Posted June 22, 2022
For those advisers that work in the field of protection, having a degree of familiarity with common medical conditions is a great way of elevating yourself from your peers and demonstrating to your clients why advice adds value.
When a client discloses a pre-existing medical condition, whether early on in the conversation or during the application process, this is an opportunity to build that trusted adviser status that we are all seeking to gain. Being aware of the condition, its impact upon daily life, the medications required, prognosis and treatment pathways will illustrate to your client that you are an experienced adviser who has their best interests at heart and are not looking to simply sell a policy.
Clients will, at times, have conditions that they are not comfortable discussing, or have a degree of embarrassment around them. By being familiar with the condition and being able to ask sensitive and relevant questions, a good adviser will be able to relax their client and build a stronger relationship during these meetings.
From a planning perspective, experience tells us that finding out about any relevant medical history as early on in the process of advising as possible is invaluable. Presenting critical illness options to a client with a history that would mean that they are not able to access this cover, as example, is not only a waste of research time, but can be frustrating to a client and an uninvited reminder of the constant impact their health is having upon their life.
Even the mundane, such as elevated BMI, is worth factoring in from the beginning of the conversation. No client likes to hear that the costings they were given initially will double as they are overweight.
Diabetes, especially type 2, is a relatively common disclosure that advisers will see frequently. It has a large impact upon the types of cover available and the corresponding premiums and advisers with a good understanding of this condition will differentiate themselves and be better placed to advise well in this area.
Fully named Diabetes Mellitus, this is a chronic and complicated condition that is characterised by high blood glucose levels that are no longer effectively controlled. This can lead to serious damage across the body, including the heart, eyes, blood vessels, nerves and kidneys.
In the UK there are 4.7 million people living with diabetes, of which 90% are type 2, representing one in ten of the over 40s. Of that 4.7 million, it is estimated that up to 1 million are undiagnosed and unaware; many advisers will have experience of sending clients for a paramedical screening only to see the case declined or postponed due to some very unsatisfactory blood results. By 2030 it is predicted that the UK alone will have 5.5 million diabetics in its population.
The most common type of diabetes is type 2, where the body has either become resistant to insulin (the hormone secreted by the pancreas in response to high blood sugar levels), or can no longer make enough to be effective. The main driver in the rise in the number of type 2 diabetics is the growing number of people who are overweight or obese. Type 1 diabetes, by contrast, is almost always diagnosed earlier on in life and does not have lifestyle as a contributing factor. The cause for type 1 diabetes is where the body attacks pancreatic cells, rendering them unable to make the insulin required for effective blood sugar control.
The symptoms of the high blood sugar levels created by diabetes include:
Excessive thirst and frequent urination (especially at night)
Unintended weight loss (type 1)
Cuts/wounds taking longer to heal
Tingling/numbness in the hands or feet (type 2)
Treatment for diabetes depends upon the type, and how well an individual controls their blood sugar through diet and lifestyle. For type 1 diabetics, every one will need to take insulin to manage their blood glucose levels as will some of the more severe cases of type 2. Type 2 diabetes is most commonly managed via tablets, with metformin being the most common, and lifestyle changes to diet, weight management and exercise.
Very often clients with type 2 diabetes taking metformin will be taking other medications alongside, to manage conditions such as high blood pressure, elevated cholesterol etc. It is always worth getting a list of these medications together, where possible, to aid underwriting the case.
Complications are diverse with diabetes and it is worth being familiar with these, as getting details up front from your client will avoid any last-minute declines from insurers or terms that differ greatly from those you expected. Eye problems (diabetic retinopathy), nerve damage (neuropathy) and kidney issues (nephropathy) are among the most common ones that will have an impact upon the cost and availability of life cover.
When presenting a case to an underwriter it is essential to have as much relevant medical history together as possible. With sufficient accurate detail, many underwriters will be happy to offer life insurance terms without recourse to a GP report, saving potentially many weeks of waiting. The main issue around diabetes underwriting is that the progression (or indeed remission) of the condition (with type 2 that is) is very much in the hands of the client and their level of control. Effective weight management, eating the right foods and maintaining good cardio-vascular fitness will all help greatly in managing diabetes well. The issue that an underwriter will have is in assessing how well they believe an individual will do in effecting this control.
HbA1c will be a key figure that an underwriter will use to assess your client’s level of diabetic control and is a measurement of glycated haemoglobin. Excessive sugar in the blood will bond to the haemoglobin in red blood cells (the process being called glycation) and this can be measured. With red blood cells surviving typically 8-12 weeks, it gives a good reflection of the average blood glucose levels over that period of time and is very useful to assess how well an individual is managing their condition.
Your clients may give you their HbA1c in one of two manners, either as a percentage or a value in mmol/mol (this is the default). A normal level would be below 42 mmol/mol, prediabetic (sometimes called glucose intolerant) between 42/47mmol/mol and then 48 mmol/mol or above will result in a diabetes diagnosis. Getting a recent reading, and if possible, a history of readings, will really help an underwriter give you an accurate indication of terms.
The following pieces of information, whilst certainly not exhaustive, should form the basis of the detail you collate to identify which company is likely to underwrite the case with the best terms offered, and it should allow you to give a client a reasonable indication of end cost, post-application:
Is the diabetes type 1 or type 2?
When were they diagnosed?
What was the most recent HbA1C reading, when was that taken, and how frequently it is checked?
How is the diabetes controlled; are they taking metformin, insulin etc or is the condition managed by lifestyle changes?
Any incidence of diabetic retinopathy, neuropathy or nephropathy?
Any hypo glycaemic episodes?
Height and weight?
Is their blood pressure in the normal range/well controlled?
If your client has had blood tests recently, were they normal?
This information, presented to a pre-sales underwriter at an insurer, will likely give you an accurate indication of the terms that will be available to the client post-application.
Type 1 diabetes case study
Grisham came to Watts with a long-standing history of type 1 diabetes. She is 54 and has been diabetic for over 35 years. Her control is average and as a type 1 diabetic she is reliant upon daily insulin injections. Her last three HbA1c readings, covering the past three years were 67, 81 and 79. Cholesterol, triglycerides and blood pressure were all within the normal healthy range as was her BMI. Grisham presented with a family history of heart disease which was relevant to most underwriters to be aware of. She had a single episode of hospitalisation due to hypoglycaemia in 2019 and had a degree of diabetic macular oedema in her right eye which was being closely monitored.
The combination of the long time that Grisham had been suffering from her diabetes, with the control level, eye issue and family history had made accessing life insurance difficult for her, and had been declined at two other insurers before she reached out to us for advice.
We were able to source life insurance here at a rating of +250% with a fully medically underwritten policy
Type 2 diabetes case study
Baljinder is age 55 and had been type 2 diabetic for three years. He had a strong family history of diabetes with both his sisters being diagnosed since age 30 and his mother passed away at age 50 from heart disease linked to her diabetes. Baljinders’s BMI was a healthy 25 and he was managing his diabetes well without the need for any medication. His most recent HbA1C was 61 and he had no complications such as neuropathy or retinopathy. With cases such as this, we found all insurers were happy to accept a life insurance application, and placed this again as a fully medically underwritten policy at a rating of +100%