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Defining moments

Critical-illness cover has been available in the UK since the late 1980s. The product seems to most satisfy the need for protection in the mortgage market. Clients can see the need to protect probably the biggest single item of expenditure they are likely to make in a lifetime. So why has the ABI introduced new definitions and how can you explain these to your clients given that you are not doctors?

The changes to the definitions for cancer and heart attack in the updated ABI statement of best practice provide an ideal platform for you to emphasise that critical-illness cover provides invaluable financial support following a life-threatening illness.

Prostate cancer is at the core of changes to the cancer definition. Medical studies estimate that currently around 20 per cent of men in their 50s suffer latent prostate cancer. With continuously developing methods of diagnosis, many of these would be valid claims under the previous ABI recommended wording.

A two-year screening programme was launched by the Government in April last year and it is predicted that some 230,000 men between 50 and 69 will be invited to attend for a prostate cancer check (I am sure male readers cannot wait for their invitation.)

Seriously though, this is an excellent development and very encouraging for the future as far as this serious and in some cases fatal condition is concerned. The positive outcome of a successful screening programme and other advances in diagnosis prior to clinical symptoms is likely to result in:

•Diagnosis and treatment prior to the disease actually becoming life threatening.

•Cases being found which otherwise would have gone undetected.

•More cases of prostate cancer being detected in men at younger ages.

The changes to the ABI recommended definition for cancer mean that benefits in the future will be payable only for aggressive and life-threatening prostate cancers, which should help to maintain premiums for critical-illness cover at an affordable level.

All tumours of the prostate will be excluded unless histologically classified as having a Gleason score greater than six or having progressed to at least TNM (tumour, nodes and metastases) classification T2NOMO. The technical terms in this exclusion are used by the medical professional as measures to classify degrees of severity for prostate cancers. The Gleason grading system reflects how aggressive a tumour is through the measurement of the extent of breakdown of the cell structure whereas the TNM classification system measures how far a cancer has progressed and its location in relation to the prostate gland.

Translating this into layman&#39s terms, consider the proverbial train travelling north. TNM measures where it is and Gleason how fast it is travelling.

As always, it is paramount for clients to understand exactly what is and is not covered. The format of the revised definition provides the ideal opportunity to conduct an explanatory discussion, positioning the protection as cover in the event of a life-threatening illness. Explaining the cover to a client at outset guards against false expectations should early-stage non-life-threatening prostate cancer be diagnosed.

The ABI definition for heart attack has been updated to take account of the development of the new diagnostic tool, troponin. As far as possible, the revised definition aims to maintain the same level of cover as currently exists while ensuring that similar claims criteria can be applied.

Advances in diagnosis have found that the biochemical marker troponin is present in the blood stream when a heart attack has taken place. However, since the same chemical may be released with conditions such as angina and acute coronary syndrome, confirmation of the presence of troponin in itself is not necessarily conclusive that an individual has suffered a heart attack (acute myocardial infarction). In order to address this, the new definition excludes other acute coronary syndromes, including angina.

Again, explanations to clients regarding the wording of this definition will clearly identify the circumstances under which a heart attack claim is valid. These discussions can take place when reviewing critical-illness protection needs for clients. The discussion can then move seamlessly into the area of the incidence of critical illness. Additionally, using data on actual claims paid can prove extremely helpful when highlighting the reality that no one is immune from the threat of serious illness. Providers can let you have this information.

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