Our Experts Weigh In

The Challenge: Collaborating with a far-flung team

The Globe and Mail by Bryan Borzykowski

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Every week, we will seek out expert advice to help a small or medium-sized company overcome a key issue it is facing in its business.

Alexey Saltykov is located in Toronto, his company co-founder is in Germany, two contract employees are in Russia, a third is in Montreal, and a business adviser is in Australia.

Needless to say, working as a virtual team presents incredible challenges.

“I work from 8 a.m. to 12 a.m.,” says Mr. Saltykov, the co-founder and chief executive officer of InsureEye Inc., a Toronto-based startup that helps consumers understand their insurance costs. “Russia is eight hours ahead and Germany is six hours ahead. There’s not lot of time to get together.”

For Mr. Saltykov, living the life of the modern-day entrepreneur, brainstorming with colleagues around the world, is difficult. And he doesn’t feel he’s found the tools to make virtual collaboration really work.

Mr. Saltykov is often on Skype for video meetings and uses the Web-based collaboration software Basecamp to assign and comment on tasks. But he finds neither program is as collaborative or powerful as he’d like them to be, he says.

Because everyone lives so far from each other, every instruction needs to be documented. He finds his current software isn’t robust enough to do that.

And while Skype lets him talk to his developers or his business partners “face-to-face,” it doesn’t allow him to brainstorm ideas the way he’d like.

“I want to be able to stand up around the white board, chat together and discuss the problem,” he says. “Nothing allows us to be as productive as people who are in one room.”

Mr. Saltykov started his business last March, but to expand it, he’ll need to find better ways to work with his overseas colleagues, he believes.

“We do try and talk every day,” he says. “But we need to be more efficient.”

The Challenge: How can InsureEye improve the collaboration among its far-away staff?

THE EXPERTS WEIGH IN

Mitchell Potter, Principal with Minneapolis-based Mercer LLC

I think he should actually do away with the Skype or other tools that provide a visual of the other people. Those are useful for personal conversations, but they don’t add value in most business group or brainstorming conversations. In fact, they can be distracting. They are not a good substitute for real body language, but you keep trying to make the visual image work as well as the real thing.

Better to be voice-only. Voice-only also relieves everyone of having to dress for the call. One of the great advantages of telecommuting is that you can focus on what you are doing and not on how you look or how the way you look may affect others.

Supplement your conversations with some form of interactive discussion software. There are many, good brainstorming tools he can buy, like Jive, Moxie, [and] Telligent. Many of these paid tools have (elements) specifically designed for brainstorming.

Ann-Marie Urquhart, Toronto-based associate director of global IT services at Ernst & Young

For brainstorming, on-line meeting software, such as GoToMeeting, is one way for all participants to see, in real time, slides and documented discussions during the meeting. Participants, at any time, can share their screen’s content to the entire team.

He might want to consider engaging a project manager to create a project’s plan and manage all the tasks – rather than doing it himself or relying only on software. This might help enable the CEO to focus more on strategy.

Finally, the actual time of the meeting should also be taken into consideration, respecting the different time zones and country-specific holidays. If every team member is expected to attend the call, then the meetings should be rotated so the ‘pain’ is shared equally.

Simon Bell, Cardiff-based co-founder and chief operating officer of Toronto-based LOGiQ3. His business partner is based in Toronto

We’ve tried Skype, but it wasn’t great for the quick conversation. Instead, we use Epik Networks, a company that offers voice over Internet protocol (VOIP). Whether we’re in Toronto or Cardiff, we have a phone that’s connected to the Internet that I just pick it up and it connects one office to the other. We don’t incur any long- distance charges.

We’ve also spent years testing differing desktop-sharing tools. We needed to be able to see the same document at the same time and make a single set of changes. We found that in Join Me, which is a simple, secure way to instantly get someone else’s input wherever they are. It’s free too.

Use BlackBerry Messenger for keeping in touch in quick messages. It’s secure, free and you can tell when the other person has received and read the message. [iPhone’s new iMessage program operates in a similar way.]

THREE THINGS INSUREYE SHOULD DO NOW

Use the phone more

Video conferencing is often distracting and the visuals can take away from accomplishing tasks. Make conference calls, or get a VOIP phone that’s only for calling team members.

Hire a project manager

Hire someone to manage the multitude of tasks. The CEO can then think more about strategy than inputting every detail of a conversation into a software program.

Rotate time zones

Change the times of conference calls every day or week, so people “share the pain” of having to get up early or go to bed late.

Special to The Globe and Mail

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Understanding Sleep Apnea

By Carmela Tedesco (Published in Advisor's Edge Report May 2011)

Although the first detailed description of obstructive sleep apnea (OSA) only appeared in the 1960s, its characteristics were described well before this in the works of Shakespeare and Dickens.

The best known of these descriptions is Dickens' portrayal of Joe, the sleepy fat servant boy of The Pickwick Papers (1837). ‘Fat Joe’ had such excessive daytime sleepiness that he fell asleep while knocking on a door. In the 1800s this sleep disorder was playfully known as Pickwickian syndrome, but doctors today recognize it is much more serious.

Studies demonstrate that between 2% and 4% of middle-aged adults have clinically significant sleep apnea, with a male to female ratio of 2:1, according to the Public Health Agency of Canada.

Complications include coronary heart disease, arrhythmias, stroke and hypertension. And, motor vehicle and work-related accidents may result due to the daytime sleepiness.

What is it?

Essentially sleep apnea is a sleep-disordered breathing in which there are pauses (apnea) or shallow breathing (hypopnea) during sleep.

These breathing pauses usually last 10 to 30 seconds, and can be longer in some cases.

We'll focus on obstructive sleep apnea (OSA) which is the most common type and accounts for 95% of cases. The other types of sleep apnea are central sleep apnea, mixed sleep apnea and sleep hypoventilation syndrome.

Obstructive sleep apnea is a disorder in which there is complete or partial obstruction of the airway (nose, mouth, throat and windpipe) during sleep. Obstructive sleep apnea is one of the sleep/breathing disorders characterized by episodes of apnea (cessation of airflow exceeding 10 seconds or more) associated with hypopnea (reduction in airflow by 50% or more for 10 seconds or more, which may result in a drop in blood oxygen levels).

When the oxygen level drops, the brain then sends out signals to rouse the person from sleep, forcing them to take a breath. Typically when the breathing resumes there is a loud snort or choking sound. If there is a partial blockage of the airway any air that tries to squeeze through the narrow passage makes the snoring sound. People with OSA will follow this cycle during sleep: quiet breathing, snoring, pauses in breathing, gasping for a breath, resuming breathing. This cycle can repeat itself many times during the night and most people can have hundreds of apnea events during one night, which means constant interrupted sleep which then results in daytime fatigue and sleepiness.

What causes OSA? Obesity is the greatest risk. The extra soft fat tissue can thicken the wall of the windpipe, which then causes the airway to become blocked or narrow.

Other causes are:

• Abnormality of the throat muscles and tongue, which relax more than normal to hold the airway open;
• Large tongue, which blocks the airway;
• Large uvula, which is the small piece of tissue seen dangling at the back of the tongue; or
• Head and neck shape (bony structure) - smaller airway size in the mouth and throat area.

Other risk factors:

• Aging - which limits the ability of brain signals to keep throat open during sleep;
• Use of alcohol or sedatives - which relax the muscles in the throat;
• Short, thick neck (17 inches for men and 16 inches for women);
• Hypertension;
• Lung disease;
• History of sleep apnea in the family; or
• Being male - men are twice as likely to develop OSA than women.

The frequent drop in blood oxygen levels during apnea events increase blood pressure, which increases the risk for heart attack, stroke, and low blood oxygen levels, which can bring on arrhythmia (irregular heart rhythms).

Further, reduced sleep triggers the release of stress hormones, which also increases the risk of heart attack, stroke, irregular heartbeat and heart failure from OSA. Other complications include accidents and poor concentration due to daytime sleepiness.

Diagnosing OSA

The most common symptoms of OSA are daytime sleepiness, and snoring and pauses in breathing. Other symptoms may be high blood pressure; fatigue; morning headaches; dry mouth; poor concentration, and irritability.

If a doctor suspects OSA, the confirmatory test will be the sleep study test or polysomnography (PSG), an overnight test done at a sleep centre to record brain activity, eye movements, heart rate, and blood pressure.

A PSG also records the amount of oxygen in a person's blood; how much air is moving through his or her nose while breathing; snoring episodes; and chest movements. The test provides the apnea hypopnea index (AHI): the total number of apneas and hypopneas measured during each hour of sleep, divided by the number of hours of sleep. AHI is required by the underwriter to determine the severity of the OSA.

Treatment

Mild cases of OSA respond to lifestyle changes such as weight loss, decreased alcohol consumption, smoking cessation. CPAP (nasal continuous positive airway pressure) is the preferred method for treating moderate to severe OSA. People, however, tend not to comply with the treatment because they find the machine too cumbersome. In other cases, a uvulopalatopharyngoplasty (UPPP) is a surgical treatment option for cases that result from a large uvula. Although surgery may be an option for treating OSA, the type and effectiveness of the surgery depends on the cause of the OSA.

Underwriting

Ratings will depend on the severity of the condition, treatment, compliance with treatment and the presence of any additional rating factors or complications.

For mild cases of OSA an APS may be avoided if the underwriter has sufficient information to determine the condition is mild, and that there is an absence of any other risk factors such as a history of high blood pressure, heart disease, stroke, arrhythmia or any other respiratory disorder. A classification of mild is defined as mild snoring, no pauses in breathing, no shallow breathing and no daytime sleepiness. A mild case of OSA may be assessed standard for life and critical illness in the absence of any risk factors including daytime sleepiness and an adverse driving record.

An APS will always be required if there was either surgery or CPAP treatment. It also will be required in the presence of OSA in the elderly, or OSA in people with any other risk factor including an adverse driving record or if there have been work related injuries.

A moderate to severe case of OSA may be assessed at standard to moderately substandard for life coverage depending on the sleep study and AHI results, how long a person has been on treatment, compliance with treatment and no other risk factors or adverse history. A case will be declined for life coverage if OSA is suspected but no sleep study has been conducted, or if there is non compliance with treatment or poor sleep study results.

For critical illness, the underwriting assessment will be favourable for moderate/severe if there has been good response to treatment for at least one year, good compliance with treatment, favourable sleep study results, and no risk factors in a non smoker.

How to expedite the Underwriting?

If your client is not on treatment with CPAP or has not been diagnosed with OSA or in cases where your client has been told by his doctor he has mild OSA, include the following information with the application:

• Do you snore?
• Has your spouse noticed you gasping while you sleep?
• Has your spouse noticed any pauses in your breathing?
• Do you have daytime sleepiness or fatigue?
• Do you wake up feeling refreshed?
• Do you wake up with a dry mouth?
• Do you fall asleep at inappropriate times?
• Have you had motor vehicle accidents where you were at fault?
• Do you have high blood pressure?

If your client has been diagnosed with OSA, include the following information with the application:

• When was his or her last sleep study?
• Does he or she use a CPAP machine every night?
• Has the client's spouse noticed an improvement in sleep habits since the CPAP?
• Has the client noticed any improvement in symptoms since using the CPAP?
• If your client has been assessed at substandard, is a reconsideration possible?
• If your client was rated for OSA for life or critical illness coverage, a reconsideration of a rating is possible if he or she has been compliant with treatment for over one year and a current sleep study report shows favourable results using CPAP.

If your client has made some lifestyle changes due to a diagnosis of OSA, such as weight loss and has maintained this weight loss for one year or has decreased alcohol consumption and the improvements in the OSA symptoms are documented by a physician, a rating reconsideration can be requested.

Keep in mind that a rating reconsideration is always subject to no other change in insurability regardless of whether the condition for the rating has improved.

 

Carmela Tedesco is VP of Underwriting Services at LOGiQ³ Corp., which is located in Toronto and provides audit, consulting, outsourcing, and underwriting solutions to the North American insurance and reinsurance industry.

No Contest: The Trouble with Contestable Claims

By Eli Wahby (Published in Advisor's Edge Report April 2011)

Handling contestable death claims is not a straightforward exercise where you can use a cookie-cutter or one-size-fits-all approach. Each company has its own claims philosophy and claims handling requirements.

In addition to a company's own claims-handling criteria, a member company of the Canadian Life and Health Insurance Association (CLHIA) whose membership accounts for 99% of the life and health insurance in force in Canada will abide by the code of ethics of the CLHIA, which includes the obligation "to pay all valid claims fairly and promptly without unreasonable requirements."

Many companies are also members of the International Claim Association, which as a condition of membership requires every company to agree to adhere to a statement of principles that includes the following:

• Every claimant is entitled to prompt investigation of all facts, an objective evaluation and the fair and equitable settlement of his claim as soon as liability has become reasonably clear.
• Claimants shall not be compelled to institute unnecessary litigation in order to recover amounts due, nor shall the failure to settle a claim under one policy or one portion of a policy be used to influence settlement under another policy or portion of a policy.
• Recognizing the obligation to pay promptly all just claims, there is an equal obligation to protect the insurance-buying public from increased costs due to fraudulent or non-meritorious claims.

Before insurers can begin reviewing a claim, they need to have the beneficiary complete and submit a claimant's statement. They also require an attending physician's statement (APS) and a copy of the death certificate, or, in lieu of a death certificate, a copy of the funeral director's statement of death.

The claim-review process can only begin once the insurer receives the claimant's statement, as this usually includes a general authorization allowing the insurer to obtain medical records and Medical Information Bureau information. The MIB offers protection services for insurers, policyholders and applicants against attempts to conceal or omit information from the underwriting of life, health, disability income, critical illness and long-term care insurance. The insurer will also want to see either or both of the APS and death certificate.

While some companies automatically conduct a contestable claim investigation, others do so only on an as-needed basis: claims where it appears the insured's health condition predates the policy issue, policy delivery or policy application dates. Regardless of how a company decides to handle contestable-claim investigations, the purpose of the investigation is first to verify the life insured by the policy is the person shown as deceased in the claim documents submitted. Second, the purpose is to confirm the validity of the claim and that no material misrepresentation occurred either during the initial underwriting of the policy or during any reinstatement.

The obligation of the insurer, whether it's a stock or mutual company, is to pay valid claims as quickly as possible and deny claims that don't fall within the coverage issued. Although statistics on this are not published, my experience is that well over 95% of death claims are paid.

Why so many questions on the claimant's statement?

The purpose of the information being requested by the insurer is to put together as complete a picture as possible of the most recent medical history of the life insured and to assist the insurer in determining which, if any, physician it should consult in obtaining health records. The insurer also wants to avoid the delays inherent in having to return to the beneficiary for any follow-up questions. An insurer may also request an agent's statement either at the time of the claim or shortly thereafter.

As indicated earlier, in some circumstances like a motor vehicle accident with no extenuating circumstances some insurers do not require an extensive claim investigation and will pay the claim promptly.

An insurer will typically conduct a contestable claim investigation if the cause of death is such that there's some indication in the APS or elsewhere that the insured may have been aware of the condition during the application process. This is sometimes the case in instances of death from diseases like cancer. In such cases, it is incumbent upon the claims professional to determine the true facts surrounding the timing of the illness.

Claim decision delays

While a life insured's attending physician may have completed the APS and provided medical records in a subsequent request from the insurer, sometimes the records from the attending physician are not sufficient to confirm to the insurer when the medical diagnosis was made and when the life insured was advised of this condition or first sought treatment.

An insurer may find they require medical records from other physicians, specialists, the provincial health ministry, hospitals, clinics, etc. These additional records are not easily obtained some have their own authorization forms and in each case, including for the life insured's attending physician, providing medical records to insurers is not a priority. This is why some insurers contract with third parties, such as investigation firms, to obtain medical records as quickly as possible and to follow up on those records as necessary.

Occasionally an insurer will find they have received either incomplete medical records or the medical records obtained during the claim investigation now reveal a new source an additional physician, specialist, hospital or clinic that provided relevant treatment to the life insured. The insurer may find they need to obtain the relevant records in order to form a more complete view.

Misrepresentation

Life insurance contracts are unlike other kinds of contracts where the parties are in an equal position as far as determining material matters. The facts that have a bearing on the life-insurance risk the insurer is asked to take are usually known in full detail only to the party seeking to be insured and are usually not as readily available to the insurer.

Life insurance contracts are prime examples of contracts uberimae fidei of the utmost good faith imposing a duty upon the party seeking insurance to make true and full representations of all facts material to the insurance risk. Similar duties of disclosure apply in making representations for reinstatement of a policy.

The law extends the duty of making true and full representations to both the applicant and the person whose life is to be insured, regardless of whether that individual is a party to the contract. Both are responsible for disclosing every material fact that is not disclosed by the other, and are bound by the representations made by the life to be insured. This applies in the common law provinces that fall under the Uniform Act as well as Quebec.

Known knowns

The duty of disclosure that falls on the insured, and the life to be insured, concerns only known or provable facts. Matters that are subjective or based on opinion are not facts and therefore need not be disclosed to the insurer.

In regard to state of health, the insured and the life to be insured are not required to diagnose their own symptoms or assess their own insurability. They must, however, reveal everything they know be it a symptom or medical test and answer the application questions fully and truthfully. Moreover, they must do so regardless of the life insured's own belief as to their importance or significance.

The insurer relies on the answers provided by the proposed insured. If the insurer's underwriting requirements did not include a requirement for medical records, the insurer will not, and is not required to, seek to obtain them during underwriting they may do so if the proposed life insured has disclosed a health condition.

One of keys to confirming whether a material misrepresentation has occurred is to review the specific policy application questions and the proposed insured's responses. That's the first place the claims professional will start, comparing the answers given by the proposed insured in the application questions, and any supplemental questions, to the information contained in the APS obtained at claim time as well as any medical records the insurer has subsequently obtained.

Materiality

Whether a fact is material or not must be considered from the point of view of the insurer. It is not open to the insured or life to be insured to make the decision as to which facts are important or unimportant, or which to confirm or omit, even if they feel they're being honest and genuine.

Under Canadian law, the test of materiality from the viewpoint of the insurer is whether the insurer would have actually declined the risk or charged a higher premium, and not if the insurer might have done so.

For an insurer to rescind or void the insurance contract based on misrepresentation, the misrepresentation has to be considered material. Traditionally, misrepresentation of certain facts, such as the age of the life to be insured, have never been regarded as justification for nullifying the life insurance contract; adjustments to the face amount are the usual remedy.

Misrepresentation is considered material, but the insurer may still issue a contract at a higher premium or with some other restriction if it thinks the risk is substandard (for example, a smoker who indicates he is a non-smoker). It is important to confirm that the test of materiality is objective: an insurer has to show that its underwriting rules have reasonable conformity with ordinary standards for measuring insurable risks. Materiality is therefore tested against a "reasonable insurer" standard, and insurers will frequently cite one of their reinsurer's underwriting manuals in support of their decision. Ultimately, the courts will determine whether or not the insurer's underwriting rules and standards are reasonable.

Thus, the onus is on the insurer to demonstrate material misrepresentation if they're to be successful in declining a claim and voiding the policy for this reason.

Fraudulent misrepresentation

The distinction between misrepresentation and fraudulent misrepresentation is important. In the absence of fraud, the insurer cannot void the contract after it has been in force for two years. There is no such time limit in the case of fraudulent misrepresentation.

A high threshold has to be met for the insurer to prove fraud:

• The deception must be intentional, or
• The statement must be made deliberately without belief in its truth or made with reckless disregard for the truth, and
• The insurer actually relied upon the deception to its detriment.

Application questions

As mentioned earlier, typically it's the insurer that develops the application for insurance and the questions contained therein. The questions must be unambiguous: any ambiguities will be construed in favour of the insured or life insured and against the insurer.

An insurer should avoid asking broad, speculative questions such as "re you presently in good health?" Insurers have been getting better at avoiding questions that use general categories, or that group together dissimilar symptoms, making application questions far less ambiguous.

Every insurability question must be answered completely and in such a manner as not to give a false impression. Partial disclosure does not excuse the insured or life insured. In cases where the agent mis-records the answers given by the insured and life insured, recent decisions have held the agent and insurer responsible.

Decision to deny claim

Insurers do not take the decision to deny a claim lightly. It is a deliberate decision that has to take all facts into account, including relevant case law. If there is any doubt, the claim should be paid; when there is no doubt, the insurer should be prepared to present and defend its decision in court that day there's no room for planning the defence after a claim denial decision.

 

Eli Wahby is a claims expert currently consulting at LOGiQ³ Corp. He has been in claims for 20+ years doing life, waiver, critical illness and ADB claims. This article expresses the opinion of the author and is not intended as a source on how to handle contestable claims.

Ulcerative Colitis: Is it insurable?

By Carmela Tedesco (Published in Advisor's Edge Report March 2011)

Are people with ulcerative colitis, a chronic inflammatory bowel disease, eligible for life or critical illness insurance? It all depends on the severity of the disease. The trick is to gain a better knowledge of ulcerative colitis (UC), its complications, and how it is underwritten to help make the underwriting process less frustrating for the advisor and the client.

Though a family doctor can provide information on medical impairment, it's critical advisors obtain the proper information concerning their client's medical condition. That's because information that physicians provide isn't always optimal from an underwriting perspective, and if there is missing or vague data, the underwriter wastes valuable time repeatedly going back to the doctor.

Instead, the advisor should ask right questions, knowing what the underwriter needs. This can speed up the underwriting process and yield the best underwriting decisions.

What is ulcerative colitis?

It is a chronic disease of the colon or large intestine, classified as an inflammatory bowel disease (IBD), and not to be mistaken with irritable bowel syndrome (IBS). Irritable bowel syndrome carries a much lower mortality risk and does not lead to IBD. IBS is also assessed at standard rates for both life and critical illness insurance. Ulcerative colitis is painful; ulcers or open sores form in the colon on the inner lining of the bowel, causing inflammation, ulceration, bleeding and scarring along with a host of other symptoms.

These symptoms can lead to more serious complications down the road. The symptoms of UC, as well as possible complications, will vary depending on the extent of inflammation in the rectum and the colon. The rectum is always involved, but UC can extend a variable distance up to and including the entire colon. The major risk with long-term ulcerative colitis is colorectal cancer; however, regular screening via colonoscopy can help reduce the risk.

According to the Crohn's and Colitis Foundation of Canada (CCFC), in 2008 there were almost 201,000 Canadians living with IBD, and of these 88,500 had ulcerative colitis. Canada has the highest reported prevalence and incidence of IBD in the world. The age of onset of UC is 15 to 45 years and it isn't gender-specific. The symptoms of UC are bloody diarrhea (sometimes severe), abdominal cramps, tiredness, loss of appetite and subsequent loss of weight. Anemia may also occur if there has been severe bloody diarrhea.

A diagnosis of ulcerative colitis, especially at a young age, can affect individuals emotionally because the symptoms can make it challenging for people to date, have intimate relationships or plan a family. Symptoms can also complicate travel and work. There is also a stigma around UC because of the embarrassing nature of the symptoms, which means people are not willing to share information about their condition. This can make it difficult for advisors to gather information about the nature and severity of their client's illness.

That's why the best approach advisors can take is to arm themselves with as much knowledge about the condition as possible, and to improve communication with the client to ease any embarrassment.

Underwriting ulcerative colitis

The underwriter will require a doctor's report with full details of the extent of the disease, the number of relapses and details on both medical and surgical treatments, as well as copies of the most recent colonoscopy and biopsy pathology reports. In order to classify the risk, the underwriter must take into consideration the following:

• severity of the disease (mild, moderate or severe);
• age at onset;
• date of last flare-up;
• list of complications, if any;
• treatment (medical or surgery);
• evidence of compliance (with treatment and follow up); and
• type of surveillance (regular screening colonoscopies).

Since the client knows most of this information, it can be conveyed to the underwriter via the advisor if details are lacking.

For life insurance, ratings can range from "mildly substandard" for mild forms of the disease to "highly substandard" for moderately severe disease. If a diagnosis has been made within the past year, and the UC is severe, the case will be postponed.

If the disease is confined to the rectum (proctitis) and there are no complications, UC can be assessed at standard rates for life. If it has been in remission for five years, it can be standard for critical illness insurance as well. For critical illness, a "mild substandard" to a "decline" is the usual outcome for UC. However, if it has been recently diagnosed, it is generally postponed.

In the case of a total proctocolectomy (the surgical removal of the rectum, colon and sigmoid), if no symptoms or complications are present, the result can be standard for both life and critical illness coverage.

It's important to note that a postponement differs from a de-clinature. A postponement either means that there must be a waiting period before a case can be reconsidered or that further investigation or information is required before a decision can be reached. A declinature most often means the case cannot be reconsidered.

How can underwriting be expedited?

To speed up the underwriting process, advisors should include the following information, along with an application to expedite the underwriting process:

• What is the diagnosis? (example: proctitis, ulcerative colitis)
• At what age was the diagnosis made?
• Explain the treatment (whether it was surgery or medical).
• If surgery was done, when and what type was it?
• Have symptoms resolved?
• If medication, provide the name(s) of the medication being taken?
• When was the date of last attack?
• How long has your client been symptom-free, i.e. when was the last flare-up?
• Is the client receiving regular colonoscopies?
• Date of last colonoscopy?
• Is time off work required during attacks?
• Are any of the complications listed above present?

Is reconsideration possible for a client assessed substandard?

An underwriter should always clarify whether a rating can be reconsidered or not and if so, at what point in time and what evidence will be required at reconsideration time. If you have not been provided with this information, ask your underwriter.

ating for critical illness is not usually reconsidered for UC unless the disease has been in remission for a minimum of five years, but it is always worthwhile to ask the underwriter if there is a possibility. Reconsideration for life coverage can be obtained if your client has been in remission for one or two years.

Although reconsideration may be possible for life and critical illness, it is also dependent on whether there has been a change in insurability.

Understanding ulcerative colitis

UC does not run the same course with all people. The disease is generally classified as mild, moderate or severe, and patterns vary.

Mild

Mild symptoms with less than four bowel movements per day, no bleeding, no weight loss, infrequent attacks and symptoms easily controlled with anti-inflammatory drugs, long periods of remission; No hospitalizations; Extent of the disease is confined to the rectum; Patient is compliant with treatment and follow-up with doctors; Patient has good insight into the disease.

Moderate

Symptoms include more than four bowel movements per day with blood, abdominal pain, and other complications (weight loss and anemia); Flare-ups require corticosteroids for relief; Disease involves one-third to one-half of colon.

Severe

Continuous symptoms are present, such as frequent bowel movements with blood, weight loss, fatigue, and fever, that require ongoing corticosteroids or immunosuppressants; Need for hospitalizations; Presence of extensive disease that involves the entire colon.

Complications

Ulcerative colitis can lead to complications such as arthritis, uveitis (inflammation of the eye), liver disease, clubbing (a deformity of the ends of the fingers) in addition to weight loss, anemia and colon cancer. If an individual has had ulcerative colitis for eight years or more with frequent flare-ups affecting the whole of the large intestine, then the risk of cancer is much greater.

About one in 10 people who have had ulcerative colitis for more than 20 years will develop cancer. Therefore, regular colonoscopy is advised after ulcerative colitis has been present for more than eight years. This regular review can identify a cancer much earlier and lead to a much better prognosis.

Treatment

Treatment of UC can involve medication and/or surgery. Corticosteroids are used for acute flare-ups and 5-aminosalicylate (5-ASA) drugs can be taken continuously to reduce inflammation.

The medical treatment is based on the severity of the disease and the type of medication prescribed can let the underwriter know how bad things are. A 5-ASA compound is generally used for mild to borderline moderate disease and is used to maintain remission. Corticosteroids are used along with 5-ASA for acute flare-ups. They are not taken on a long-term basis because of possible side effects. A severe case of UC involves frequent hospitalizations, a failure to control the disease with corticosteroids, and treatment with an immunosuppressant. If medical treatment does not bring UC under control, the option is surgery.

This involves the removal of the whole colon, including the rectum (proctocolectomy) with the creation of a permanent ileostomy (the ileum or small intestine is brought out of the body to allow wastes to pass). Historically, surgeons tried to leave the rectum and remove the colon only and create an ileo-rectal anastomosis (attaching the ileus to the rectum), as this avoided the need for an ileostomy. However, as the significant risk of cancer developing in the rectum still remains, this procedure is very rarely performed these days.

It is important to note that individuals who have had a proctocolectomy with ileostomy are cured of the disease.

An option for younger patients as an alternative to an ileostomy is the ileo-anal pouch. This pouch is created internally using the ileum (small intestine), which is connected to the anus, after the colon and rectum are removed. This surgery may involve up to three surgeries by the time it's complete. The latter is the best option for young adults as it eliminates the need for an ileostomy.

Finally, surgical removal of the entire colon is a curative approach for UC and eliminates the risk of colon cancer. Surgery has come a long way and has provided dignity to these individuals by eliminating the need to wear an external bag for the elimination of wastes.

 

Carmela Tedesco is VP of Underwriting Services at LOGiQ³ Corp., which is located in Toronto and provides audit, consulting, outsourcing, and underwriting solutions to the North American insurance and reinsurance industry.

How Do You Communicate? Insurers Jumping On Social Media

By Natalie Ho (Published in SOA Reinsurance Section - Reinsurance News July 2010)

During our annual Freedom to Think reception this year, we had the opportunity to poll our community of clients, partners, and staff on "How do you Communicate?" We asked each of our attendees to select a name tag with a pre-printed icon that represented their preferred form of communication.

As a business, we want to ensure we are using the right form of communication channel to reach out to our community. With the rise of several social communication channels, such as LinkedIn, Facebook, and Twitter, we wanted to see what the current preferred communication tool is.

I am sure many businesses share the same challenge as LOGiQ³ - operating in the Web 2.0 world but servicing a traditional industry, such as ours - Life Insurance. However, to our surprise, the LOGiQ³ community is more progressive then we had thought! Here are the results to our poll, expressed as a percentage:

26% of our attendees preferred to use email communication (not a surprise), but followed tightly by LinkedIn at 22%, Facebook and Phone calls, both at 18%, Twitter at 13% and lastly, traditional postage at 3%. This is certainly insightful information for us as a business, as it allows us to focus our communication to these preferred channels. It also allows us to connect with our network on a real time basis, providing relevant content, and listen to what is being said on their preferred channel.

LOGiQ³ has presence on LinkedIn, Facebook, Twitter, and most recently launched our THiNK Blog, but how do we compare to the rest of the industry?

I did a quick search on LinkedIn inputting the key words Life Insurance and Life Reinsurance under the company search option, and it returned 125 results. Of these 125, it included companies such as ACE (4,954 followers), Sun Life Financial (7,280 followers), Swiss Re (5,924 followers), AEGON (5,226 followers), RBC Insurance (1,302 followers), and Partner Re (677 followers). I performed the same exercise on Facebook and Twitter, results were definitely not as compelling as LinkedIn, only a handful of companies have presence on Facebook and Twitter. However, there were a lot of mentions by consumers on these two sites, meaning that people are talking about life insurance and life reinsurance. Companies should be proactive in leveraging on these tools to listen to consumers' feedback.

Though our industry is not yet as progressive as others, those companies who are innovative are leveraging on social media to make their businesses better.

The Insurance Networking News webpage published a blog in February, 2011 by Craig Beattie. It speaks on an event hosted by Celent in London, "How Digital & Social Innovation Challenge the Insurer Business Model", with the first presentation given by Chris Denison, managing partner at AXA Innovation Hub, and Manjit Rana, partner in Innovation Hub. The presentation explained how AXA UK plans on utilizing social media and other technologies to determine individual digital profiles, define target challenges and identify solution generators.

Life insurers are also using social media networks to detect fraud in submitted claims. Investigators are now using sites such as Facebook to investigate suspicious claims. They're looking for clues that don't add up to the claim submitted, such as someone bragging about running a marathon while submitted a claim for an injured back, etc. Though data gathered on these sites are useful, they can only be used as insight and never as final proof of fraud.

There have also been talks that social-networking data could be used to help price policies. Insurers could use information posted on social networks posted by an applicant and compare with lifestyle choices and medical histories actually filled out on their application.

Many businesses are treading lightly with the use of social media because there is a lack of concrete measurements on the value it brings to a business. It is difficult to measure the success of implementing a social media strategy.

I don't believe social media is a "must", more so it is another communication channel (talking and, more importantly, listening) to reach our community of clients, partners, and staff.

 

Natalie Ho is AVP of Corporate Strategy at LOGiQ³ Corp. in Toronto, ON, Canada. She can be reached at natalie.ho@logiq3.com.