Underwriting

• Delegated underwriting – allows your client to complete sensitive questions in the comfort of their own home, speeding up the process.
• Interactive underwriting rules –  asks the relevant questions to drive more instant decisions.

• Alternative terms – provides flexibility and choice in offering different outcomes to the client at the point of decision allowing budgets to be kept. This avoids the need to begin the application from the beginning, saving time for you and your client.
• Contractual change - multiple changes can be made, all controlled by you as an adviser on our new adviser portal. Medical evidence being valid for 12 months.

• Pre-application underwriting helpline – providing direct contact with experienced underwriters who can give guidance prior to submitting the application.
• e-AMRA – allows your client to electronically provide their consent to obtain medical evidence, reducing the time to make a decision.
• i-GPR – embracing digital technology where General Practitioners will provide a digital medical report, speeding up the process.
• Links with Square Health, Medical Screening Solutions, and Medicals Direct Group – allowing flexibility when choosing a medical examiner with a mobile screening service and faster booking of appointments.
• Web-chat – interactive real-time support during the whole of the application journey.
• Real time underwriting updates via adviser portal – greater control and understanding of where your client’s cases are, reducing time spent chasing for updates.

Description

Angina is chest pain caused by restricted blood flow to the heart muscles. This could be a warning sign that your client is at risk of having a heart attack or stroke. It’s possible to control the symptoms through treatment and lifestyle changes, subsequently reducing the risk of more serious problems.

Information we'll need from your client

• How long ago it was diagnosed
• Date of last symptoms
• Details of any outstanding tests, investigations, consultations or referrals.

Evidence we'll require

Where terms may be possible, we will request a report from their GP asking for full details.

Terms we could offer

When terms may not be offered

• If the customer is 39 or younger
• If the application is made within six months of the diagnosis, or the condition is considered unstable
• If the customer has also been diagnosed with diabetes.

Description

Arthritis is a range of disorders that cause pain and inflammation in a joint. This could result in restricted mobility, or in more severe cases, problems with other tissues and organs in the body. The two most common types or arthritis are osteoarthritis and rheumatoid arthritis.

Information we’ll need from your client

• Client’s age
• Type of arthritis
• Affected joint(s)
• Details of any operations completed or awaited including dates
• Frequency and severity of symptoms
• Details of any outstanding tests, investigations, consultations or referrals.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

^{*Terms depend on occupation and number of joints affected}

When terms may not be offered

• Rapidly progressive or highly disabled
• Associated vasculitis or interstitial lung disease.

Description

Asthma is a common lung condition that results in occasional breathing difficulties, coughing and chest tightness. Preventative treatment with inhalers usually controls these symptoms, however, more severe symptoms may require treatment with tablets. If not controlled, asthma could lead to tiredness, mental illness and lung infections. A severe asthma attack could be life-threatening.

Information we’ll need from your client

• Frequency and severity of symptoms including date of last symptoms
• Treatment received both past and present
• Details of any hospital admissions
• Impact on daily work and personal activities
• Details of any outstanding tests, investigations, consultations or referrals.

Evidence we'll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

Smoking asthmatics will attract an additional +50% on top of the outcomes above.

Other factors that may impact terms include hospital admissions and associated disorders such as Chronic Obstructive Airway Disease (COPD).

If there has been no symptoms or treatment for more than 2 years prior to the application, we may be able to offer standard terms for all products.

When terms may not be offered

• Poorly controlled asthma with a history of hospital admissions and significant treatment such as oral steroids.

Description

Back pain is very common and in most cases not caused by anything serious. With the correct treatment this usually gets better over time, however, the pain can sometimes last a long time or keep coming back. Treatment is usually in the form of therapy, such as physiotherapy, with more significant back pain requiring a combination of therapy and medication or even surgery. 

Information we’ll need from your client

• Frequency and severity of symptoms including date of last symptoms
• Treatment received both past and present
• Impact on daily work and personal activities
• Details of any operations completed or awaited including dates
• Details of any outstanding tests, investigations, consultations or referrals.

Evidence we’ll require

In most cases we will offer terms from the information provided on the application. If we are unable to do so then we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• With nerve root compression causing neurological deficit (including bowel or bladder problems)
• Significant impact on health and wellbeing.

Description

Breast lumps have lots of different causes. Usually there is a harmless cause such as a non-cancerous growth or an infection (mastitis), however, sometimes there is a more sinister cause such as cancer.

Information we’ll need from your client

• Diagnosis including cause, if known
• Whether any change in size and shape
• Details of any treatment completed or awaited including dates
• Outcome of any tests or investigations.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

^{Terms will be dependent on the exact diagnosis}

When terms may not be offered

• Confirmed malignant.

Description

The fundamental cause of obesity is the consumption of excess calories, although other factors may also contribute. Obesity can lead to many health problems including diabetes, heart disease, stroke and some cancers. There are many ways in which a person's health in relation to their weight can be classified, but the most widely used method is body mass index (BMI) as it corresponds very closely to the actual mass of body fat.

 

Source: https://www.nhs.uk/live-well/healthy-weight/height-weight-chart/

Information we’ll need from your client

• Height
• Weight.

Evidence we’ll require

In most cases we will offer terms from the information provided on the application. If we are unable to do so then we may need to obtain a medical examination or doctor’s report.

Medical evidence and BMI Calculator

Work out what medical evidence is needed across a combination of benefits

Use the Medical evidence and BMI Calculator tool

Terms we could offer

When terms may not be offered

• Associated risk factors present such as heart disease, raised blood pressure or cholesterol.

Description

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs. Cancer sometimes begins in one part of the body before spreading to other areas. This process is known as metastasis. There are more than 200 types of cancer, the most common being:

• Breast cancer
• lung cancer
• Prostate cancer
• Bowel cancer.

Information we’ll need from your client

• How long ago it was diagnosed
• Type of cancer and whether it has spread
• Details of any treatment completed or awaited including dates
• Outcome of any tests or investigations 
• Details of any outstanding tests, investigations, consultations or referrals
• Any details such as TNM scores, Gleason scores or staging information will be very helpful

Evidence we’ll require

Where terms may be possible, we will request a report from the GP asking for full details.

Terms we could offer

Cancer is a complex condition to underwrite and our decision will be based on many factors such as cancer type, size, treatment and time since treatment completed. Terms range from standard to decline. Where terms are possible for critical illness, Cancer will be excluded in addition to any rating.

When terms may not be offered

• Incomplete treatment
• Uncontrolled growth
• Stage 3 or higher
• Diagnosis within the last 2 years
• Not discharged by specialist unless for annual review only
• If there are any outstanding tests, investigations or referrals

Description

Cholesterol is a fatty substance known as a lipid that is vital for the normal functioning of the body. Having an excessively high level of lipids in the blood (hyperlipidaemia) can have an effect on health and could lead to serious health problems such as heart disease and stroke. Lipid levels can usually be controlled through diet and exercise or a drug known as a statin.

Information we’ll need from your client

• How long ago it was diagnosed
• Treatment received
• Last levels or how these were described
• Details of any tests, investigations, consultations or referrals completed or awaited.

Evidence we’ll require

In most cases we will offer terms from the information provided on the application. If we are unable to do so then we may need to obtain a medical examination or doctor’s report.

Terms we could offer

Where the lipid levels are controlled we will usually allow standard terms.

When terms may not be offered

• Uncontrolled raised lipid levels
• Poor compliance with treatment.

Description

Crohn’s disease is a chronic inflammation commonly affecting the intestine, but which may also affect any part of the gastrointestinal tract. Symptoms include diarrhoea, weight loss and rectal bleeding and can be a risk factor for colonic cancer.

Information we’ll need from your client

• How long ago it was diagnosed
• The number and severity of attacks
• Treatment received including whether surgery has taken place
• Details of any tests, investigations, consultations or referrals completed or awaited.

Evidence we’ll require

In most cases we will offer terms from the information provided on the application. If we are unable to do so then we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Surgery within the last 6 months
• Significantly underweight with active disease
• Requires nutrition through a tube
• Liver function abnormalities.

Description

A chronic condition associated with abnormally high blood sugar levels due to the body’s inability to produce sufficient insulin (or to respond to the insulin it produces). With Type 1 diabetes – no insulin is produced by the body and insulin injections are required. With type 2 diabetes – not enough insulin is produced by the body, or the body produces insulin but becomes resistant to it. Complications linked to diabetes include heart disease, stroke, kidney failure and blindness.

Information we’ll need from your client

• Type of diabetes
• Date diagnosed
• Details of any associated complications such as kidney, foot or eye problems
• Any hospital admissions
• Length of time off work, if any
• Latest HbA1c, blood sugar or how these were described to the client e.g. normal, raised etc.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

 

When terms may not be offered

• Critical illness Select will be declined for all diabetics
• TPD and income protection are not available if there has been any time off work
• Personal history of heart disease, stroke or diagnosis of chronic kidney disease
• Life cover only is available to smoking diabetics
• BMI >40
• hbA1c blood test result >11%

Description

A brain disorder that causes recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. It is usually diagnosed following an electroencephalogram(EEG). There are many types of epilepsy including simple and complex partial seizures, tonic-clonic seizures and absence seizures.

Information we’ll need from your client

• Diagnosis including type
• Date of diagnosis
• Frequency and severity of attacks
• Date of last seizure
• Treatment received and/or any ongoing treatment or medication
• Outcome of any tests or investigations.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Full evaluation/investigation incomplete
• Diagnosed less than 6 months ago
• Multiple episodes of status epilepticus
• Presence of personality changes
• Alcohol misuse
• Non-compliance with treatment.

Description

The medical term for a heart attack is ‘myocardial infarction’ and occurs when the blood flow through the heart vessels is blocked. The heart muscle becomes starved of oxygen and is permanently damaged as a result. The main symptoms of a heart attack include chest pain, shortness of breath and dizziness.

Information we’ll need from your client

• Age at diagnosis
• Severity of the heart attack
• All investigations completed
• Any treatment given
• Details of smoking history, height and weight, blood pressure and cholesterol readings.

Evidence we’ll require

We will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Suffering a heart attack under age 40
• Heart attack within the last 6 months
• Continuing unstable angina
• Severe ongoing symptoms
• Also suffering with diabetes or had a stroke or TIA.

Description

High blood pressure is also known as hypertension and means the heart has to work harder to pump blood around the body, increasing the risk of developing heart disease or suffering a stroke. Hypertension rarely has any noticeable symptoms, the only way to find out if your blood pressure is high is to have it checked.

Information we’ll need from your client

• How long ago it was diagnosed
• Treatment received both past and present
• Latest blood pressure reading
• Details of any tests, investigations, consultations or referrals completed or awaited.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Non-compliant with treatment
• Poorly controlled
• Associated risk factors including smoking, high cholesterol and obesity.

Description

A common condition that affects the digestive system causing stomach cramps, bloating, diarrhoea and constipation. The cause is unknown but is linked to diet, stress and family history. It can become a lifelong problem, treated through dietary changes and medicine.

Information we’ll need from your client

• How long ago it was diagnosed
• Details of any treatment completed or awaited including dates
• Outcome of any tests or investigations
• Details of any outstanding tests, investigations, consultations or referrals
• Length of time off work, if any.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• We would rarely decline for a definite diagnosis of Irritable Bowel Syndrome alone.

Description

There are a number of disorders affecting the renal system that may affect the kidney’s performance to filter blood and remove any waste products. Common kidney disorders include renal calculus (kidney stones) and nephritis (inflammation).

Information we’ll need from your client

• Age at diagnosis
• Type of kidney condition
• Any investigations completed
• Treatment received
• Current reading of renal function blood test.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Evidence of severe or worsening kidney function.

Description

A type of skin cancer that can spread to other organs within the body. The most common sign of a melanoma is the appearance of a new mole or a change to an existing mole. The biggest cause of melanoma is over exposure to ultraviolet light from the sun.

Information we’ll need from your client

• Age at diagnosis
• Type of melanoma including staging
• Treatment given.

Evidence we’ll require

Where terms may be possible, we will request a report from the GP asking for full details.

Terms we could offer

Cancer is a complex condition to underwrite and our decision will be based on many factors such as cancer type, size, treatment and time since treatment completed. Terms range from standard to decline. Where terms are possible for critical illness, Cancer will be excluded in addition to any rating.

When terms may not be offered

• Simultaneous melanomas
• Incomplete treatment
• Stage 4 melanomas.

Description

A mental illness is a condition that affects a person’s thinking, feeling or mood. There are a wide range of conditions including stress, anxiety, depression, bi-polar disorder and schizophrenia. Mental illness presents various risk factors including time off work, alcohol and drug misuse, poor lifestyle choices resulting in other conditions such as heart disease.

Information we’ll need from your client

• How long ago it was diagnosed and when the last symptoms were
• Treatment received both past and present
• Details of any treatment including hospital treatment
• Impact on daily work and personal activities
• Length of time off work, if any
• Whether any suicide attempts, self-harm or thoughts to do either
• Type of mental illness.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Suicide attempt within the last year or recurrent suicide attempts or self-harming within the last two years
• Suicidal thoughts within the last year
• Associated alcohol or drug abuse, current or in the past.

Description

An inflammatory disease of the central nervous system. Signs and symptoms include muscle weakness, tremor, disturbance of speech and vision, and bladder dysfunction. The most common type of multiple sclerosis (MS) is described as relapsing remitting MS. It’s characterised by recurrent attacks of symptoms with periods of remission in between. With progressive MS, symptoms continue to get worse over time, with no distinct periods of remission.

Information we’ll need from your client

• Age at diagnosis
• Type of MS
• Date of last attack
• Severity of symptoms
• Investigations completed
• Treatment given.

Evidence we’ll require

We will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Severe functional limitation i.e. ataxia, speech or swallowing difficulty.

Description

A stroke occurs when there is permanent damage to part of the brain caused by a sudden interruption in the blood supply. This can be due to a blockage in one of the blood vessels supplying the brain or a bleed in the brain. Most strokes occur when a blood clot blocks an artery.

Information we’ll need from your client

• Age at diagnosis
• Type of stroke
• Severity of symptoms
• Date investigations completed
• Treatment given
• Any ongoing disability or complications.

Evidence we’ll require

We will request a report from the GP asking for full details

Terms we could offer

When terms may not be offered

• When the client also has diabetes, all cover will be declined
• Diagnosed less than 6 months ago
• Severe disability affecting daily living.

Description

Chronic inflammation of the colon and rectum due to the formation of small ulcers that can bleed and produce pus. The main symptoms include diarrhoea, stomach pain and tiredness.

Information we’ll need from your client

• Age at diagnosis
• Frequency of attacks
• Date of last attack
• Investigations completed
• Treatment given including any surgery.

Evidence we’ll require

If we are unable to make a decision from the client’s disclosures alone, we will request a report from the GP asking for full details.

Terms we could offer

When terms may not be offered

• Less than 6 months since diagnosis
• Underweight or unstable weight loss
• Surgery is being contemplated.

A report from the client’s own doctor detailing:

• Current and past health including treatment, investigations and tests
• Any outstanding medical investigations, consultations or treatment
• Any known medical conditions suffered by family members
  
  

Before we obtain a GPR we’ll need permission from the client, as per the Access to Medical Reports Act. The client also has the opportunity to view the report before it is sent to us.

A medical screening carried out by a nurse at a time and place convenient to the client. The nurse will carry out a brief examination including blood pressure, height and weight and urine, as well as asking the client some brief questions regarding their medical history.

A medical examination carried out by a doctor.  The doctor will carry out an examination including blood pressure, height and weight, chest, heart and urine, as well as asking the client some questions regarding their medical history.

Tested using a sample of blood or saliva, the nurse or doctor sends the sample directly to the laboratory. The client will always be made aware of the result. In the unlikely event of a positive test result, our Chief Medical Officer will personally manage the situation.

An exercise electrocardiogram is a simple test used to check the heart's rhythm and electrical activity during exercise. The test will normally take place on a treadmill.

A microscopic urinalysis looks at a sample of urine under a microscope to check for blood, protein and cells that could indicate problems elsewhere in the body.

A full blood profile looks for signs of potential abnormalities in the body including the liver, kidneys, cholesterol and blood sugar.

A cotinine test looks for nicotine in the body. These are rarely required on their own and will usually form part of any medical examination requested for non-smokers and ex-smokers.

We may issue a variety of medical and non-medical questionnaires to the client directly.

Usually only required for large cases, this questionnaire gathers details about the client’s or business’ finances to help us validate the requested amount of cover.

The client’s smoker status is taken into account when underwriting due to the different risks each status presents.

We use three smoker statuses for underwriting purposes and these are detailed below.

Failure to declare the correct smoker status could result in non-payment of a claim.

Smoking can impact terms in various ways, the most common being:

• Increased premium
• Increase to the rating for certain conditions such as asthma, chronic obstructive pulmonary disease (COPD) and heart disease
• Declining the application when in combination with an associated medical condition.

In moderation, alcohol consumption can be relatively harmless and have no impact on the terms we offer. Terms could be affected where the consumption is deemed excessive.

Excessive drinking maybe be described as:

• Hazardous drinking – The quantity and pattern of alcohol use could be deemed excessive without any impact on physical, psychological or social wellbeing.
• Harmful drinking – The quantity and pattern of alcohol use is deemed excessive with some impact on physical, psychological or social wellbeing as well as medical intervention.
• Alcohol dependence – A pattern of use with difficulties controlling alcohol-taking behaviour, tolerance, physiological withdrawal, persisting use following medical intervention.

Unlike most companies, we do not assess alcohol use by simply looking at the weekly consumption of units. We ask for the number of days drinking per week and the typical number of drinks taken on those days. We believe this gives a more accurate and fairer assessment of the clients alcohol use.

Drug use/abuse can have a significant impact on health, this is why we take it into consideration when underwriting. This could be the abuse of legal or illegal drugs, or simply the use of illegal drugs.

Historical drug use/abuse does not always result in a decline, the terms will depend on the type of drug used, frequency of use and time since last used. Terms could also be impacted by other associated risks such as smoking, alcohol use and some medical conditions.

Current use of illegal drugs will almost always result in the application being declined.

The occupation is required for all applications, with some products requiring additional information due to the nature of the cover provided.

For life and critical illness the occupation almost always has no impact on the final terms. Some high risk occupations could attract a rating or an exclusion, examples of these include:

• Offshore oil/gas industry
• Armed forces
• Height work
• Mining or quarrying.

 

For income protection the occupation is key to the assessment, as the product pays a benefit to the client if they are unable to work due to injury or illness. In order to provide a fair and accurate assessment we will ask for additional information including whether there any:

• Hazardous duties
• Driving as part of the occupation including annual mileage
• Manual work including frequency and extent
• Site work including frequency and extent
• Other occupations.

Our policies are designed for customers who are resident in the United Kingdom.

The policyholder and life assured must be deemed permanent UK residents at the time the policy starts.

We define UK resident as someone who is:

• Habitually resident in the UK for a minimum of 6 months and being resident in the UK for tax purposes. Habitually resident means the UK is their centre for economic, domestic and social interests.

We appreciate that a UK resident may travel or even reside abroad during the life of the policy. We assess this risk during the application process by asking:

“In the next 2 years, do you expect to travel, live or work outside the United Kingdom, European Union, North America, Australia or New Zealand? You do not need to tell us about a total of 30 days holiday each year or the reason for your travel.”

Answering “Yes” to this question will prompt further questions. These answers will then be individually considered by an Underwriter to ensure a fair and accurate assessment of the risk.

All clients will be asked whether they are a member of the armed forces and if so, the nature of their duties. Terms will depend on their duties and potential for deployment. If we cannot offer standard terms, the client could be given a temporary rating on life cover or an exclusion on critical illness. The more higher risk roles, such as Special Forces and bomb disposal, will unfortunately not be offered any cover.

We also do not offer income protection, waiver of premium or total permanent disability (TPD) for members of the armed forces.

Pursuits

Pursuits can be fun, though some attract a degree of risk. The main risks are accident or injury and our assessment of this risk depends on many factors including the type of pursuit, extent of involvement, level of experience and frequency of participation.

The below table details the pursuits we ask about on our application along with some of the decisions we might give.