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The TPD Story Nick Kirwan Association of British Insurers CMO Event – March 2010 Why focus on TPD? Consumers don’t get it Different types are confusing… Occupation based – Own, Suited or Any Occ Work tasks, ADLs No standard definitions 3% of CI claims 55% of claims are declined

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the tpd story

The TPD Story

Nick Kirwan

Association of British Insurers

CMO Event – March 2010

why focus on tpd
Why focus on TPD?
  • Consumers don’t get it
  • Different types are confusing…
    • Occupation based – Own, Suited or Any Occ
    • Work tasks, ADLs
  • No standard definitions
  • 3% of CI claims
  • 55% of claims are declined
the original plan
The Original Plan
  • Make case with the regulators
  • Analyse past TPD claims
  • Identify the underlying causes
  • Replace TPD with standard definitions
  • Remove occupational underwriting
  • More clarity between TPD and IP
with the objectives
With the objectives…..
  • To reduce declined claims for TPD by being clearer for consumers and sellers about what’s covered, and what’s not.
  • To maintain broadly the same level of cover.
the proposed definition set
Chronic rheumatoid arthritis

Severe brain damage (expand severe head injury)

Cardiomyopathy & cardiovascular conditions

Complex Regional Pain Syndrome (CRPS) with clinical symptoms lasting for at least 6 months

Loss of independent existence? (based on ADLs)

Respiratory conditions

Severe specified mental health conditions

Surgery for severe back and neck conditions

Severe inflammatory bowel disease

The proposed definition set
plan b
Plan B...
  • Original proposals too radical
  • Workshop
  • Rebrand and Standardise
  • Education – standard training material, web pages
  • Claims process – work with HCF
the draft definitions
The draft definitions...
  • Own occupation
  • Suited Occupations
  • Work tasks
  • ADLs
  • Mental health
slide10

Becoming physically or mentally unfit to do your own type of work ever again (before age X)

Loss of the physical or mental ability to do your own type of work ever again (before age X)

Unable to do your own type of work ever again (before age X)

Becoming severely physically or mentally disabled through an illness or injury (before age X) to the extent that you have become unable to do the material and substantial duties of your own occupation ever again. The condition must be expected to last throughout life with no prospect of improvement, irrespective of when the cover ends or you expect to retire.

Your occupation means your trade, profession or type of work you do for profit or pay. It is not a specific job with any particular employer and is independent of location.

slide11

Definition or Guidance?

  • When we assess your claim, we will consider all the available evidence including the following:
  • Whether you have received optimal medical treatment for your condition
  • How long you have been off work (typically more than a year in the absence of an unequivocal prognosis)
  • The prognosis for recovery based on the advice of independent specialists
slide12

Becoming physically or mentally unfit to do any suitable work ever again (before age X)

  • Loss of the physical or mental ability to do any suitable work ever again (before age X)
  • Unable to do any suitable work ever again (before age X)
  • Becoming severely physically or mentally disabled through an illness or injury (before age X) to the extent that you have become unable to do the material and substantial duties of a suited occupation ever again. The condition must be expected to last throughout life with no prospect of improvement, irrespective of when the cover ends or you expect to retire.
  • Suitable work means any work you could do for profit or pay taking into account your employment history, knowledge, transferrable skills, training, education and experience, irrespective of location.
slide13

Becoming physically unfit to do any 3 of the 8 specified work related tasks ever again

  • Loss of the physical ability to do any 3 of the 8 specified work related tasks ever again
  • Unable to do any 3 of the 8 specified work related tasks ever again
  • Losing the physical ability through illness or injury to do at least 3 of the 8 tasks listed below with no reasonable prospect of there ever being any improvement. The person must be unable to perform the task on their own, even when using physical aids routinely available to help (for example, a hearing aid, walking stick or glasses).
  • Walking – the ability to walk 200 metres on level ground without having to stop.
  • Lifting – the ability to pick up an object weighing 2kg at table height and carry it for 5 metres.
slide14

Continued...

  • Bending – able to get into and out of a saloon car and to bend or kneel to pick something up from the floor and straighten up again.
  • Communicating – the ability to answer the phone and take a message.
  • Reading – having the eyesight required to read 16 point typeface print (vision is measured at 3/60 or worse in the better eye using a Snellen eye chart).
  • Writing– the physical ability to write legibly using a pen, pencil or keyboard.
  • Financial – the ability to recognise the value of money and handle routine financial transactions.
  • Healthcare– the ability to independently make arrangements to get medical attention and take medication as prescribed.
slide15

Loss of the physical ability to look after yourself ever again

  • Losing the physical ability to do at least 3 of the 6 tasks listed below with no reasonable prospect of there ever being any improvement. The person must need the help or supervision of another person and be unable to perform the task on their own, even with the use of special equipment routinely available to help.
  • Washing – the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means.
  • Getting dressed and undressed – the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances.
  • Feeding yourself – the ability to feed yourself when food has been prepared and made available.
continued
Continued...
  • Maintaining personal hygiene – the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function.
  • Getting between rooms – the ability to get from room to room on a level floor.
  • Getting in and out of bed – the ability to get out of bed into an upright chair or wheelchair and back again.
slide17

Severe specified mental health conditions – causing in-patient care of at least 8 consecutive nights

  • A definite diagnosis by a consultant psychiatrist of any of the following conditions:  
  • Bipolar affective disorder
  • Paranoid (delusional) psychosis
  • Schizo-affective disorder
  • Schizophrenia
  • Severe depressive illness 
  • with chronic unremitting symptoms and under care for at least 2 years, and the condition must have required and resulted in an in-patient admission to a psychiatric in-patient ward where treatment (in-patient or otherwise) was provided for at least 8 consecutive nights and not have responded to comprehensive management and treatment for which the person has completed, based on the best current UK clinical practice for more than 12 months.
continued18
Continued...
  • This definition does not cover;
  • Conditions related to or exacerbated by alcohol or drug abuse
  • Other mental health problems such as mild or moderate depression, anxiety and stress.
questions
Questions...
  • Do we need an overarching heading?
  • If so, what should it be?
  • Catastrophic Disability Benefit? Other?
  • Do we need an ‘Any Occ’ definition?
  • Do we need a mental health definition?
direct to consumer genetic testing

Direct to Consumer Genetic Testing

Alastair Kent

Genetic Interest Group

Human Genetics Commission

genetic interest group
Genetic Interest Group

Registered charity

UK patient alliance for individuals and families affected by/at risk from genetic disorders

140 independent organisations

All types of genetic disease

Promote high quality R&D

Use of new knowledge to improve the lives of those affected or at risk

Combat unfair discrimination arising from abuse of personal genetic information

human genetics commission
Human Genetics Commission

Government Advisory Body on ELSI and developments in genetics

21 members and CMO advisors

Consultative panel

Independent

Oversight of genetic testing and insurance since demise of GAIC

direct to consumer genetic testing23
Direct to Consumer Genetic Testing

Ancestry

Paternity

Health related (e.g. Nutrigenomics)

Disease related (e.g. susceptibility testing)

dtc genetic tests in health and disease
DTC Genetic Tests in Health and Disease

Scientific validity

Clinical Utility

Counselling

Privacy/disclosure

The $1000 Genome

gig asking relevant questions
GIG “Asking Relevant Questions”

Improving understanding of insurers

Travel insurance

Life insurance

Lay membership of ABI Genetics Committee

hgc principles for dtc genetic testing services
HGC – Principles for DTC genetic testing services

International

Enabling informed decisions

Collaborative approach with key stakeholders

Consensus on good practice

Comprehensive

Single gene disorders

implications for patients citizens
Implications for patients/citizens

“Prediction is difficult especially when it is about the future”

- cost of sequencing falling (University of Edinburgh)

- Data production increasing

- Interpretation as the rate determining step

- Consumer uptake slow

- Proliferation of small firms

Plus a few big fish – dCODEme $895

23AndME $499

- Quality and evidence base variable

implications for insurers
Implications for insurers

Poor decisions about risk/need for insurance

Anti-selection

Divorce of test from intervention

Loss of sense of proportion

thank you
Thank you

www.gig.org.uk

alastair@gig.org.uk

www.hgc.gov.uk