Conditions covered

About the condition

The heart needs a constant flow of blood to supply the cardiac muscle with nutrients and oxygen, enabling it to keep pumping. If the cardiac arteries are restricted, the blood flow is reduced, and the cardiac muscle becomes starved of oxygen. This causes tightness and pain in the chest, and shortness of breath - symptoms we know as angina. Initially this may be noted during strenuous activity or stress, when the heart requires extra oxygen but the arteries are unable to supply enough blood to keep up with demand. The pain will disappear as the demand returns to normal, but if the arteries are severely blocked the symptoms may occur even at rest.

The restriction of the blood flow in the coronary arteries is usually the result of a build-up of fatty deposits, mainly cholesterol, on the artery wall, known as atheroma or a plaque. The plaques can take years to build-up but they will eventually cause sufficient narrowing of the arteries to restrict the blood flow and this is what causes angina.

Some plaques are unstable and may rupture, and blood cells stick to the surface to cause a clot, entirely blocking the artery. This can happen within minutes of the rupture. Rather than merely being restricted, the blood flow in that artery is totally blocked so oxygen starvation is prolonged, and the part of the heart muscle that is affected will die. This is a myocardial infarction, or heart attack, and damage to the heart muscle is permanent.

About half of people who have a heart attack will die within 28 days, but a heart attack survivor will often make a full recovery to normal activities as the remaining heart muscle compensates for the dead muscle. However in severe cases if the damage is widespread, especially over the main chamber of the heart (the left ventricle), the pumping ability of the heart will be restricted and the heart attack victim will be more limited in their activities. The pumping function of the heart is measured by the “ejection fraction” and it is the reduction in ejection fraction which is used to determine the severity of a claim.

There are other causes of heart attack but this is the most common.

Underwriting information required

We will need the following information from the client:

• Diagnosis
• Date of diagnosis
• Frequency of symptoms and date of last symptoms
• Treatment
• Details of additional complications such as high blood pressure, heart failure, irregular heart beat.

This will allow us to judge whether terms are likely to be offered. We can then obtain a report from the client’s GP to establish details about the client’s cardiac function and the history of their condition.

Likely underwriting outcomes

Important information

• Anyone who has a history of coronary artery disease under the age of 40 will generally be declined.
• Anyone who continues to smoke will be declined.
• For all other cases terms will not be offered until six months after return to work or normal activities.

Angina

For Life Cover terms are based on the client’s age. Ratings range from +50% to +200%. However cases of severe angina (i.e symptoms not brought about just on exertion, poor response to treatment or not being able to carry out some normal daily activities) will be declined.

Serious Illness Cover and Income Protection Cover will be declined.

Heart Attack

For Life Cover, after the initial postponement period ratings would be at least +200%, depending on the client’s age. Ratings then decrease over the survival period to +50% 10 years after the heart attack.

Serious Illness Cover and Income Protection Cover will be declined.

Surgical treatment
Where the client has had successful bypass surgery or a stent the ratings will be a little lower.

Co-morbidities
Any conditions which complicate, or are complicated by, coronary artery disease such as diabetes, high blood pressure, obesity, heart murmurs or arrhythmias will be declined.

For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk with the underwriting information required as detailed above.

About the condition

The human body is made up of millions of cells which are continuously broken down and replaced in order to maintain structure, function and growth. Occasionally uncontrolled multiplication of cells takes place, a process called "neoplasia". This usually results in a solid lump known as a tumour although sometimes it doesn’t, for example leukaemia which is a cancer of the blood.

Tumours can be benign or malignant. Benign tumours remain localised to the organ of origin; they do not invade local tissues (although they may compress them which is particularly significant for benign tumours in the brain). In most cases they can be easily removed and are not life threatening.

Malignant tumours, or "cancer", invade and destroy local tissues, and spread through the blood and lymphatic system (metastasize) into remote organs. Treatment is usually carried out through a combination of surgery, chemotherapy and radiotherapy. The cure rate varies according to the type of cancer and how far it has spread.

Underwriting information required

We will need the following information from the client:

• Location and type of tumour, and whether it has spread
• Date of diagnosis and date treatment stopped

This will allow us to judge whether terms are likely to be offered. We can then obtain a report from the client’s GP to establish the size, grade (type of cell) and stage (how far it has spread) of the tumour which we will use to determine the final rating.

Likely underwriting outcomes

All tumours are assessed individually but as a guide the following are the most common underwriting outcomes:

• For most cancers there will be a postponement period of up to four years for Life Cover and eight years for Income Protection Cover.
• After the postponement period, temporary ratings are used, which will be applied for up to the first 12 years of the policy term. These are in the form of per mille ratings and range from three per mille to 20 per mille per annum, depending on the type of cancer. The more recent the cancer, the higher the rating. If a cancer is rateable, Serious Illness Cover is likely to be declined.
• 12 years after treatment has been completed and provided there has been no recurrence, Life Cover can usually be accepted at standard rates and Serious Illness Cover with a cancer exclusion.
• If the cancer has metastasized beyond the organ of origin, most cases will be declined.

For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk with the underwriting information required as detailed above.

About the condition

According to the Department of Health one in six people has a mental health problem at any one time  this covers a wide range of psychiatric conditions, but NHS figures show that one person in 10 develops depression at some time in their lives. Accurate statistics for anxiety are difficult to obtain but the Office for National Statistics suggests one in 20 will have Generalised Anxiety Disorder in their lifetime. Despite the lack of accurate information it is clear that depression and anxiety are common and are therefore going to be frequently disclosed conditions.

Periods of low mood or worry are normal fluctuations of our emotions, and may be triggered by a particular event such as bereavement or job loss. If the symptoms are prolonged, excessive, or interfere with everyday life, a diagnosis of anxiety or depression may be made.

Generalised anxiety disorder is characterised by excessive, persistent and/or unfounded fear and worry, as well as symptoms such as restlessness, difficulty in concentrating and irritability. Depression is characterised by low mood, loss of interest, low energy, poor concentration, and changes in sleep pattern and appetite. While depression and anxiety are separate conditions they often coexist.

The obvious concern is the high risk of suicide, but there are other health risks associated with anxiety and depression, such as alcohol and drug abuse and neglect of one’s health. The overall mortality rate for those with a psychiatric disorder is significantly higher than the general population .

Underwriting information required

For the majority of disclosures of mild anxiety or depression, in the first instance we will obtain a tele-medical questionnaire to ascertain the following:

• Type of disorder or symptoms
• Date of onset
• Cause
• Number of episodes
• Treatment
• Who has been the care provider (GP, psychiatric nurse, psychiatrist)
• Was inpatient treatment required
• Time off work
• Any suicide attempts, suicidal thoughts or self- harm
• Current mental state

If the information on the tele-medical questionnaire indicates a more severe psychiatric condition, or Income Protection Cover has been applied for, we would obtain a GPR.

Likely underwriting outcomes

Terms will depend on the following:

• Whether it is a single event, recurrent or permanent
• Whether the client has been referred beyond GP care
• Whether the client is on treatment, the type of treatment, and whether they are compliant
• Work absence
• Date of last episode

Life Cover will often be acceptable at standard terms if it is proven that the client’s condition is low risk. This would include someone who is currently controlled and stable with treatment (no frequent changes of medication), has had no hospital admission or suicide attempts, no or minimal time off work and no associated conditions which could be attributable to anxiety.

For more serious conditions, substandard terms will apply.

A mood disorders exclusion will be applied to "own occupation" TPD.

For Serious Illness Cover, mild anxiety or depression is unlikely to incur a loading, but there will be a loading for more serious psychiatric illnesses.

Depression is one of the most common causes of a disability claim and terms for Income Protection Cover are offered with this in mind. Anyone currently on treatment for depression is unlikely to be accepted for Income Protection Cover. Where treatment has stopped and the condition has resolved, there will be a postponement period of up to two years depending on the severity of the initial symptoms and duration of the condition. Depression will then be excluded. If treatment stopped more than seven years ago, then we will be looking to accept Income Protection Cover at standard rates with no exclusions wherever possible, although this will depend on the previous history.

For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk  with the underwriting information required as detailed above.

About the condition

There are several conditions which are named diabetes, but the term usually refers to Diabetes Mellitus, a condition that affects over 2.5 million people in the UK. The word diabetes is derived from Greek and means, "a syphoning of water through the body". Mellitus means "sweet as honey", and the name Diabetes Mellitus means that patients with this condition lose large amounts of urine which is sweet and full of sugar.

Diabetes is a fault in the production of insulin, a hormone produced by the pancreas, which controls the flow of glucose in and out of our cells, required for energy. If there is a fault in insulin production glucose accumulates in the blood, which leads to a multitude of complications.

There are two main types of diabetes.

• Type 1 - this is when the pancreas fails to produce any insulin at all. It is not known exactly why this happens, but it usually starts in childhood or early adulthood. The condition develops rapidly and if untreated death would occur within weeks. There is no cure and the patient has to undergo lifelong treatment with replacement insulin which they inject daily. Good control can be maintained with regular blood sugar monitoring, adjustment of insulin dosage and regulation of calorie intake.
• Type 2 - about 85% of diabetics have type 2 diabetes. The pancreas either produces a reduced amount of insulin, or a regular amount but the body’s cells become resistant to it, or there may be a combination of both. This most commonly occurs in people over the age of 40, but it is also associated with being overweight and with the increase in obesity in the UK it is occurring at increasingly younger ages, even in children.

Because the pancreas is still producing insulin, symptoms develop much more gradually in type 2 than in type 1 and it can be many years before the symptoms are recognised and a diagnosis is made. According to Diabetes UK there are approximately half a million people with undiagnosed type 2 diabetes.

Type 2 diabetes can be regulated by diet, oral treatment to change the way the body produces and deals with insulin, and in some cases insulin will be injected. It is important to note that type 2 diabetes treated with insulin injections is not the same as type 1 diabetes.

The complications of diabetes are serious and of great concern when assessing insurance applications.

There are three acute complications of diabetes – hyperglycaemia, ketoacidosis and hypoglycaemia. Hyperglycaemia is an increase of glucose which leads to severe dehydration and is more common in type 2 diabetes. Ketoacidosis occurs when the body cannot utilise glucose for energy and uses fat instead. If it is sustained over a period of time it causes acidity of the blood and dehydration which can lead to a coma and eventually death. It is more associated with type 1. Hypoglycaemia is abnormally low blood glucose and occurs when too much medication has been taken, after a delayed meal, after strenuous exercise or when insufficient carbohydrates have been taken in. This occurs in both type 1 and 2, and is usually remedied by quick intake of sugar, although in severe cases it can lead to unconsciousness. These conditions are of interest at underwriting stage as they can indicate a lack of diabetic control.

Chronic complications are the result of vascular disease. The cells lining the blood vessels do not have the amount of glucose they take in regulated by insulin, so if the blood glucose is constantly elevated, the cells will take in too much glucose which weakens them and damages the blood vessels. Because the diagnosis of type 2 diabetes can take years, the damage done by the long term increase in blood glucose can already be well under way. Type 2 diabetes should therefore not be regarded as a mild or less serious form of diabetes.

Vascular disease leads to coronary artery disease, angina, heart attacks, stroke, peripheral vascular disease, kidney disease, impaired vision and blindness. The incidence of all these conditions is increased in diabetics. High blood sugar can also result in damage to the nerve fibres causing numbness, muscle weakness and many other neurological symptoms. Impotence and "diabetic foot" (causing ulcers, gangrene and may lead to amputation) are common complications of diabetes resulting from a combination of vascular and nerve damage.

Underwriting information required

From an underwriting point of view the complications of diabetes are clearly of concern. Because of the high incidence of serious illnesses, all applications for Serious Illness Cover and Income Protection Cover will be declined.

An application for Life Cover from anyone who already has a diagnosis of diabetes will result in medical evidence being obtained, and special terms. In addition, we will also be looking for undiagnosed type 2 cases.

Type 2 diabetes is particularly associated with obesity. Central obesity (fat concentrated around the waist in relation to abdominal organs, but not subcutaneous fat) is known to predispose individuals to insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones that may possibly impair glucose tolerance. For this reason applicants who are overweight and have a waist measurement over a certain threshold (see our BMI calculator) will be asked to undergo a nurse screen and be tested for diabetes by measuring their blood sugar.

Where diabetes has already been diagnosed we will need to know:

• Type of diabetes
• Date of diagnosis
• Treatment
• Blood sugar and glycosylated haemoglobin (HbA1c) levels if known
• Frequency of follow up at a diabetic clinic
• Details of any complications or co-morbidities

Some of this information can be obtained from the client, particularly around their understanding and control of their condition. However the most useful information for assessment is gained from a medical examination, with a blood test called HbA1c which is a measure of blood sugar indicating long term control, and a urine test to indicate early kidney problems. The medical exam also gives other important information such as blood pressure, which is an additional risk factor in vascular disease. There is limited value in obtaining a GPR, so the majority of our applicants will be asked to attend a medical exam.

Likely underwriting outcomes

Serious Illness Cover and Income Protection Cover will be declined.

For Life Cover ratings depend on the type of diabetes, the age of the client, the length of time since diagnosis, control of the condition and complications. If there are complications or indications of poor control, terms are unlikely to be offered. For controlled diabetics, ratings can vary from between +50 to +400.

For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk with the underwriting information required as detailed above.

About the condition

When the heart beats it contracts and relaxes, pumping blood round the body through the arteries to muscles and organs. When the heart contracts it forces blood out into the arteries and at this point the blood pressure in the arteries will be at its highest. Following a contraction the heart relaxes and refills with blood, and the blood pressure in the arteries will be at its lowest. The highest pressure is known as the systolic pressure, and the lowest as the diastolic. When a blood pressure reading is taken it is therefore in two parts, with the systolic reading always listed above the diastolic. If the systolic reading is 120, and the diastolic is 80, it will be written as 120/80 and expressed as "120 over 80".

Blood pressure is affected by the elasticity of the arteries. There is a natural tendency for blood pressure to rise with age as the elasticity of the arterial system reduces over time. Age is therefore one of the factors that needs to be taken into account in deciding whether a person's blood pressure is normal or too high. In general terms regardless of age (NB.Treatment initiation thresholds and desirable targets are advocated in the primary care management guidelines set out by NICE (National Institute for Clinical Excellence), the independent organisation responsible for providing national guidance on treatment and care for the NHS in England and Wales)-readings consistently over 160/100 will require treatment. Readings below 160/100 but over 140/90 will be of concern and require monitoring by a GP, although treatment will depend on age and whether there are additional health problems. It’s therefore possible that a client could be rated for high blood pressure even if they have not been put on treatment by their GP.

Hypertension is usually symptomless and only discovered during a routine medical review, or not until a serious complication such as a heart attack or stroke has occurred. The patient may suffer headaches and fatigue, but contrary to popular belief nosebleeds or a ruddy complexion are very rarely associated with high blood pressure.

Hypertension can be caused by chronic kidney disease, alcohol abuse, underactive thyroid and some other disorders; however 90% of cases have no specific cause. Anyone can suffer from high blood pressure, but certain factors can increase the risk of hypertension and the risk of complications such as:

• a family history of hypertension
• diabetes
• kidney disease
• some medications such as steroids
• lifestyle risks - smoking, obesity, high alcohol intake, high salt intake, lack of exercise

If the blood pressure readings have not yet reached the treatable threshold of 160/100, only lifestyle changes, and regular blood pressure and risk-factor review will be instigated. If this is ineffective or the presenting blood pressure is critical, then drug therapy is initiated, often requiring more than one type of treatment to effectively lower the blood pressure.

Complications of uncontrolled or untreated hypertension include:• stroke

• heart attack
• heart failure
• eye damage
• kidney failure
• aneurysm of the aorta (stretching and weakening of the main artery which may rupture as a result)

About 30% of the population will be hypertensive -Department of Health "Health Survey for England 2003- so this is a commonly disclosed condition.

Underwriting information required

High blood pressure is either disclosed on the application form, or is discovered on a routine medical examination. Where a diagnosis has already been made we will try to obtain the relevant information from the client through a tele-medical questionnaire. We need to know:

• Date of diagnosis
• Treatment prescribed
• Whether the treatment has been modified
• How often the client goes to their GP to have their blood pressure checked
• The most recent reading. Not all clients are aware of this information and it is worth them checking with their GP for this information when they submit an application, otherwise they may be asked to attend a medical examination
• Whether any additional tests such as an ECG, echocardiogram or kidney tests have been carried out
  
• Whether they have undergone any other tests for associated risk factors such as raised cholesterol or diabetes, and the results

Likely underwriting outcomes

The starting point for all ratings is the blood pressure reading itself. If this is normal, and the client is compliant with treatment and follow up, and has no additional risk factors, all benefits can be accepted at standard rates. If there is any indication that the blood pressure has not been controlled (which will be indicated by the frequency of follow up or the combination of treatment given), or the client cannot give the full information required, we will ask for the client to undergo a medical exam.

If the blood pressure is unacceptably high, uncontrolled, or there are additional risk factors, the most likely outcome is to postpone the cover for six months to allow for control to be achieved. In some cases the medical history shows that control is unlikely, and therefore cover will be declined, for example if the client has not modified lifestyle factors over a period of time.

Where high blood pressure is found for the first time on a medical exam, we will either rate on the readings on exam or we will postpone cover until the client has been to their doctor for investigation and treatment. Terms will not be offered until the blood pressure has been brought under control and maintained for six months.

Co-morbidities
Any conditions which complicate, or are complicated by hypertension, such as diabetes, obesity, heart disease, vascular disease or a strong family history of vascular disease, have a cumulative rather than an additive effect and terms will be more severe than for these conditions in isolation, particularly if the client is also a smoker.

For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk with the underwriting information required as detailed above.

About the condition

Multiple sclerosis (MS) is the most common neurological disorder of young adults, usually being diagnosed between the ages of 20 to 40. Destruction of the nerves causes loss of functional ability. The cause is not fully understood, and there is no cure.

MS is a disease of the central nervous system (the brain and the spinal cord). Nerve fibres are covered with a fatty substance called myelin, which acts as an insulator and allows impulses to travel down the nerves quickly and efficiently. In MS the myelin becomes inflamed and scarred, and is eventually destroyed – sometimes MS is referred to as demyelination for this reason. The nerve impulses become weaker as the myelin is less efficient, and may eventually fail altogether. Whatever is being controlled by the affected nerve will therefore also become weaker and unable to respond to the signals from the brain.

The most common early symptoms of MS are visual disturbances (blurred or double vision, severe eye pain), sensory disturbances (tingling, pins and needles, numbness) and motor disturbances (limb weakness). However these symptoms are not specific to MS; there are 79 conditions which mimic it and no single definitive test to determine a diagnosis, and while negative testing makes a diagnosis of MS less likely, it does not rule it out. This makes MS notoriously difficult to diagnose. The criteria for a diagnosis are that there must be at least two episodes and they must affect different parts of the body, which further delays a definite diagnosis. As there is no cure there can also be a reluctance to make the diagnosis and clinicians may adopt a wait and see approach if a patient exhibits symptoms, delaying giving what can be a devastating diagnosis.

There are four main sub-types of MS and the classification depends on the clinical course following diagnosis.

• Relapsing remitting
  This is the most common type. There are unpredictable periodic relapses, with interim periods of remission which may last months or years. Each relapse will leave the patient with increasingly impaired neurological function. A small number of people will have very long periods of remission with small relapses and complete recovery in between. This type is often referred to as "benign" MS, but can only be described as such when this clinical course has been followed for 10 years.
• Secondary progressive
  This is where there is a relapsing-remitting onset but after a period of time there is a steady deterioration in neurological function with no periods of remission. Secondary progressive causes the greatest degree of disability.
• Primary progressive 
  The initial symptoms have an insidious and vague onset, followed by a steady decline in function with no periods of remission. In severe cases disability occurs within five years from the initial symptoms.
• Progressive relapsing 
  This is the least common subtype which begins with a progressive course, but rather than a steady decline periodic attacks do occur as well.

At present as no cure exists for MS and treatment is regarded as palliative. There are two basic strategies for treating Multiple Sclerosis; the first is to modify the course of the disease by controlling inflammation and destruction of myelin through using steroids and/or beta interferon. The second is to treat the symptoms, such as using Baclofen for spasticity.

Underwriting information required

With such a complex condition to underwrite we will usually obtain a GPR. However any information the client can give us will assist with the assessment of the application. We will need to know:

• Type of MS
• Date of diagnosis
• Symptoms and course since diagnosis
• Treatment
• Degree of disability

Likely underwriting outcomes

With a condition which is difficult to diagnose, incurable, and with a very varied, unpredictable course it is not surprising that the underwriting outcome is also extremely varied. Terms can be anything from standard rates for benign MS to decline where progression has been rapid. It goes without saying that Serious Illness Cover will be declined if a diagnosis of MS has been made.

• An underwriting assessment is made on the current degree of disability suffered by the client, based on scoring eight functional systems for the degree of disability. The scale is 1 to 10 and the functional systems are:
• Ability to walk
• Co-ordination
• Speech and swallowing
• Sensory (touch and pain)
• Bowel and bladder functions
• Visual
• Mental
• Other

Mild disability in one functional system or minimal disability in two functional systems equates to "mild MS". The ratings then depend on the number of years since the last attack, and the age of the client with younger people being rated more heavily. The range of possible ratings are shown in the table below.

Key
High = +250% EM - +400% EM
Med = +125% EM - +225% EM
Low = +25% EM - +100% EM
Std = standard rates

Assessment can be refined using prognostic indicators. 
Good prognostic indicators

• Female
• Relapsing remitting onset
• Sensory symptoms (eg numbness/optic neuritis)
• Complete recovery between relapses
• Infrequent relapses
• Few attacks early in course (less than four in two years)
• Long time to permanent disability

Poor prognostic indicators

• Male
• Polysymptomatic onset
• Motor symptoms (eg weakness/paralysis)
• Incomplete recovery between relapses
• Frequent relapses
• Many attacks early in course (within 6 months)
• Short time to permanent disability

One of the biggest issues for underwriters is assessing a case where MS is suspected but not diagnosed, particularly when Serious Illness Cover has been applied for. Where there is a disclosure of vague neurological symptoms such as pins and needles/tingling, numbness, blurred vision, bladder dysfunction, tremor, weakness and fatigue and others it may mean that Serious Illness Cover is declined, or multiple sclerosis is excluded, regardless of whether a diagnosis has been made or tests have been carried out.

Finally, there is a strong familial link, so for Serious Illness Cover a family history of MS is significant and an exclusion may be applied.

For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk with the underwriting information required as detailed above.

About the condition

The vast majority of conditions which affect the musculoskeletal system can be disregarded for Life and Serious Illness Cover, but they are significant for disability benefits including TPD.

Arthritis is caused when the cartilage, which provides a smooth surface to allow the joint to operate smoothly, degenerates and is worn away until the bones in the joint rub against each other. As the cartilage degenerates it produces enzymes which further damage the cartilage, causing the degenerative process to escalate.

The synovial fluid which cushions the joint from shock becomes less effective and bony growths occur on the ends of the bones which makes the joints even less flexible and more painful. In addition loose bits of bone and cartilage float in the joint causing inflammation, and add to the loss of movement and pain. There are many forms of arthritis but mainly it is due to age, trauma (accident), infection (septic arthritis) or deposit of uric acid crystals in the joint (gouty arthritis). Symptoms are increasing pain and stiffness in the joint. Any joint can be affected by infection or trauma. The main joints affected by aging are the knees, hips and hands.

Treatment is through exercise and physiotherapy to improve flexibility, mobility and muscular support for the joints. Pain killers and anti-inflammatory drugs can also be given. If there is a severe loss of mobility, extreme pain or disability, the joint may be replaced with an artificial joint.

Arthritis is usually diagnosed by x-ray which shows the deformities in the cartilage and bone at an early stage. Some conditions causing pain do not have an apparent physical cause which can be diagnosed using clinical tests and investigations. The most common condition in this category is back pain which is often non-specific in origin with no discernible physical cause.

Back pain is also one of the most common causes of disability claims, along with depression, so it has to be treated with caution.

Underwriting information required

As much information as possible should be obtained from the client, in particular:

• the joints affected
• the degree of disability
• the treatment

Likely underwriting outcomes

In most cases of osteoarthritis the affected joint will be excluded.

Where back pain has been experienced in the two year's preceding the policy start date an exclusion will also be imposed.

The following factors add to the risk and mean an exclusion may be inadequate, and therefore Income Protection Cover may be declined:

• Being overweight adds to the strain put on joints, particularly the knees and back.
• Chronic pain can cause depression, an important point for disability benefits especially where there is already a history of depression.
• Where the client’s job requires any degree of physical work, standing for long periods or manual dexterity, and there is a higher chance of being affected by an arthritic joint.
• For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk with the underwriting information required as detailed above.

About the condition

A stroke is brain damage resulting from a blockage or a haemorrhage in the brain. Like all organs, our brain needs the oxygen and nutrients provided by our blood to function properly. Brain tissue ceases to function if deprived of oxygen for more than 60 to 90 seconds, and after a few hours will suffer irreversible injury, leading to death of the tissue. At least three quarters of strokes are caused by a blockage in an artery which stops blood flow to part of the brain. These are called ischaemic strokes. The rest are haemorrhagic strokes, a bleed resulting from a ruptured blood vessel.

An ischaemic stroke can result from a thrombus, where a blood clot which forms in the main arteries of the brain, or an embolism where the clot is carried to the brain from another part of the body. The embolus is often a blood clot, but may also be fat, an air bubble, cancer cells or a clump of bacteria. The most common source of an embolus is from the heart, for example if there is an abnormally fast heart beat the blood gets trapped in the fluttering heart and clots. There are many other heart conditions that can result in the formation of clots.

There are two type of haemorrhagic stroke; an intracerebral haemorrhage which bleeds into the brain, or a subarachnoid haemorrhage which bleeds into the space between the brain and the skull. The most common causes are high blood pressure, and weaknesses in the cerebral arteries.

There is also a related condition known as a transient ischaemic attack (TIA), where the supply of blood to the brain is temporarily interrupted, causing a 'mini-stroke'. The symptoms may be similar to a full stroke but are temporary, lasting for a few minutes or hours but always clearing within 24 hours. Although a full recovery will have been made, there is a high risk of a more serious stroke in the future.

The symptoms of a stroke occur very suddenly, and medical attention is required immediately for the patient to survive. Symptoms include:

• Numbness, weakness or paralysis on one side of the body
• Slurred speech, difficulty understanding speech or finding words
  
• Blurred vision or sudden loss of sight
• Confusion
• Unsteadiness, dizziness, vertigo
• Headache

The effect of the stroke will depend on the part of the brain that has been affected, the type of stroke, and the extent of the injury. In the UK stroke is the second most common cause of death after heart attack, and 75% of stroke survivors are affected by disability enough to decrease their employability.

Underwriting information required

We will need the following information from the client:

• Type of stroke if known and whether there was more than one
• Date of occurrence
• Extent of disability or residual symptoms

This will allow us to judge whether terms are likely to be offered. We can then obtain a report from the client’s GP to establish the type of stroke and extent of brain damage, the cause and whether there are any continuing risk factors.

Likely underwriting outcomes

Serious Illness Cover and Income Protection Cover will be declined.

For Life Cover, if there are severe residual symptoms such as paralysis, or they are unable to care for themselves, cover will be declined. Where the residual symptoms are not so severe, terms will depend on how long ago the stroke was. There is an initial postponement period of a year after the event, then terms start at +250% EM. This decreases over time and after seven years the rating offered could be as low as +50% EM.

For a more accurate indication of terms please contact the underwriting helpline (freephone 0800 012 1796) or email lifeunderwriting@vitality.co.uk with the underwriting information required as detailed above.