Underwriting mental health

By | Uncategorized

The underwriting of mental health conditions has always been notoriously difficult. To properly assess such applicants an underwriter needs to look at the complete picture of not only the applicant’s health but also factors such as employment record and support network. But in these days of increasing automation, insurers are under increasing pressure to accept as many cases as possible through an automated process, driving up their straight-through processing (STP) rates and keeping costs down. An engine-based process involves only a few drill-down questions. But mental health risks tend not to lend themselves to this approach very well, if at…

Read More

Mental illness risk

By | Uncategorized

Our companion article discusses concerns from various quarters about the way insurers handle mental health risks and some of the underwriting practicalities. What sort of magnitude of risk does mental illness present? We offer a handful of observations drawn from dozens of journal articles in our research library. There is plenty of evidence that, generally, mortality is elevated in mental illness. That it should be so in the more severe forms such as schizophrenia and bipolar disorder should be no surprise, but it is interesting to note that even milder conditions may present an extra risk. For example, in a…

Read More

Over-diagnosis

By | Uncategorized

In August 2018 the British Medical Journal published a lengthy review article1 dealing with the issue of over-diagnosis. This is defined as the diagnosis of a condition (often subsequently treated) that would otherwise not cause symptoms or harm to a patient during his or her lifetime. Over-diagnosis arises in a number of ways, including: The broadening of disease definitions via lowering of diagnostic thresholds and the recognition of risk factors as pre-diseases Greater use of technology and technological advances that improve testing sensitivity More widespread screening programmes Physicians’ over-estimation of the benefits of treatment in mild or low-risk disease Changing…

Read More

Interesting times in a land ‘down under’

By | Uncategorized

Australia has always been an interesting market protection business-wise. And in the past few months it has become even more interesting. In 2016 there were some startling revelations on the ABC TV news programme Four Corners. The programme revealed a ‘disturbing culture’ at an insurer where critical illness and TPD claims were being denied. The firm’s ex-chief medical officer claimed that he was put under increasing pressure to deny claims. The Sydney Morning Herald reported the story as follows: ‘A joint investigation between BusinessDay’s Adele Ferguson and ABC’s Four Corners this week revealed doctors in the bank being pressured to change…

Read More

Alcohol – a postscript

By | Uncategorized

The press release for the journal article1 referred to in our previous thoughtpiece has some interesting statistics relating to alcohol around the world as part of its ‘notes for editors’. The following relate to 2016. Highest prevalence of alcohol consumption Males   Females Country Prevalence %   Country Prevalence % 1 Denmark 97.1 1 Denmark 95.3 2 Norway 94.3 2 Norway 91.4 3 Argentina 94.3 3 Germany 90.0 4 Germany 94.3 4 Argentina 89.9 5 Poland 93.8 5 New Zealand 88.5 6 France 93.1 6 Switzerland 88.4 7 South Korea 91.3 7 Slovakia 87.2 8 Switzerland 91.2 8 France 86.9…

Read More

Alcohol risk in perspective?

By | Uncategorized

The publication by The Lancet recently of an article discussing the risk to health posed by alcohol1 seems to have put paid for all time to the notion that moderate drinking does no harm or is even ‘good for you’. It has thus caused a bit of a stir in some quarters. The authors found that there was no ‘safe’ limit for consumption of alcohol and that even having one drink2 a day increases the risk of developing one of 23 alcohol-related health problems ranging from injury to liver disease and cancer. While alcohol may have a protective effect in…

Read More

Underwriting engine banana skins

By | Uncategorized

SelectX has, over the years, been involved in a number of projects supporting underwriting rules engines (UREs). We have helped firms choose the best URE for their needs. This can involve defining business requirements, assessing the merits of different products based on objective criteria and short-listing contenders for in-depth consideration. We have written rule sets for insurers, reinsurers and software providers. And we have carried out strategic reviews for firms who already had a URE in place and were looking to optimise its performance. So over the years we have identified a number of potential banana skins that can disrupt…

Read More

Cancer risks: Are we getting them right?

By | Uncategorized

Researching cancer mortality over the past few months has proved to be a bit of an eye-opener, and in three ways: firstly the level of excess mortality seen in a number of cancers, secondly the duration over which an extra risk persists, and thirdly that excess mortality may extend over a considerable period. Some of the high excess death rates (EDRs) were noted stage II/III disease, where mortality was substantially higher than in localised. For example, from the US Surveillance, Epidemiology and End Results (SEER) Program1 relating to diagnoses between 2006 and 2012: Cervical cancer: five-year relative survival for localised…

Read More

Turning the world on its head

By | Uncategorized

Turning the world of insurance on its head, that is. We are just back from the Society of Actuaries’ annual ‘Underwriting Issues and Innovations’ seminar in Chicago, where we go to learn what is happening in what one might call paradoxical North American markets where underwriting sophistication and tradition have very different meanings compared with most other places. In North America, and in the US especially, underwriting to the nth degree via blood and urine tests for purposes of preferred-life categorisation is still king and advanced underwriting engines are a rarity. But things are changing, and in two ways. One, insurers…

Read More

Underwriting and calculators

By | Uncategorized

On our travels we speak to a lot of people about underwriting manual developments. One topic which comes up time and again is calculators: great invention or the work of The Devil? Some underwriting manuals have had simple calculators for many years, for example for pulmonary function tests, financial ratios and BMI, all of which are designed to help the underwriter by speeding up and simplifying assessment. In recent years calculators have increased in number and complexity. There are calculators for overall cardiovascular risk, coronary heart disease itself, breast and skin cancer, liver function tests, and even occupation risks. In…

Read More