Kathryn (00:06):

Hi everybody. We’re on season seven episode 12 and I have Matt Ram back with me. Hi Matt. How are you doing?

Matt (00:12):

Good morning. Nice to be back. Yes, not too bad. Although as a man, as a part of the male section of our community, I’m delighted to tell you that I’m dying of man flu again, apologies if I start coughing during our discussions or in fact I just collapse and pass out on floor.

Kathryn (00:36):

That’s okay. Well

Matt (00:37):

We’re

Kathryn (00:38):

One the thing together. I know how to

Matt (00:41):

This man flu can be dreadful. It

Kathryn (00:43):

Absolutely can be. I was going to say I must certainly get man flu I have to say. But I’m going to say I like the fact that we have a theme mass. It’s either that you’ve got man flu or a holiday to tell us about. It seems to alternate every time.

Matt (00:56):

Indeed we do, don’t we? Yes. It’s either having to visit the hospital emergency for cutting my arm or something equally silly, but yeah, what can I say?

Kathryn (01:08):

Absolutely

Matt (01:09):

I’m not, well, I’m dying in fact. So there we go. Well

Kathryn (01:12):

Let’s think.

Matt (01:13):

Move on quickly. Yes,

Kathryn (01:14):

Let’s, let’s get it done before anything like that happens. Okay. Right. Today everybody we’re going to be talking about arranging protection insurance for people living with sarcoidosis. This is the Practical Protection Podcast.

(01:34):

So we’ve chosen sarcoidosis today because it’s something that I’ve seen more and more over the last couple of years and before the last couple of years I did see it a little bit but it just seems to be something that I just dunno, I’m just seeing more people with it. Now that could be because of the fact that it’s my client base tends to be people with health conditions. It might be that as know some kind of social poems somebody’s gone on and said, oh I have psychosis. Ki are amazing. Can you do this? Everybody go and see them and we just might be getting that way. But it is unusual. It’s a rare condition and we just think it’s worthwhile and going across because I think as well for the majority of advisors, if they suddenly have someone say to them sarcoidosis, I think a pretty significant number of advisors would just go, what on earth is that?

(02:18):

So a little bit of a background and then mapping can really, really go into it with a bit of a deep dive from the medical side. So with sarcoidosis is usually diagnosed in people, well the NHS in their thirties to forties and sarcoidosis UK actually says from the twenties to the forties. So we were kind of in that kind of area ground and it is marginally more common in women than men. And in terms of the statistics side of things, when we’re looking at it, it is a rare condition and about one to two people out of every 10,000 people will be diagnosed with it. So in terms of advisors, it might be that you never speak to somebody with sarcoidosis but you just never know. And so if you do need that bit of a help, we are here obviously to give you that bit of background, about 90% of people that have sarcoidosis will have what’s known as pulmonary sarcoidosis, which means that the lungs and lymphatic system are affected and about 30% of people will have extra pulmonary sarcoidosis, which includes the liver. It can include the bones and the joints, it can be the skin and eyes, it can be heart, it can be the endocrine and kidney systems. So lots and lots of things can potentially be affected. If I’m right, I do think it can be probably quite a mild condition at times potentially, but it can go right through to being an incredibly serious condition as well. So Mass, if you can start us off please with giving us some background about what sarcoidosis is, what’s happening to the body.

Matt (03:46):

Absolutely. I’d probably throw in another stat there which talks about the numbers that you gave but in a different way. And it’s to say that with sarcoidosis, three to 4,000 people are diagnosed each year in the uk.

(04:04):

So it’s very similar to the numbers that you just gave. Just I’m understanding it a different way, which again, if you are looking at the 30 to 40 year category, then the chances are I think somebody who has been around an advisor who’s been around for a while will have come across the disease with some of their clients, 30 to 40 being course the prime age for buying life insurance or maybe 25 to 40. But those are the key areas there. So perhaps maybe a little bit more common in terms of the advisor’s desk than maybe we think. Now Kathryn, you quite rightly said that sarcoidosis is rare and it’s one of these diseases of which there are a good number really, particularly with more modern thinking where the autoimmune system overreacts and starts attacking all the cells in the body and attacking the organs and tissues and so on and so forth. So it’s very much an inflammatory disease and we can see that a bit later with types of treatment that are given to try and dampen the activity of the immune system so that it comes back to normal.

(05:27):

You’ll see the term or potentially see the term granuloma a lot with sarcoidosis and these really are simply clusters of inflamed swollen tissue where the cells clumped together and they form this mass if you want to call it that. But these are tiny, I say mass but mass and they form in different organs of the body. Now you’re quite right to say that the majority of cases impact the lungs, the system, and again quite right to say that this condition can be very mild and for no real reason they can actually go into remission if you like, with no treatment whatsoever. So it’s quite an interesting disease, but it has to be said that there is no cure. You really where medicine is at the moment, it’s around treating symptoms, but to go back on this can be very, very nasty. You can have lung involvement from very minor involvement right up to pulmonary fibrosis and scarring and that can distort the way that the lungs work and get to. So

Kathryn (06:56):

What’s pulmonary fibrosis? Just

Matt (06:59):

It’s really fibrous. So in other words, the tissue becomes very hard and tough and it doesn’t move in the way that it should,

Kathryn (07:08):

Which would clearly be an issue especially for breathing. Well I suppose for anywhere isn’t it really? But definitely the lungs because we need them to be

Matt (07:17):

Absolutely flexible. Absolutely. And the end stage if you get to this pulmonary fibrosis at the end of the day is a lung transplant.

Kathryn (07:27):

Oh wow.

Matt (07:29):

Stroke and then, or even if that can’t be done, the client is too poorly then I’m afraid death,

Kathryn (07:36):

I’m just going to pick that. Sorry, just going to pick something very carefully there if that’s alright. So you said essentially a lung transplant and then you said stroke, I wasn’t sure if you were stroke

Matt (07:48):

Medical, not a medical stroke. Yeah,

Kathryn (07:50):

I just wanted to double check that because I I just missed that one. Okay,

Matt (07:53):

No, no, no. Good point actually, good point. As you quite rightly said, it can also affect the eye skin, heart, kidneys, and the nervous system as well. Diagnosis with the heart is usually from one of the actual symptoms which is called ventricular arrhythmia, where effectively the heartbeat becomes abnormal and the ventricles of the heart, particularly the left ventricle, which is the big pumping chamber of the heart, it doesn’t work properly. That’s the easiest way to put it. It doesn’t work properly, it doesn’t pump the blood around the body and again, with that you end up having a heart transplant. So

Kathryn (08:45):

Talking potentially from an underwriting point of view, as an advisor, that’s what the underwriters are probably going to be looking for in a sense and of is that, is this person potentially going to be needing something like this?

Matt (08:59):

That’s right. And that’s very much the end game and to be perfectly honest, you’re absolutely right in saying that it’s those stages in between if you like, that the underwriter is going to be most interested in particularly those cases, which to pick up the point here, people with a history of sarcoidosis that has gone into, let’s call it remission, disappeared, either just don’t naturally or be from drugs and the drugs have taken it into remission. Those cases can’t be given at standard rates for life insurance. So again, if somebody’s had a heart transplant or a lung transplant, you’re going to struggle to find terms in most cases. That’s not to say never, but in most cases. So you can see the complete range that we have with sarcoid.

Kathryn (09:53):

Yeah, absolutely. I was going to say, I’ve actually tried to help somebody before in the past with a heart transplant and the options were incredibly limited to the point of you either had it where phenomenally expensive and it comes down to that thing of sometimes it’s phenomenally expensive in some situations or an exclusion and for me, when I was chatting to the person I felt and they felt as well that past exclusion was an incredibly big exclusion to have on an insurance policy. Even just talking about life insurance, I’m not talking about the critical illness cover side, but just on the life insurance, it didn’t feel, I didn’t feel like I would’ve done. I think I would’ve constantly fell if we had gone ahead with it, I could have done it, but I was just very clear from the start that for me I felt like I was in a very, very gray area because obviously we rely on the heart so much, it’d be almost like excluding the brain in a sense. I dunno, for me as from an advice point of view, I found that one very, very tricky. There are obviously some very specialist options. Options we can look at, which could be fine. People might be covered by their employer through group insurers potentially and that would work depending upon the size of the scheme and the insurers in terms and conditions. But generally just for the heart side of things, it’s unfortunate. It’s very, very tricky.

Matt (11:28):

Not easy whatsoever. It has to be said hopefully in years to come Kathryn, things will get better with that.

Kathryn (11:35):

Hopefully

Matt (11:36):

Some of the things that are going on at the moment are just fantastic as we were discussing earlier, so we’ll go on. Okay. Sometimes we talk about symptoms here and again these are symptoms like we’ve spoken so many times about, well what should you look for if you’re an individual in particular and with the lungs it’s no surprise that coughing shortness of breath but also you can get those wonderfully vague symptoms of fatigue, sweats, joint pains, skin rashes, you talked about the eyes, so red and painful eyes, you talked about the lymph system, so swollen glands. So I do wonder whether quite a few of the actual eventual diagnosis of sarcoid are actually missed and they just resolved naturally

Kathryn (12:30):

A,

Matt (12:31):

This will be an interesting one we get on. From my view, it’s not a particularly educated view, but it’s a view on covid and sarcoidosis.

Kathryn (12:42):

Yes, that was something I wanted to chat to you about. That’s

Matt (12:45):

Something we’re going to touch on, touch on later on I think. Yeah, so in terms we’ve looked at what sarcoidosis is and I’ve already said that it’s one of those nasty diseases where the immune system starts attacking the body itself about the symptoms, which sadly I say sadly are pretty vague unfortunately in terms of the treatment, the key word that I mentioned right up at the very beginning of the chat was inflammatory and therefore there’d be no surprises that immunosuppressants, particularly if the lung heart or neurological areas and body are involved and what they do. Just to touch on this, again, I know we’ve talked about it before, but that reduces, it suppresses immunosuppressant the immune system activity so it calms it down, it gives it a nice friendly stroke and says, don’t be so silly to try and attack your own body. So I’m being daft then and bits flippant, but that’s effectively what they do

Kathryn (13:57):

And immunosuppressants are something as well, even in their own right there’s something that underwriters are quite, because obviously it is suggesting that the body, well as we said, autoimmune condition, the body is attacking itself, which is definitely not as good as the body not attacking itself. So we’re having to sort of really do something to stop the body really making itself. I mean we’ve done so many different ones we recently, I’m thinking type one diabetes and all this kind of thing where there’s different things happening and body attacking. We need to be very aware in terms of, I’m not saying we’re necessarily using immunosuppressants there, but in terms of the immunosuppressants, they and themselves and hopefully Matt, you’ll be able to share some names of some of them because I think that can sometimes really help advisors as well because we can hear medications and what I always suggest to people when I’m doing my training is Google searches your friend because a lot of the time with advisors we’re not obviously medically trained and we’ll get used to some medication names, but sometimes the names of the medications are ridiculous.

(14:57):

So what I tend to do is I’ll tend to have, if someone starts telling me something and I’m not sure what the condition the medication is that’s being said to me, I’ll type what I think is being said to me in the search but in Google and then also type what the condition is and then if you do a search it often then brings it up what it is. But I think it could really help to know some of those ones that we’ll be talking about here, but I know again probably something that’s going to come up in a minute.

Matt (15:24):

Yeah, I must admit with drug names, there are so many names which are effectively brands. Brands name which actually hides, well hides for a marketing reason I’m sure, but hides the actual product that it actually is. Yes. I hope that makes some sense.

Kathryn (15:45):

It does, it does. I was going to say in terms of Parkinson’s, one of the main medications is levodopa, but then the actual brand name is Stalevo and there’s another one as well, I want to say Sinemet I think possibly if I remember rightly and straight away. So somebody might say to you, I’ll take Stalevo and it’s just like, right, okay, that’s in my mind. I know that’s the brand, it’s levodopa, but the majority of people aren’t going to probably know that and so I think whichever which way you’re getting it, just do your Google search. I’m very much a fan of that Google search.

Matt (16:15):

Yeah, yeah. I mean I must admit, I think you’re probably better than me on that because I tend to, rather than try and remember them all, I tend to Google because the brand names in my experience, you can get several brand names for exactly the same base product.

Kathryn (16:30):

Yeah, it’s just my dad has it. That’s the only reason I know.

Matt (16:32):

No, no, no, not at all. Not at all. So I mean Prednisolone is one that we will see as a core name and also methotrexate, which people I think, oh my goodness, yeah, that’s a strong immunosuppressants, but nevertheless it’s used for treating sarcoid and anti-malarial tablets. There’s some benefit from those. So there are a number of treatments out there which can do one of two things effectively. They can drive the disease, the active disease into remission

(17:09):

And it can be a very long-term remission or they’re used as maintenance therapy. In other words, they’ll be used for however long is needed, which might be the patient’s life, but they’re pretty good and unfortunately at the end of the day of course you’ve got to go into the transplant kind of mode. Just as a comment in terms of some of the underwriting issues, not issues exactly. Guidelines that are used out there. It’s again possibly no surprise to our listeners, but when a doctor suggests that treatment is stopped because the symptoms have disappeared, most flareups will occur within the first six months of somebody being treatment being stopped.

Kathryn (18:03):

Okay.

Matt (18:04):

I’ll link that now to something I’ll say maybe touch on a little bit later on, but that’s where you’ll find why you’ll find most underwriting guides will say there is no cover or postpone cover for six months after a diagnosis to see how the patient goes.

Kathryn (18:27):

Absolutely. Yeah. Just giving that little bit of leeway, just none of us ever know how our bodies all react to things, so that makes sense.

Matt (18:38):

Okay, good stuff. The numbers we’ve already talked about and just to build on what you’ve already said, Kathryn, I’ll say that, and it kind of goes back to whether people, I do wonder about people having sarcoid they never even know about it never gets diagnosed, but 60% of people who have been diagnosed with sarcoid don’t need any treatments at all.

Kathryn (19:08):

Right. So it’s obviously something where it can be quite mild then potentially very

Matt (19:12):

Mild. Yeah, 60%. It’s a big number isn’t it?

Kathryn (19:15):

It’s a very significant portion,

Matt (19:17):

Absolutely. And just building the number up there, 30% may experience persistent symptoms but or without treatment. Okay. So 30% will go on and 10% develop damage to the organs, which can be life-threatening. This is where you get your transplants coming into it as well. Now in terms of the prognosis, we’ve talked about all the areas of the body where this can be impacted and you mentioned skin and in medical terminology, cutaneous is often used for that and I can say that in the absence of any disease in the intrathoracic cavity, which is effectively the bits and pieces that are held within the rib cage, the disease disease is completely benign. So if you’ve literally just what I’m trying to say is there, if you literally have sarcoidosis of the skin, it is a completely benign condition.

Kathryn (20:26):

Okay.

Matt (20:27):

Okay. Now what’s often looked for as well with when the medics look at sarcoidosis as a whole or potential for sarcoidosis is something hypercalcemia. I’m sure if you’ve heard of that one. I

Kathryn (20:43):

Have not.

Matt (20:44):

Okay. Well immediately go to raised, you’ll know that from your medical knowledge yourself and calc is literally calcium, so it’s raised calcium. Again, it’s not an uncommon, the link between hypercalcemia and sarcoidosis, it’s not an uncommon link, but it’s very important that we know or the doctors look into it and therefore the in will be interested because if can be treated without any real concern, not dangerous drugs or anything like that, but it can kill you if it’s left untreated because what it causes is it’s a build of calcium in the tiny blood vessels of the heart. Sorry, not the heart I’m talking about in terms of the kidneys. So it’s something called nephrosclerosis and that can lead to kidney failure, right? Again, you’ve got dialysis and so on and so forth and transplants and things like that. But hypercalcemia is an important part of the testing picture with sarid with the liver, granulomas can occur in the liver, but the liver is such a large organ that as long as you’ve, it’s functioning normally liver and backed up by liver function tests, normal liver function tests, again, that is not a problem.

(22:16):

So cycle sarcoidosis of the liver with a normal function, not a problem For life insurance, the big area that you talked about already is the lungs and here you’d look at the pulmonary infiltration again. So in other words, we’re looking at the scarring and the eventual fibrosis of those lungs and the tests which you normally carry out there are a chest x-ray, but together with a pulmonary function tests and no doubt, modern scanning as well, but again, as long what you’ll need to look at the underwriter will need to look at. I’m jumping a little bit here, sorry Kathryn. In terms of the underwriting side of it is that they’ll be looking at the progression of the disease. So if the pulmonary side of it, the infiltration, the scarring, and then fibrosis, if it remains stable over a couple of years, then life insurance terms can be given. If it starts to progress, then the underwater is going to be a lot more concerned because if it’s progressing and treatment isn’t really helping or slowing down that progression, then we’ve already talked about the end game there. Absolutely. I was going to say, is there anything there? I’ve run through probably quite a bit, which I apologize, but

Kathryn (23:47):

No, it’s fascinating.

Matt (23:48):

Is there anything that jumps out?

Kathryn (23:51):

There’s a couple of things that I thought would be interesting to just go over. So just things that come my mind. So when you were saying about how sarcoidosis it is an information of the tissue and it starts to, in a sense, grow in a sense, could there be, not a misdiagnosis but a confusion for, I’m just wondering, could somebody be worried that they may have cancer? Because obviously we’re taught that with cancer we get tumors, change of tissue and the way that it looks and things like that. For somebody without obviously the medical knowledge and even for somebody with medical knowledge cause they’d need to have all the tests done, could we potentially seen things that would maybe be presenting as a skin cancer kind of looking situation or another kind of lump?

Matt (24:43):

If we go right back to the very beginning, I suppose the symptoms here, shortness of breath, for instance, chest pain, getting cardiac chest pain for a second, then of course those symptoms can be a whole variety of medical conditions or lead to, and that’s hence why you go for tests and they will have a look. My understanding is that once you’ve had your test x-ray then and the associated tests, things like hypercalcemia, then sarcoid is pretty easy to diagnose. That’s not to say that if there is an even smallest chance of a malignancy of some sort that the doctors will, what they will do is go in and take a biopsy

Kathryn (25:38):

Biopsy

Matt (25:39):

Just as a precautionary measure. So that’s where I would be on that one. I think it is a lot of things what our listeners would need to do if they’re worried about that is go and see their doctor or the doctor will arrange for the tests, the tests that are applicable to the symptoms and then you go on from there.

Kathryn (26:07):

Absolutely. Okay, so I’ve now thought of another one, so well yeah, so the next one is, I know you said that it can go to remission, so it is possible. Is it possible to completely recover or is it always going to be kind of there in the background?

Matt (26:22):

No, completely recover.

Kathryn (26:23):

Okay, brilliant. That’s obviously very, yeah,

Matt (26:25):

Nobody ultimately knows why the immune system suddenly switches on and why it switches off in terms of attacking the body. I would say as long as I get over my man flu, which could be terminal of course, I think as long as I live to the average age, then I would suggest that we’ll know an awful lot more about how the immune system works and how we can switch it on and switch it off as opposed to the body doing it than we know today.

Kathryn (26:58):

Absolutely. I was going to say

Matt (27:00):

Fantastic. Some of the stuff that goes on these days.

Kathryn (27:02):

Definitely, and I was going to say, I did just giggle there when you said about being terminal, but I think it’s just because I don’t want anyone to think I’m being flippant with that. It’s just that me and each other quite well, we speak beforehand and we have a good, we do giggle with each other. It is our humor to potentially giggle over something like that because I’ve certainly been in that situation as well where it is just that kind of thing where you use call, say I’m dying, I’ve got this kind of

Matt (27:24):

Thing. Oh no, sorry, apologies. Apologies to everybody. It’s my black humor.

Kathryn (27:29):

No, I was going to say I’m there with you as well with that. So

Matt (27:32):

You’re a medical person, you tend to even use it even in a very helpful way. So do apologize to everybody. I’m not dying into No, no,

Kathryn (27:42):

No, no, no. I was saying it’s just the fact that I’d giggled when you said it, I was wanted to make sure I wasn’t hopefully offending anybody. Yeah, exactly. I don’t want to offend anybody, but no, I completely get that. My parents are police officer, so dark humor is ingrained into me

Matt (27:57):

Completely over my head, Kathryn, which really just points point. Yeah, there you

Kathryn (28:05):

Go. So the other thing is before we start going into what you would really need to know as an underwriter to give a pre-sales indication, is this thing about let’s say potentially is there a long covid connection? Because I say it’s something that we’ve not seen lots of, but then I’d say post covid we’ve seen it more and it’s been quite a jump more in a sense just even for myself, not even necessarily speaking to us of my team, but I’ve gone from pretty much not hearing about this from a client before Covid. I’ve got quite a few that we’ve been supporting and then that I’ve personally spoken to. So is there a potential link or is it again one of those things that we just don’t know long covid could be in a sense, a bit of everything in anything.

Matt (28:50):

Yeah, I would always have to say particularly as an underwriter and having an inkling to the actuarial science behind underwriting numbers that we’re still in a far too early stage of really understanding the damage of covid and long covid as well. But nevertheless, my personal take on this and I’m willing to be shot down by anybody is that what we’re finding is that people are being investigated for covid and during those investigations they’re finding sarcoid, which the client didn’t know. They simple view on it, but literally we are finding more because they’re being investigated in the pulmonary area, the lungs area in particular or other things. And in fact, of course it’s not just investigating the lungs with covid, it’s investigating all the organs as we’ve found out sadly, that a lot of organs can be attacked by covid or impaired by covid, damaged by covid. And I would guess, and it is a guess, educated guess possibly that we are finding people who had not been diagnosed with sarcoid previously. That would be my take on it. Whether there is a link there possibly is a link in the purely medical side of it. There may be a link, but I think the link is more testing and they’re finding things which they didn’t know about.

Kathryn (30:38):

Okay, then interesting.

Matt (30:39):

So sorry, not a particularly technical answer, but

Kathryn (30:42):

No, no, I find it really

Matt (30:43):

Interesting to be honest with you. I think, I can’t think of them off the top of my head, but there are other examples of that type of thing in the medical world where they look for A, but then they suddenly find B.

Kathryn (31:00):

Absolutely.

Matt (31:02):

It’s an interesting one, but that will be where I would put my five pounds as of today’s date

Kathryn (31:09):

That it’s something that basically something that’s been there, but the long curve has just led to the investigation in a sense. Yeah, interesting. As well as I know we’ve spoken just between us as well, obviously I’m always open about the fact that I have pots, which is postural orthostatic tachycardia syndrome and I’ve had it all my life and my symptoms probably got, I was going to say they get more increased. They’ve not necessarily got more increased as I’ve got older. I think now that, well long line of things, obviously the hyper mobility syndrome, when I was diagnosed with it when I was 12, I was told to stop all exercise because at that time the rule was stop exercise because, and especially with the amount of injuries I was having, it was basically we really need to do this. And then obviously as I’ve gotten older and that I’ve gone, you know what, actually no, I really do need to exercise.

(32:00):

I need to make this work. And so actually I know the symptoms pre stop exercising matched my symptoms now in a sense. So I’ve definitely always had it, but it’s interesting. So it’s obviously a bit of a genetic thinking that with me is that, and I was speaking about this before Matt, is that my mum is probably the person that I get a lot of my hereditary stuff from and she’s not really been symptomatic of pots. I mean there’s maybe been some very, very light indications of it, but she suddenly, and obviously she’s had a covid vaccine and all of a sudden the pots has suddenly gone wild with her really, really intensely and I know she won’t mind me talking about her. So it is just interesting that because again, that’s that kind of thing of, well, it’s not necessarily that Covid has developed something like pots, it’s possibly just been there very likely being there underlying and it’s just gone. No, let’s have a moment. So really fascinating to obviously hear it from that kind of an angle.

Matt (33:04):

Yeah, it’s interesting. I mean we’ve spoken before, I think one of the first chats we ever had was I film, we’re very lucky, man. I’ve been in the underwriting world for 43 years now. What a fascinating world that we have in medicine and particularly over the last 10 years or so that it just changes things or it can change things almost on a monthly basis. And to have a job where the fundamentals work like that is quite incredible really. So yeah, I’m looking forward to the future in medicine. I think it’s incredibly interesting part of the world or part of our lives at the moment.

Kathryn (33:50):

I was going to say I find it, I was going to say I find it interesting, but sometimes I do worry myself because I also as well, I know I don’t obviously have the same level of training or understanding as an underwriter, obviously I do do my best obviously to learn a significant amount about a lot of medical conditions and I’m serious, same for a lot of people. You can’t help sometimes but come across a condition and go, oh, I’ve had that, I’ve definitely had that symptom. And you almost start to, there’s some people sometimes in my team where they’ll a couple life and I’m just like, no, you can’t do that to yourself kind of thing. And obviously you do listen and if there is anything you think, right, you know what, yeah, let’s go and maybe get checked or things like that, but so many common symptoms of so many different things.

Matt (34:31):

Well, it’s one thing that comes out time and time again, isn’t it in our chats that what are the symptoms and goodness gracious, you could probably pick half a dozen of the symptoms as you’ve had in the last few months. I do know of train underwriters who have had to get out of that particular role because they’ve so worried and anxious about what they’re reading. Absolutely. And reflecting back on them. So no, completely necessarily understandable. And on the other side, it can help. Having had this and a lot of our listeners will know it, having had stage three cancer, my wife having stage two cancer and knowing about it in a quite detailed way was actually quite useful I suppose with both of us. The statistics, well, and because you know about it to quite a relatively in depth degree, it kind of leads to a degree of control of the outcomes. The likely the probable outcomes. The probable outcomes is a good way of putting it. So it can be a good thing, but people, it’s everyone to their own really.

Kathryn (35:50):

Yeah, absolutely. I think some people would love to not know, and then some people would to as much as possible,

Matt (36:01):

The people I take my hat off to is the people that work on the claims teams protection claims teams about thinking about, oh my goodness. Because Under Ice can say, oh yeah, but highly unlikely a claims person actually knows what those symptoms were and what it eventually ended up being. So I really do take my hat off to those guys. It’s an incredibly difficult job for a whole variety of reasons.

Kathryn (36:30):

Absolutely.

Matt (36:30):

It’s interesting, but luckily there are people around who want to do it and find it. I’m not sure if it’s the right term to use, but interesting.

Kathryn (36:39):

Yeah, and I was going to say I imagine as well rewarding even though it’s obviously not pleasant, what I’m dealing with. Yeah, huge, huge. Hugely rewarding. I was going to say, I’m doing claims stats next episode, so I will talk a little bit like that and I’ll talk about probably the pros and cons of what a claim is underway to experiences I imagine to a certain extent. Obviously I know I’m certainly not there in them, but I imagine there’s definitely positives and negatives to the jobs, just as with any of us, and we’ll go into that a little bit. So Matt, in terms of osis, my idea is that I’d be saying to somebody when were you diagnosed with osis, what treatments did you have? When did they end? What parts of you were affected and any ongoing symptoms. Is that a good range? Is there something I’ve missed?

Matt (37:33):

The only thing I’ve run those through in my head again, so first of all is date of commencement. When were you first diagnosed that my second question would be, which part of the body so that you’ve covered that, what treatment you had, when was the date of your last review?

Kathryn (37:58):

So

Matt (37:59):

Outpatient’s review and are you still being reviewed?

Kathryn (38:04):

Yeah, if you’re been discharged or not. Yeah,

Matt (38:06):

Yeah. Still being reviewed or what is useful there from underwriters, what’s the date of your next appointment? Although when you’ve just asked when was you last review and you’re being reviewed every six months. Did I say that? How often are you being reviewed?

Kathryn (38:22):

No, I don’t think we did do. I don’t think we,

Matt (38:25):

Because then obviously you don’t have to ask when’s the dex date review

Kathryn (38:30):

And how often the reviews can be really useful as well can with diabetes and if somebody’s saying to you it’s really well controlled, but they’re like on a four monthly review and that’s been quite consistent and will be going forward and that would, I wouldn’t usually expect somebody with well controlled diabetes to be on such a short review frame. I mean if it was really recently diagnosed, depending upon they might have had a bit of a blip in the medication or of a reading at some point then maybe, but you would usually expect it. I think quite a lot of the time I would expect diabetes to be just more of an annual test. Now would that be right in saying that

Matt (39:05):

I think it’s more six months. Six months every year. I think one of the challenges I would throw it in, and you’re absolutely right by the way that it is a very useful guide, is that I believe that there are guidelines, probably nice guidelines to how often people should be followed up that I know there is, but I’m not entirely sure that the NHS have got the ability to follow up people as often as they used to.

Kathryn (39:31):

Yes, I would say, and when we’re saying about the next appointment date as well, I think that’s kind of a

Matt (39:37):

Throw

Kathryn (39:37):

Pin at a data board of calendar isn’t it really is to sort it when it might happen.

Matt (39:42):

So I’ve just warned at the moment for Android in particular, but they will know this, it’s just a bit hit and miss, particularly with the NHS and when these things are actually followed up with all the doctors as well going on strike and so on and so forth, nurses going on strike, then these things can get very, he

Kathryn (40:01):

Absolutely.

Matt (40:02):

I think with diabetes in particular, I know it’s not the subject we’re talking about today, home testing testing is now coming out to be really, really strong. Same with rate, blood pressure that I think underwriters are looking more using that type of evidence now, taking more notice of it than maybe we used to. And then you get back into tracking devices and using that, using those, not for those two particular points, but that’s another story for another day. I was going to

Kathryn (40:36):

Say, this just reminded me of something. So as you know, I went to Lucid recently, so for anybody advisors listening at Lucid is a conference that’s really kind of geared towards claims underwriting actuaries, but incredibly fascinating, especially if you do work in the space that I do, which is helping people really specifically usually with health risks. And it’s the first time I’ve ever been really, really glad that I went there. But just with you saying about the tracking, there was a person there called Lisa Alboa and incredibly intelligent, really into data tracking devices, wearables, all this kind of thing, and she mentioned there was somebody on her stall and they mentioned to me about this app that she’s sort of had and she was using and they’d put it up on the screen as well, her and a colleague, and it was all about using this app on your phone to look at your, it basically looks at your face and scans your face and it gives you so much data.

(41:36):

It tell you, I think it tells you your heart rate just from scanning just on your facial recognition thing on your phone, your heart rate, your breathing regularity, your skin quality, quite a few other things as well if you put in some extra bits of data and it was just like, that’s actually really, really fascinating. I can’t imagine at the moment that that would be something that would be, I can’t imagine us suddenly going to that for underwriting, but it was just so fascinating to see how much it can do. We were even showing what the showed you on the screen, what the software is seeing and how it’s looking at different things and picking it up. And I was personally very happy. I did do the app and it said that my skin is 11 years younger than I actually am. Wonderful. Very, very pleased with that.

(42:29):

And I think some of my readings were better than Alan’s and obviously I was very happy because it’s always a competition between the two of us. But yeah, it was just really fascinating to see that and to think, you know what, actually this could be so good. Potentially identifying things and the amount of stuff that’s just happening now where it’s just so easy to do it on your phone is incredible. Okay. I know we’ve got a bit of a side tension. There are, so we’ve done all those questions to the person that we’re helping with. Are there any linked conditions or specific long-term symptoms that we should be really trying to look out for? Because obviously if we put in sarcoidosis on an insurer’s application, it’s probably going to ask us some of those things that we’ve just said. So when we are diagnosed, are you discharged or not? Have you needed to take maybe some of these medications? I can’t off the top of my head remember what the application questions are, but there will come

Matt (43:23):

Apart. You vary anyway, don’t they?

Kathryn (43:24):

Yeah, they do, but there will come a point where we won’t necessarily capture everything in that application that will actually be absolutely integral to what the underwriters will want to know from that GP report. And obviously if we can capture it first off in the beginning, then we can maybe help to in a sense, save everybody a bit of time if it ends up being a bit of a no go with one insurer, but a yes with another one. So is there anything else on top of that list that we should be looking out for?

Matt (43:54):

I’m not sure about top of list in terms of extra lists, but what I would look out for is the damage to the organs that we’ve talked about. So you’ve got lung, I don’t think I’d worry too much about skin hypercalcemia. You want to look out for liver, kidney, so it’s the end damage to those that you would want to look out for really

Kathryn (44:19):

Basically. And obviously heart, obviously I mentioned before side

Matt (44:22):

Things, sorry.

Kathryn (44:23):

Absolutely right. So basically we’re kind of doing an around body organ check, but I think probably from an advisor point of view that the best that we can do is probably say to somebody in a sense, what were the symptoms, which organs were affected. I think that’s probably the safest bit for us.

Matt (44:43):

Yeah, absolutely. That should focus the mind. Yeah.

Kathryn (44:47):

Brilliant. Okay, fantastic. So in your opinion then as we’re coming towards the end of the episode, what is the most likely outcome for life insurance, critical illness cover income protection and maybe I think if we’re looking at the extreme ends, then we’d know that we’d be super specialist anyway. So maybe if we look at we sort right to one that’s mild, that’s been very, very mild, potentially recovered from, and maybe someone who’s a bit, I don’t know if that’s possible.

Matt (45:15):

Well, mild, mild, low progression remission for a year. It can be standard rates. I would say for kick then you would be saying that income protection is always a difficult one. I would probably say either a small loading, I wouldn’t look at excluding to be honest with you, but I’m not really a great ex anyway as an underwriter.

Kathryn (45:45):

Everybody wants to know maths, all the advisors in the land’s, like I want maths.

Matt (45:50):

Oh well, music’s my ears a small loading or if it’s after two years I would’ve said then standard rates. Okay, and

Kathryn (46:01):

Is that across the board? So mild we’d expect standard, but for kick in ip, maybe a bit of a rating, but we would hope after a period of time

Matt (46:10):

Think I would look at KI in a, excuse me, in a forget I’m not including necessarily only occupation TBD in way. Oh

Kathryn (46:21):

Yeah.

Matt (46:22):

But straight kick. I would look upon it in a more favorable way than I would for income protection just because of very nature for critical illness, you need to have a definite diagnosis of A, B, C. Yes. The income protection as you very well know when you paid out if you’re off work for over after a given time.

Kathryn (46:45):

Yeah, and I was going to say on the kick side of things, we’re talking, obviously sarcoidosis isn’t in nameable condition, so we’re talking it’s only within the TPD aspect and obviously that that’s often quite hard.

Matt (46:59):

You’ve got transplants of course.

Kathryn (47:01):

Oh yeah, of course. Yes.

Matt (47:02):

Yeah. You could know with the my teeth have fallen out hypercalcemia. You’ve got the kidney failure. So more in there. That’s why an underwriter would be interested in just the definition of sarcoid if you want. Sorry, the diagnosis of sarid within the critical illness plan. So there are a few of those areas that could be covered in terms of middle range. Again, we are talking about somebody, let’s say, let’s just go basic here. We’ll look at a person. So we’re looking at a person who is still on treatment, but there’s no progression. I think you’re looking at life at 50.

Kathryn (47:51):

So just be clear for anyone who’s not familiar with that, that means plus 50% of the premium. I’ve just suddenly thought, could somebody listening think you can get it once you’re 50 years old.

Matt (48:01):

So what does plus 50 mean? I’m afraid I’ve grown up that since I was 18 years of age about give or take one and a half times a little bit lower than the basic ordinary premium. Right? For kick. Then I think it rather depends on you’re going to bring in the treatment on this, I suppose you would for life as well. The level of say, let’s say Prednisolone, I think I’ll probably be looking at maybe plus 50 75, maximum income protection. I would have to take, I’m going to be very boring and say individual consideration here.

Kathryn (48:39):

Yeah, I can appreciate that. Because it doesn’t take,

Matt (48:42):

As you know, there are so many variables.

Kathryn (48:45):

Yeah,

Matt (48:47):

You are looking at things like occupation for a start would immediately spring to mind with somebody.

Kathryn (48:54):

I was going to say on the income protect side, would this be because I know I’ve experienced this sometimes, so again, just in case an advisor hasn’t experienced this, sometimes with some condition you can have a bit of an enforced minimum deferred. So it might be that somebody might say, well we can maybe offer this. There might even go, there’ll be evading, there might even be an exclusion and it needs to be at least a three month deferred period on it. So I imagine that we might fall in the realms of that potentially. I,

Matt (49:24):

Yeah, I would say so. I don’t think I’ll be looking at four weeks deferred period. So I think you’d be looking at 13 or 26. Yeah, yeah. 13. I hope because again, I’m a huge believer in income protection. It’s my favorite project product to be honest with you. I love

Kathryn (49:40):

It.

Matt (49:40):

Absolutely. Especially to underwrite as well, as well as the benefits that it gives to the client. But if somebody is self-employed or so on and so forth, and they’ve got their income stops after even four weeks giving them a D 26, very much a default position for me, really try and get down to the D 13 because need to make sure that the plan has some use.

Kathryn (50:08):

Absolutely. At end,

Matt (50:11):

Once you get to D 26, D 52, you’re looking at, well not D 26 maybe, but D 52, you’re looking at almost like TPD cover in a way.

Kathryn (50:20):

Yeah, absolutely. I know what you mean. It works well with very, it’s dependent upon sick pick can work very well the term 52 or potentially if obviously if they’ve got significant savings that they can draw on and things like that again, then yeah,

Matt (50:38):

It’s variability. It’s the great thing about the variability of income protection.

Kathryn (50:42):

I know how flexible it’s

Matt (50:44):

Yeah, absolutely. Both at sale and at underwriting and a claim. Does that matter? Yeah.

Kathryn (50:49):

Fantastic. Well I’ve got a little, does that help? Yeah, it does. I’ve got a little case study to finish us off there. So somebody who we supported who’d had sarcoidosis in the past, so it was a female, she was in her late forties and she was a non-smoker. So she’d had sarcoidosis almost 10 years prior to us doing the application. It had just affected the skin on the forehead and the shins. There had been some previous steroid medication. I know we mentioned that earlier about the steroid side of things and the last symptoms had been five years before the application. We had a good period of time. There was some additional factors though with this person. They also had type two diabetes and fatty liver. So when it came to looking at the insurance for their mortgage, we were able to do them decreasing life insurance of 350,000 pounds of 15 years at around 84 pounds per month.

(51:41):

So that’s I think a really good example to say to people, we do have a condition here that is rare discussed as a rare condition and it is not something that’s going to come across much. It is something that can be mild right through to very extreme. But even with this situation, we have a mild situation here. The condition, there’s additional factors here that will have impacted upon the underwriting of the application, but we still managed to get cover. It’s not a phenomenally out there out of the way premium as we can sometimes see. It is obviously still quite a high premium, but for the factors that we’re looking at, it’s quite well says quite a good premium for the different things we’re looking at. So when you do see something and it is rare and then you maybe see something else as well, don’t assume that, then that means, oh actually that’s it. I’ve already got this and this that they’ve told me about. I know that they’re not particularly easy to get underwritten now they’ve got this, never heard of it. NHS says it’s a rare condition, I’ve got no chance. It’s always worthwhile still checking and at the very least chatting to a specialist advisor who can potentially step in. Okay then. So thank you for listening everybody, and thank you as always Matt for your insights.

Matt (52:52):

My pleasure. Thank you for having me.

Kathryn (52:54):

Lovely to have you with us next time. Like I mentioned earlier, I’m going to be talking about claim statistics, so I have wanted to do it a little bit earlier in the year, but actually I found tensing, I think that most insurers release them about May. That’s go by May, but may for some reason why not Converses to every other month. It’s just one of those things. So I’m going to be going through that pretty much from the life and critical illness stage because it’s a bit easier to do some of the comparisons between the different insurers about just stick with the life and kick because not everybody works in the IP space. We’ll be talking about that. We’ll be talking about the times that claims don’t pay out as well. So that was the thing I was meaning earlier, Matt, when I was saying the negative side of things.

(53:30):

Sometimes with claims where people are speaking to people, they may be haven’t met the claim definition or something else has happened and obviously the claims handler is then having to speak to somebody who’s obviously in a very vulnerable space and how that can obviously have quite a bit of a fallout, not only for the person but for the claims handler too. Yep. If you’d like a reminder of the next episode, please drop me a message on social media or visit the website, practical home from protection.co uk. And don’t forget that if you’ve listened to this as part of your work, you can claim the CP D certificate on the website too. Thanks to our sponsors, the Optum members. Thank you Mads. Thank you. Goodbye. Bye.