Ask the underwriter: alcohol

Why is it important to assess the risk with regards to alcohol?

Most people think about alcohol in terms of the potential to become an alcoholic and the associated risks of that – liver disease and liver cirrhosis tend to spring to mind. Although liver disease remains relatively rare, figures from the British Liver Trust show that since 1970, deaths due to liver disease have increased by 400%. Alcohol-related liver disease accounts for 60% of all liver disease, and liver disease is the biggest cause of death in people aged 35 to 49.

There are, however, a lot of other conditions that can be exacerbated by the level of alcohol intake. The most common ones are breast cancer, increasing the risk of stroke, increasing the risk of cardiac arrhythmias where the heart doesn’t beat properly (it may be too fast or beat erratically), diabetes, high blood pressure and other cancers such as colorectal cancer.

Customers are becoming more aware of the risk associated with alcohol and breast cancer through publicity campaigns that the NHS undertakes but even so the many associated risks of alcohol may not be within the awareness of customers and advisers. As an underwriter we need to understand how much alcohol a customer is consuming and whether there could be any increased risks on their life expectancy, health or levels of disability.

What questions do you ask about alcohol?

We looked at how we asked the questions a few years ago because we could tell that nobody really understands units. In fact, a survey of around 600 trainee doctors published by the Royal College of General Practitioners in 2014 found that 18% of them had no knowledge of alcohol units despite that fact that 82% of them thought they had good knowledge. When asked how many units are in a bottle of wine only 31% of them got the answer right. [If you’d like to test your knowledge you can find the answer at the end of this article.]

We took some of that research and looked at what the NHS was doing in terms of how to ask about alcohol and mirrored our questions to AUDIT-C, an alcohol screening tool used by nurses and doctors. It asks how often you have a drink containing alcohol, how many units of alcohol you drink on a typical day when you are drinking and how often you have six or more units if you are a female or eight or more if you are a male. However, we changed it from units to drinks.

For some people a drink could be a small glass and for others a drink could be a large glass but it gives us a general indication of how much someone is drinking and the pattern of drinking so that we can try to identify binge drinking. We also ask if the applicant has been told they have liver damage, advised to reduce their alcohol consumption or if they have attended an alcohol support group. And we ask if the applicant has been banned from driving due to drink driving, in which case we request a GP report to identify instances of problem drinking and alcohol-related health conditions.

How important is the pattern of consumption?

We look carefully at the frequency and pattern of alcohol consumption, allocating a higher score to those who consume more in a single sitting. We would view somebody who goes out and parties on a Friday and Saturday night and each time they have ten drinks as a higher risk than someone who consumes the same amount but spaces it out throughout the week. Drinking a lot of alcohol in one go puts stress on the liver, heart and affects blood pressure. We also bear in mind the accident risk that comes with binge drinking. If you drink a lot of an evening there is a strong chance you are over the limit the following morning, putting yourself at greater risk of having a road traffic accident.

At what level would you start to get concerned about alcohol intake?

We equate one drink to two units of alcohol and our ratings typically start when the total number of units is more than 30 per week (or 15 drinks). However, this varies depending on how often someone drinks, so it could be as low as 18 units per week if all the consumption is infrequent but a higher number of drinks, for example allowing up to 42 units per week if someone drinks every day but consumes lower amounts each time. We would go up to ‘plus 75’ or possibly ‘plus 100’ extra mortality risk (twice as likely to die than the average person) if this is purely for alcohol but there is a strong chance that other health factors will come into play. Once someone has a total unit equivalent of more than 50 per week (the equivalent of three or four drinks per day) chances are they are doing quite a lot of damage to their health and we would decline to offer terms. We would consider covering a recovering alcoholic depending on how long ago they gave up and whether there was lasting damage to their health.

What is the key takeaway for advisers regarding alcohol?

Alcohol is a very common area of non-disclosure and that is why this is one of the areas of questioning that we keep coming back to and taking another look. Often alcohol goes hand in hand with mental health conditions and/or drug use. In Britain, people who experience anxiety or depression are twice as likely to be heavy or problem drinkers. Advisers should bear in mind that if someone is under-disclosing in one area there is a chance that they may have under-disclosed elsewhere. So if you are getting disclosures about mental health, make sure you check the alcohol questions and vice versa. It’s always best for clients to tell the truth, give us all of the relevant information and then we as underwriters can look at the overall picture and determine the correct acceptance terms.

Q: How many units of alcohol are in a 75cl bottle of wine that has 12% alcohol by volume?

A: Nine units