Due to new methods of gathering data, it may be possible to predict future income protection claimants. Wilson Carswell explains.
The third similarity between IB and IP claimants is that a significant proportion of claimants suffer from mental health problems, which are widely present in the general population.
Mental health problems may be identified as the main reason for absence from work, but they commonly also act as factors potentiating physical conditions.
The ubiquity of mental health problems is not always identified, partly from perceived stigmatisation.
Whatever the reasons it may again lead to delay in effective therapeutic interventions. Prolonged absence from work is often the final stage in a process of increasing difficulty an individual has in coping with unresolved mental health issues and an on-going presence in the workplace.
In both IB and IP scenarios any underlying mental health problems, are often only identified once a claim has been made and an appropriate psychiatric or psychological assessment has been obtained.
IP insurers might be tempted to use this study as a model and try and identify future IP claimants using GHQ-12 and ‘frequent attenders’ data. Alternatively, they might attempt to replicate the study, to confirm or refute its findings for their own IP -specific populations.
There are considerable logistic and financial problems in this approach. Such a study would almost, by definition, require the involvement of an academic or commercial research body and would be both lengthy and expensive.
Intervention
The really exciting implication of the published study lies in the possibility of actually providing effective therapeutic interventions before a claim is made. Disregarding for a moment the logistic, financial and ethical issues, providers may be able to identify future IP claimants and at that time offer effective therapeutic interventions.
These interventions are likely to be along the lines of very focused therapy such as Cognitive Behaviour Therapy (CBT), rather than non-focused counselling. Were this to be successful, the IP provider would then be less likely to have pay out the large sums that some successful IP claims attract.
There is, however, another downside. Most studies of depression and anxiety, the core of mental health problems, do not usually have continuing employment as an outcome or are based on those already out of work, and these interventions have very variable results.
There are relatively few good studies on effective interventions to identify and treat mental health problems before a prolonged absence of work takes place.
Theoretically, medical interventions taking place at an early stage of any disease are more likely to be successful than those undertaken later on in the disease process, and this surely applies to mental health problems.
On the positive side a NICE-recommended course for mild to moderate depression consisting of eight to 12 sessions of CBT is likely to cost less than £2,000. This by itself might seem a lot, but is a small amount if it prevents a successful subsequent IP claim of, say, £15,000 a year for 20 years. The words ‘sprat’ and ‘mackerel’ come to mind.
The published paper presents a challenge to insurers. As a body, they may not welcome the upfront costs, the uncertain outcome and possible negative publicity. Protection insurers might also question their need to be involved too heavily in ‘preventive medicine’.
To balance this is the attractive thought that insurers might be able to identify, for up to three years ahead, a possible IP claim and actually to prevent it ever taking place.
J Wilson Carswell, OBE FRCS is medical director of psychological management and rehabilitation service Moving Minds
