Alice suffered from anorexia in her teens and early 20s. She now has a partner with whom she shares a joint mortgage but also has some underlying mild depression.
Now in her early 30s, these mental troubles are making it problematic for her to get protected with life, critical illness or income protection. How do I approach this case?
Peter Chadborn, CBK (Colchester)
This highlights the importance of pre-underwriting research, not just product research. Without such an approach the adviser and their client are going to become frustrated by a prolonged and unpredictable application process.
I would begin by asking Alice and her partner to anonymously complete a short list of health questions ranging from height and weight through to family history and current medication and historic conditions. These questionnaires would be emailed to a short-list of six providers based upon our knowledge of their product quality and attitude towards the prevailing health issues.
The indicative underwriting attitude of each provider would serve to facilitate a meaningful conversation with the clients and assist in managing their expectations regarding likely premiums and counter-offers. Only then would recommendations be made.
Our preferred route for all applications is ‘Big T' tele-underwriting and this is particularly relevant for sensitive cases such as this.
As an example; LV= would view Alice's anorexia as a minor issue for life, critical illness (CI) and income protection (IP) if her weight and height ratios are now stable, as her anorexia was some time ago. They indicate a loading would depend on the severity of Alice's depression and whether it is an isolated incident, or long term, e.g. related to the anorexia in her 20s.
If her depression is mild and an isolated incident it is likely LV= would offer standard rates for life and CI. However, if it has been ongoing for some time a loading may be applied. It is likely there would be an exclusion for depression placed on IP.
Phil Brown, Zurich Life UK
Anorexia Nervosa and mild depression can be challenging to underwrite. The factors underlying both conditions can persist, making the likelihood of recurrence higher. However, in many cases, cover can still be provided.
We would need to obtain medical evidence from Alice's doctor to get full details on her medical history. A GP's report would provide details of the cause of her illnesses, treatment, hospital admissions for depressive type illness, any suicidal thoughts reported or attempts at self-harm.
It would need to include details of any relapses of her Anorexia and if her weight is currently in the normal range for her height. Information would also be needed concerning any linked abuse of drugs or alcohol, the causes of her current mild depression and how she is responding to treatment. We would also need to know if Alice has lost time from work, with dates and duration of absence.
The longer Alice may have taken off work due to depression or related mental conditions, the less likely it is that we could offer her income protection. However, if there has been no time lost from work due to the illness, she might be offered income protection with an exclusion clause for mental health conditions.
Life and critical illness cover might be offered with an extra premium payable. The extra premium would vary depending on the severity of the depression, current symptoms, any psychiatric admissions or suicide attempts. If there has been any suicide attempt, then critical illness could be declined and life cover postponed, depending on when the incident occurred.
Paul Sandilands, Pulse Insurance
The good news is that life, income protection and even critical illness (CI) cover can be obtained for many applicants who have had anorexia earlier in their lives.
Of these protections, CI is the most difficult to achieve and, if available, it is likely to have mental health exclusions. The key to Alice's case and all anorexic applicants is to establish the details involved.
There are positive factors that underwriters take into account, such as her age - the longer the passage of time since recovery the better. What is her current weight and can she show consistent weight recovery with a satisfactory body mass index (BMI)? Life underwriters like to see evidence of a constant weight over say five years.
Other aspects of her life can demonstrate stability, for example Alice's relationship with her partner, such as how long has she had this relationship and has it been stable?
Another important consideration is does she work, and if so how long has she been in her current job?
Negative factors to be considered may include the severity of the illness? Was hospitalisation required or was she treated by her GP and/or a clinic?
Have there been any suicide attempts and are there any problems associated with her current mild depression such as alcohol or drug abuse? And has she had to take time off work?
Any recent or ongoing anorexic illness will result in declines for any of the covers required.
The above are only broad guidelines. Every case handled by Pulse receives bespoke treatment as individual details can make a crucial difference to cover available to this class of applicant.
