The new definition should not have a significant impact on critical illness premiums
The Association of British Insurers (ABI) Critical Illness Working Party is seeking the industry's views as to whether the heart attack definition for critical illness cover should be broadened.
A consultation paper has now been issued and interested parties have until 31 January to respond to the new draft definition, which includes the use of troponin tests and heart scans as evidence for a claim.
Troponin tests, which measure the extent of heart muscle cell damage, are being increasingly used in accident and emer- gency departments to determine whether a patient has suffered a heart attack. Although the test alone is not conclusive, policyholders are being turned down for claims that use troponin as evidence.
There is speculation that claims could increase if the definition is changed to include troponin, but according to Nick Kirwan, chairman of the ABI's Critical Illness Working Party, heart disease is on the decrease, so even with the wider definition claims should not significantly rise.
'As the overall incidence of heart disease in the UK is falling, we do not believe there will be any significant effect on premiums. The key point is that we want to make sure our definition is in line with today's technology and medical practice,' he said.
According to the consultation paper, the proposed definition will maintain the key philosophy of critical illnesses ' that is providing for conditions that are life-threatening or affect lifestyle. It also states there will be no significant impact on premiums and will increase clarity for medical practitioners and consumers when assessing claims.
Possible disadvantages include confusion among consumers. There may be a belief that all cases where there are raised troponins should be covered even though they have a different prognosis. Likewise there could be a mistaken perception that the change in definition means a reduction in cover, decreasing consumer confidence.
Views on whether the current definition needs to be changed and if the wording in the draft definition is appropriate, should reach the ABI before the consultation deadline.
Heart attack definitions
Current ABI model heart attack definition:
The death of a portion of the heart muscle as a result of inadequate blood supply as evidenced by an episode of typical chest pain, new electrocardiograph changes and by the elevation of cardiac enzymes. The evidence must be consistent with the diagnosis of heart attack.
Draft ABI model heart attack definition:
The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in each of the following:
• Typical chest pain.
• New electrocardiographic changes or relevant findings on a heart scan.
• The characteristic rise of cardiac enzymes or troponins.
The evidence must be consistent with acute myocardial infarction.
Source: ABI
