The TPD Story

1. The TPD Story Nick Kirwan Association of British Insurers CMO Event – March 2010

2. 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

3. 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

4. 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.

5. Declined TPD Claims by Cause

6. Accepted TPD Claims by Cause

7. 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

8. Plan B... • Original proposals too radical • Workshop • Rebrand and Standardise • Education – standard training material, web pages • Claims process – work with HCF

9. The draft definitions... • Own occupation • Suited Occupations • Work tasks • ADLs • Mental health

10. 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.

11. 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

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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?

20. Direct to Consumer Genetic Testing Alastair Kent Genetic Interest Group Human Genetics Commission

21. 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

22. 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

23. Direct to Consumer Genetic Testing Ancestry Paternity Health related (e.g. Nutrigenomics) Disease related (e.g. susceptibility testing)

24. GIG and HGC working to improve understanding of genetic information by non specialists

25. DTC Genetic Tests in Health and Disease Scientific validity Clinical Utility Counselling Privacy/disclosure The $1000 Genome

26. GIG “Asking Relevant Questions” Improving understanding of insurers Travel insurance Life insurance Lay membership of ABI Genetics Committee

27. HGC – Principles for DTC genetic testing services International Enabling informed decisions Collaborative approach with key stakeholders Consensus on good practice Comprehensive Single gene disorders

28. 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

29. Implications for insurers Poor decisions about risk/need for insurance Anti-selection Divorce of test from intervention Loss of sense of proportion

30. Thank you www.gig.org.uk alastair@gig.org.uk www.hgc.gov.uk