms of the underwriting, so with lung cancer there is more than 43,000 people diagnosed with lung cancer each year. In the UK about 55% of these people live for more than five years and that’s when the cancer has been what’s considered what’s known as a low severity. So caught very, very quickly. It’s not had chance to grow significantly in the cells have behaved themselves as much as possible when it comes to the cancer side of things, but we have up to possibly just 5% of people for living more than five years if they’ve had the advanced lung cancer. So that is where it has grown quite significantly. The cells have been very naughty, very misbehaved themselves and about 10% of people will live longer than 10 years once they’ve had lung cancer.

(02:18):

So it is a condition that if we look at those statistics, 10% of people living longer than 10 years, that’s 90% of people who wouldn’t be and that is where the insurers are going to be using all the statistics, the actuaries are there, the underwriters there looking at all that information I think well actually 90% of people here might not survive for more than 10 years and whilst we are always wanting to see better outcomes from insurers, see better outcomes in terms of underwriting and things like that, we do sometimes need to understand that they are led by these statistics to a certain extent and we can just do our best as advisors to try and understand these conditions and manage people’s expectations as to what they might be able to arrange. So to start off with Matts as usual, can you give us a bit of background please about lung cancer?

Matt (03:08):

Yeah, sure. Well it’s fair to say that lung cancer mainly affects older people or let’s be fair with that comment. The symptoms first start or become more noticeable when people are getting on in their years. It’s pretty rare under the age of 40, the younger members of the people who are listening be glad to know and in fact 40% of all diagnoses are on people of the age of 75. So that reinforces my comment about the condition, mainly the effects older people

Kathryn (03:51):

Mass. Is that potentially just a bit of side tension then? You might not have this information to hand because it’s a bit of an offshoot, but is that maybe because I’m just thinking people who are 75 ish now that was still quite an era where smoking was pretty normal and obviously I’m not saying that lung cancer has to be

Matt (04:11):

Linked

Kathryn (04:12):

To somebody who’s a smoker, but it is quite significantly linked to people who have smoked in the past or maybe worked in significantly smoking environments. Do you think that’s possibly the case? I dunno if we may be seeing, I dunno, I suppose we quite a few years before we start to see if hopefully the luck of smoking is starting to reduce that risk.

Matt (04:35):

I think Bob on you’re absolutely right Kathryn, in terms of thinking around that particular statistic, it was interesting. My next comment was be picking up this point about you don’t have to be a smoker or have current or past to get lung cancer because I know in the media that this has been, it seems to be news to a lot of people, but I say only I’ll have to use that in relation to people who don’t smoke but 72%. So as statistics last year, 72% of lung cancer is related to smoking. Now strangely, I would’ve thought that maybe a lot of people, maybe outside our industry mind you think that that would actually be a lot higher than 72 and reversing it, so that’s 28% or it’s the 28% that it is not related to smoking. Now I think here, and we’ve talked about smoking a lot and that’s generally down to inhalation of the various toxic toxic substances within nicotine, but what is now coming, and again it’s very high, well in my opinion got a high media profile is that there are a lot of other reasons for people developing lung cancer and air pollution being one of them.

(06:10):

And again, cars banned or having to pay vast amounts to get into cities these days will be part of the government councils trying to help reduce that particular cause. Lung cancer. I won’t get into the politics of whether that’s a good way of making money or not, but there is actually generally a very good reason for it. I’ll go onto that a little bit later on. When we look at family histories of lung cancer, I know that’s something that’ll pick up in a little bit later. In terms of types of lung cancer, then the two major areas medical terms that are used is non-small cell, which I hope somebody medically could come up with a better term than non-small cell because the most very obvious one is small cell, that’s the other one. But they’re also keeping it simple Matt, so that’s kind of nice about it as well.

(07:16):

Can’t be such a bad thing at the end of the day can the medical world is full of terminology so maybe that’s the reason and good for them maybe, but non-small cell is most common form of lung cancer for 87% and you can break that down. I won’t go into any detail of it, but you can break that down into squamous cell carcinoma, dino carcinoma and large cell carcinoma and again, commenting on maybe what I’ve said before around cancers, the reason why medics do this is to try and put a label on the kind of cancer so that they can provide the most appropriate treatment for it. The good news is that non-small cell, as I’ve said, counting for 87% of cases, the other one small cell is the one that spreads very fast in indeed and there are cases whereby people who’ve died from lung cancer within months being diagnosed with small cell.

(08:27):

So that is I suppose the vernacular is the nasty one of the two different forms. I think it’s pretty worth just saying here with lung cancer, I think advisors for a start I should say that tumor questionnaires, genetic tumor questionnaires are available on all of the insurer’s websites and when we get into what important for the underwriters to know that I can touch on some of those areas, but if you’re unsure of questions to ask, do grab one of those tumor questions. They nearly all ask the same type of questions, but as far as advisors, if they have a client with lung cancer, just be aware before you step in I suppose and make assumptions that what we are talking about today is primary lung cancer. So this is where the cancer starts off in the lungs you you’ll often see the terminology secondary lung cancer and this is where the cancer has started somewhere else in the body but ended up spreading to the lungs and the outcomes are pretty different as you can well imagine secondary lung cancer, if it’s already spread from another part of the body into the lungs, that is pretty bad news.

(09:52):

Primary lung cancer, even despite some of the statistics still pretty scary, but at the very early stages and court early doors, then people do survive. Absolutely no two ways about it. Kathryn, do you want me to talk very briefly about stage 1, 2, 3, 4 cancers or shall we leave that?

Kathryn (10:13):

No, I think that’s really important. That will be,

Matt (10:15):

It’s a key question for the underwriters and also the key question in context of survival.

Kathryn (10:22):

Exactly and I think as an advisor we need to make sure that we’re very sort of in a sense familiar as much as possible with those different stagings and the different outcomes that we could see at different levels.

Matt (10:33):

Right, okay. Well stage one you’ve got stages 1, 2, 3 and four. Some of the cancers that we’ve talked about on the podcasts stage one is the staging, the level which has the best prognosis, the best outcome in terms of survival and here the key determinant for stage one is that the tumor is confined to the lung tissue only and it’s not spread to the local lymph nodes. You can look at the life expectancies here of five year life expectancies are always the terminology that is used for cancer. You’ll see that awful lot if you either read medical reports or your client is for enough to actually know or have recorded what they have been told by their oncologist. But stage one, five-year life expectancy in the age of 50. I did mention earlier that in the age of 40 cancer, lung cancer is pretty rare but it’s up to 84% under the age of 50 and it’s 65 plus is around the 55%.

(11:55):

80% of people can live at least 20 years, so that’s pretty good. So 80%, that’s everybody. Stage two is where the cancer cells have spread to lymph nodes that are near to the lungs. Stage three is where the tumor cells have spread into lymph nodes that are further away and they tend to be in the middle of the chest and stage four is where to spread to other parts of the body, the areas of the body which lung cancer tends to go to and it’s certainly not exclusive is the brain and also the bones in the body as well. So not at all pleasant. I think Kathryn did mention, you mentioned in your introduction you mentioned survival rates, but I’ll just reinforce if I may. Yeah,

Kathryn (12:59):

That’d be good, thank you.

Matt (13:00):

If you look at all lung lung cancer cases, that’s stage 22 3 4, the five year survival rate is only 18.6%. Remember this is on diagnosis. Okay, and you think 18.6% you think grief that is pretty awful particularly with the medicines that are available now, but there’s a good reason for that and the fact that only 16% of lung cancers are diagnosed at an early stage, so only 16% of all lung cancers are diagnosed around the stage one because people, it’s a bit of a silent killer. Bit like other cancers that we’ve talked about, particularly ovarian is another classic that springs to mind.

Kathryn (13:50):

So the symptoms can be very broad, it can be subtle, can be a cough, it can be tiredness, it can be loss of appetite and it is almost a case of if you pay attention to all the symptoms a lot of the time for a lot of these things, there’s always something that you should be going to the doctor for in some ways to sort of double check it. Also, it’s really, really difficult to really establish, but I do think that the persistent cough is a really key thing, isn’t it that soft,

Matt (14:16):

It’s word persistent. It’s word persistent. Yeah. I’m doing a little bit of research on lung cancer as well. I think there was a classic sentence that I read. It was talking about smoker’s cough and the smoker may say, well I cough all of them in time, but the sentence or maybe the next sentence, the following sentence said, well, if that cough starts to change, so you might have a cough all the time if you’re a heavy smoker, sorry, a smoker, but if that starts to become more frequent or you finding it more difficult to breathe, that is the time that the red flag go and see your doctor. But I think we’ve talked about cancer on a number of occasions here and the symptoms, but it changes that are not normal for you. That I think is one of the key determinants to just go and get it checked out and I would hope that despite the challenges that the NHS have got at the moment or frankly have had for many years, then your GP will treat it seriously and if there’s any concerns that he or she have will get you off under the two week check.

(15:33):

Definitely. But you’re absolutely right. It’s the subtlety of those that go on particularly if you have ever been a smoker, can’t get into if you stopped when you were 20 or 30 years ago. But let’s be honest with you, some statistics show that there is still an increased risk of getting cat lung cancer. Even if you stopped a long time ago. If you have been a smoker or flat matter, maybe you could even argue you live against a major road in a big city, you’re thinking about air pollution here, get down to see your doctor pretty early. As I say, 16% is pretty awful really in terms of early diagnosis, but that’s where we are at the moment and we as advisors and under autism to deal with what we see at the moment. So there you go. Absolutely. In terms of treatment, if the tumor is an early stage and general health, when somebody is good noting that a lot of people tend to be older when they get diagnosed with lung cancer, then it’ll be just surgery, localized surgery.

(16:58):

If that’s unsuitable or the unsuitable because generally because of the client’s health or the patient’s health or they frankly do not fancy surgery, then radiotherapy can be used. But also these days as well, adjuvant as they call it, chemotherapy can be given even at the early stages just to make sure that if any cancer cells had escaped but weren’t shown on any of the scans that those could be dealt with as best as can be anyway. So in terms of the treatment, I would normally suggest that if a patient has had chemotherapy then that’s indicative of the tumor. The cancer source may have spread throughout the body, but these days chemotherapy is done given on a just in case basis. Obviously given chemotherapy or somebody going through chemotherapy isn’t something that a doctor would do lightly because of the potential, not always but the potential side effects. But for an advisor, if you hear chemotherapy, please don’t automatically assume that you’re looking at a stage three or four. It can be given at stage one as well.

Kathryn (18:18):

I always, I could be wrong, but my impression has always been a slightly in terms of scales of intensity of treatments, obviously the surgery in some ways, obviously I’m not going to say that that’s the least severe option, but in the sense of when we’re looking at how much is needing to be done, so as the surgery I see as like okay, that’s kind of the minimum of what we’d be probably expecting a lot of the time. Then if I’m going up the scale of intensity, I would then think the radiotherapy and then the next one after that be chemotherapy. So for me with chemotherapy, I always think of that as the one where we’ve needed to go full go at this thing kind of thing, just make sure that everything’s all right and I think I could be wrong, but I think usually if there’s chemotherapy, there’s often radiotherapy done at a similar time. I tend to hear that quite a lot. Is that quite standard, Matt, or is that more of a individual situation?

Matt (19:15):

Yeah, I think it’s an individual. I mean your broad point that you were making there about surgery, radiotherapy, chemotherapy in that kind of order, I tend to at a high level go with that as well. I think in terms of your direct question, which I think was chemotherapy and radiotherapy at the same time, I think very much down to individual cases if I’m honest with you. I think with lung cancer it tends to infect older people. You also have need to take into account the general health otherwise of that person also, a lot of people don’t want to be cut open, just to be blunt about it and apologies to the trial while listeners,

Kathryn (20:01):

Because there is a point as well, isn’t this sometimes with age, I know this happens quite with prostate cancer doesn’t it? With prostate cancer there’s a lot of sometimes watchful waiting in the call it where it’s more case of we’re just going to keep an eye on it. But you’re at an age now where we don’t really want to be using anesthetic, we don’t want to be going into the full because it’s the thing obviously for all of us when we have surgery, your body’s having a moment and it’s not a pleasant moment.

Matt (20:25):

Absolutely. I mean prostate cancer, there’s over the last few years as well, taking age and general health out it, there is of course a move to surveillance only now with cancer even in relatively fit people, prostate cancer, sorry. So things are moving along. That’s where some of the old assumptions I to use 20, 30 years ago for me, me personally, a little bit of an out of date now I shouldn’t be assuming as much as I did all those years ago, particularly with cancer with, I mean there are some fantastic treatments around which is great for people if you’re now changing the subject completely. If you’re a claims person and you’re trying to deal a terminal illness claim,

Kathryn (21:16):

Terminal illness just popped straight into my head then max,

Matt (21:20):

It is, it’s a headache for those guys. Let’s be honest for the chief medical officers as well.

Kathryn (21:27):

It’s one of the things when I train people, but when I’m training people about stuff as well, and I talk about life insurance and I know there’s a lot of calls. Alan did a talk, a protection review and our osteo O talks about a terminal illness claim that we were involved in. We eventually did get paid out, but it was not a pleasant experience I have to say. And we said that it needs to be rewritten in many ways because if I’m right terminal illness, the rules around it was sort of set up around 40 years ago and obviously medical advancements have changed significantly and it’s that thing with me with terminal illness cover especially where it’s that thing if you are told you have less than 12 months left to live and it’s usually to do with cancer with majority of people. And one of the things that we’ve found where we’ve been helping people in those situations is that with an oncologist, they’re quite reluctant to say

Matt (22:16):

Absolutely

Kathryn (22:16):

Will definitely have less than 12 months, usually might or think or I believe, and unfortunately that’s enough for the insurers to go well that’s not a certain which. It is horrible because ultimately if someone’s told terminal cancer, they’ve got, they’re looking at this document that says we’ll pay up for terminal illness and it does cause quite a lot of it. I know that’s a bit of a side tangent there, but yeah, absolutely. I agree with you there and it is something that we definitely feel that needs a really good deep dive into in the industry as to how that’s, and obviously not all insurers are like that. We do have somewhere, if someone has told that they’ve got terminal incurable cancer, they will pay out regardless of length of timeframe given, but the majority are on this 12 month thing still.

Matt (23:04):

Yeah, I totally agree with you by the way. I know that I sat on a panel at a reinsurance seminar where, and it’s an interesting one as an advisor by the way, because you probably will disagree with my very black and white statement. I know you can’t believe I’m black and white on occasion. Oh god.

Kathryn (23:25):

Then

Matt (23:25):

On this one, how long ago was this? It must have been 10 years ago, and I said terminal this well and TPD for that matter, I’ll even go a little bit more extreme. It’s totally broken. Absolutely. We think about how we, because it just confuses our clients

Kathryn (23:49):

And it gives negative feeling

Matt (23:51):

And absolutely we get it all the time and it, I’m not sure, it may have sounded like a good idea at the time and I can go back into why TPD and particularly was developed, but we haven’t got time for that today.

Kathryn (24:04):

Maybe we should do an episode on that.

Matt (24:06):

Yeah, absolutely. It does need a complete rethink. I completely initially agree with you Kathryn on that might be a bit of a side issue to what we’re talking about, but I think it’s absolutely very, very important side issue.

Kathryn (24:21):

Absolutely. I was going to say, and just for advisors listening, what I tend to do with clients, and it’s obviously to each their own and do what your compliance and what your manager says, but when I speak to people and I explain terminal illness cover, I generally say to people, this is awful to claim on. It’s not pleasant. I give that exact thing that I just said there where I said it’s usually cancer, the oncologists usually don’t say less than 12 months. Most people understand that because we do get told about cancers a lot. It’s something that a lot of us are very mindful of and try to be very aware of. And so what I say to ’em is that if you are in that situation, absolutely we can try, but I just don’t want to give in a sense, I don’t want to give false hope because we see so many points where it doesn’t. So I kind of see it’s nice to have it on there rather than not have it on there. A bit like TPD. If you can have it, why not? But at the same point, to be honest, it’s not really, it’s not bringing significant value to the policy with the majority of insurers contracts. I’m probably going to get myself really told off there, but

(25:25):

It’s just being truthful at point of claim, we are not seeing the outcomes that we would expect for terminal illness covenant. And obviously in terms of the claim statistics that we see for insurers, life insurance, critical illness cover income protection, phenomenally good claim statistics, we don’t usually get that breakdown of the terminal illness statistic and the success rates of those, which would be very interesting to see

Matt (25:49):

As well. Kathryn, sorry just to interrupt you very, very quickly. I know we could, we’ve gone up on a tangent, haven’t we? As usual, but I think with the claim statistics on terminal is, it’s just worthy of note. I’m not going to make any further comment to this, but when a client, sorry, when an insurer, let’s say you get the example of, well, your doctor is saying, I’m not sure about, your oncologist is saying, not sure about whether this person’s going to die, et cetera, et cetera, and the insurer does not pay out. That is not treated as a decline. That is treated as a postpone. So I’ll leave because of

Kathryn (26:36):

Course, because in a sense it’s potentially postponed depending upon when the person does pass away and then the end of the policy day, they might still,

Matt (26:44):

Well also, I mean what I think you’ll find as well on practical basis is that if a new treatment is being used or one of these targeted drug therapies is being used, then it’ll often be in a trial basis and it may or may not work. So what an insurer will say, and I can understand it to a degree, they’ll say, okay, well let’s review this in 12 months and see where you’re going at that stage.

Kathryn (27:12):

Yeah, I actually, I’m familiar with somebody very close to me who

Matt (27:18):

I’m sorry

Kathryn (27:19):

To hear. No, no, no, no. Their mom, it was unfortunately, obviously eventually it did pay out, the mom did pass away, died. But during the terminal illness side of things, there was a lot of uncertainty and feeling over information to know and not know because they kind of didn’t want to know there was potentially terminal illness there, but they also wanted to make sure that financially they were secure and that things could be done supporting. And I know the insurer when they did it, they basically, well, we’re turning this down because you are terminal, however you are now on this new drug, so you might not be, and it was a real shock and jolt to them. They were faced with that thing of, well actually yes, and it could sound deaf. People might think, well, hang on, why were they going for terminal illness if they didn’t want to know if there was a terminal illness?

(28:09):

You’re having something which is incredibly emotionally traumatic happening and the emotions you can’t describe or assume or make any judgment as to anybody’s feelings or what they do and don’t want to know at that stage. So they had this double whammy of going, oh wow, yes, actually this is terminal, but now there’s this trial, but actually now that I’m on the trial, I can’t actually get the payout. So then it just ends up being very, very difficult and very emotionally exhausting for everyone involved. And obviously as advisors we tend to be the emotional support for that.

Matt (28:46):

Yes, of course you do.

Kathryn (28:47):

Yeah, far more I think. Do you know what we’ve done that we’ve had a really good matters, so I’ve got to go through the next two things we usually book on very fast. So in terms of what you need to know as an underwriter, I’m going to be saying what type of lung cancer? I mean I think a lot of people would just say lung cancer, but we’re probably going to going lung cancer, what type is it? When was it diagnosed? The staging and grading, if we knew it, if we know it or potentially what we said before the TNM score. So tango November MIC score potentially the treatments. And it’s quite important. I always find as well, I say to people, when did you have that treatment for chemotherapy? They might say, oh, well I had it from the February to the May of that year, but then it might also be that they say, well, I dunno, but I know I had 13 sessions and I think either of those tends to be interchangeable to a certain degree. I think with underwriters I could be wrong and when that treatment ended it was always really, really important as well. And then anything that’s kind of any lasting complications that can sometimes be something that we really need to know about. Have I missed anything, Matt, that you would want to know? Nope.

Matt (29:54):

Nope. You’ve got it. All data diagnosis has ended important because that’s kick date, sorry, that’s the kickstart date. Not be confused with cic, the staging type of treatment. And I think I’ll also add the results of follow-ups.

Kathryn (30:11):

Yeah, the ongoing annual checkups and things like that,

Matt (30:14):

Which should last for five years generally and the result of the last checkup and if they’re still within that five year period, what’s the date of the next checkup? So those follow-ups are very useful. I have seen a number of cases over the years where people have just said, right, I’ve got cancer and I I’ve had surgery. Let’s say I’m talking about cancer generically here, but I’m not going to be reviewed. I don’t want to know. Yes, those cases are usually decline. I’m afraid we can’t offer terms the follow-ups are extremely important.

Kathryn (30:49):

Yes, no, of course

Matt (30:51):

I’ll shut up there.

Kathryn (30:52):

No, absolutely no, absolutely. So then the other thing is any kind of connected conditions or long-term symptoms that we should be aware of as an advisor? I know there’s certain things, I know this could sound a bit silly. Well, I was going to say it could sound silly, not silly at all. So one of the things I do with people who have neurological conditions quite a lot of the time I tend to ask them as well, are they able to hold a driving license? Because I always think that for me that’s a really good indicator of how strong the neurological condition is. I mean obviously people might just not drive because they don’t drive, but it can be really useful, especially say like somebody who’s got epilepsy, they might have had at some point where they’ve had a seizure in the last few months. And that can really affect the options at times.

(31:38):

And we could just be asking, obviously women lost seizures and that, but sometimes just asking that little bit of an extra of a related but not insurance application question in a sense can really, really help us to get a good understanding of Parkinson’s. For my dad obviously is a really good one as well. Are they able to hold a driver license? It really helps the underwriters to understand the stage of progression in the condition. Is there anything that we should be looking for? I’m sorry, at the top of my head I’m thinking anything like recurrent pneumonia, bronchitis, anything like that?

Matt (32:07):

Well certainly lung conditions, yeah, particularly, excuse me, if you’ve had surgery, depending on what has been removed, certainly lung conditions because of the surgery are worth noting for life insurance. Then generally, unless you’ve had a complete lung removed, one of your lungs completely removed, then there isn’t usually too much of an issue. But if you’re talking living benefits, so critical illness and income protection, then obviously that can have an impact on your lifestyle and your ability to work or whatever. But really it’s from the surgery, I’d probably leave it at that to be perfect honest with you.

Kathryn (33:03):

No, that’s absolutely fine. And the main thing is then what do we think the potential outcomes are for life critical illness and income protection?

Matt (33:12):

Well, if you alluded to, and I know we spoke very briefly about this in our pre-chat then for stage one lung cancer follow-ups, importantly all clear for that period or ongoing, then you can usually get life insurance at usually around four years to stage one, stage two, I think you’re looking at least five years and potentially you’re going to need an underwriter would need assistance from a chief medical officer on those types of cases. And also depending on the treatment as well, given some of these new treatments that are around stage three and four, then life insurance is usually certainly not available for a long period of time. Say let’s say between best case I would probably say is around seven, eight years to 10 years.

(34:08):

So I’m afraid rather like you’re opening gambit on this and we talked about some of the frightening statistics, we’re not looking a great outcome in terms of the living benefits. I would be surprised, and I know you’re going to disagree with me, I’d be surprised this would be available given the statistics that we’ve talked about. And I would be surprised if income protection was available given some of the statistics. But I know you and Keira being Keira can sometimes produce miracles. So that’s where I come from. So overall I’m afraid we’re not looking at great response from the insurance industry on this, but I’m afraid some of those assistants we’ve talked about really just reflect the why. Yeah,

Kathryn (34:58):

I think in terms of the research that we have and indications and things like that, probably very similar to yourself. I think the key thing is, I think you said there’s only about 16% of cases are caught really early, didn’t you? That was what that you said. And so with the ones that are caught really early, depending upon how quickly the treatment’s gone, those long-term implications and symptoms, there can be after a certain period of time, there might be some options for potentially standard terms for the life insurance and income protection from things that we’ve been seeing, there is potential maybe for critical illness cover, it’s going to be very, very restricted in terms of who would be even able to potentially look at it. And I would be saying that I would think that there would be a premium increase. It sounds terrible, but it wouldn’t surprise me if there was also at least a lung cancer exclusion on there, possibly some other cancer exclusions as well.

(35:55):

But yeah, there are often lots of different ways and options of looking at things and I would hope that with most people there would be some kind of option that can be looked at. But I think as well, it’s always that thing, again of managing expectations really early on for advisors as well. We don’t promise the earth, we say, look, we need to research this first. And it might be that the options that we can do for the clients, there’s options there and they’re good for what that client can have. But it might also be that that client just doesn’t feel that they actually meet exactly what they’re wanting to achieve. And that can be quite difficult because they maybe feel that they’re not getting everything that they’re wanting. But as an example, I’m just thinking if somebody had had lung cancer two years ago and it was stage two and we’re wanting life insurance, it’s quite likely that we’d have to go to a specialist policy and that is very likely to exclude claims relating to the lung cancer, which is not all situations, I’m going to say it’s not all situations, but majority of situations that would happen.

(37:00):

And that’s very, very hard because there is an option there. It is going to pay out for a significant amount of circumstances. But ultimately as well for that person, just from an advisor’s point of view, they’re probably still in a bit of an emotional state to a certain degree and they’re going to feel possibly a bit vulnerable actually. And it’s not exactly meeting what they want it to do. And even though we know it’s there, we know it’s potentially a good option. It might have lots of add-ons as well. Potentially there’s value added benefits that are going to be really useful for this person. They might just decide it’s not right for them. And in some cases I’d say it’s not that the advisor’s done anything wrong, it’s not that you’ve not tried hard enough. It’s not that you’ve presented it in the wrong way.

(37:43):

Sometimes people, depending upon the options, if it is going to be quite limited in what they can have, sometimes they just don’t feel it’s right for them. And you’ve done your best job as long as you’ve put the option in front of them, you’ve explained it clearly, then that is the best that you can do for them. Okay, so last one then Matt, just very, very small before we go about family history of lung cancer, because we were having a little bit of a chat about this beforehand, we where a lot of family history, they will say history, family history of maybe cancer before the age of 60 or 65. So from what we were saying before in terms of numbers, probably quite a lot of people with lung cancer would be older than 65. So they wouldn’t necessarily come up in the question set and advise us.

(38:30):

If you ask someone and say, oh, lung cancer, and then they say 72, we’re not going to suddenly whoop and rejoice and say, fantastic, they don’t need to go on the application. We need to handle that very, very sensitively because still, yes, it is a positive outcome for that person in the application, but there’s still a close family member there who’s had cancer. So we just need to make sure that we’ve been trained in the right way to handle that. But not all insurers ask about all cancers. Some of them specifically ask more targeted, has somebody had this cancer or this all the ones that you would see as maybe a familial connection. So lung cancer wouldn’t necessarily fall into the question set anyway at times. But Matt, I know you’ve got some things about lung cancer and family history. So sir, share your wisdom, please.

Matt (39:16):

No, not at all. I agree with everything you just said there. It’s unusual. I say unusual. We’ve talked about various cancers during the last few years on these podcasts, but I thought it’s interesting just to note and share with everybody that the lung cancer gene mutations are not usually inherited. Okay? They’re not familial. They’re usually what medics and I called acquired mutations. So they’re not born with thetic mutation, but these mutations happen during the lifetime of the individual down to external factors. And the one that we’ve already spoken about is the insulation of tobacco smoke and the toxins within it. But we’ve also mentioned things like air pollution. There are certain types of other chemicals, radon, gas, of all things I kind of came across, which can cause these mutations later on in life. So I’m not saying that it cannot, there isn’t genes around that are not acquired. But generally speaking, these are things called acquired mutations caused by external factors during the lifetime. So somebody having lung cancer even before age 65 or age 60, I don’t think automatically trigger an underwriter to be concerned. It’s pretty rare to have a genetic familial disconnect that would run through families. So I think, again, lung cancer shouldn’t be, he says knowing your research, something that underwriters would start concerning themselves with.

Kathryn (41:13):

I don’t have any research to contradict you, Matt, so don’t worry.

Matt (41:16):

Goodness for that. Excellent.

Kathryn (41:21):

No, that’s fantastic. Well, thank you Matt.

Matt (41:22):

Don’t leave you with that one.

Kathryn (41:24):

Yeah, no, thank you. And thank you for listening everybody, and as always, Matt, your insights are incredibly helpful. If you’d like a reminder of the next episode, please drop me a message on social media or visit the website practical hy from protection.co uk. And 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 OX members. Thank you, Matt.

Matt (41:45):

Thank you. Pleasure as always. Thank you.