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Swiss Re is not ducking cancer claims

The suggestion in last week’s Money Marketing that Swiss Re is seeking to avoid valid claims for two cancer conditions is, unfortunately, misleading. Swiss Re’s dialogue with the Association of British Insurers on critical illness cancer definitions is not directed at preventing consumers from claiming for malignant myeloproliferative disorders.

In earlier stages of draft-ing, the cancer definition in the April 2006 version of the ABO Statement of Best Practice for Critical Illness Cover originally contained a separate and specific exclusion of myeloproliferative disorders, mentioning essential thrombocythaemia (ET) and polycythaemia rubra vera (PRV) as two examples. ET and PRV are part of the wider group of myeloproliferative disorders that also includes myelofibrosis and chronic myeloid leukemia.

Medical opinion differs on the classification of ET and PRV, with some haem-atologists saying they are malignant immediately at onset. Others disagree and see a distinction between these and disorders such as chronic myeloid leukemia.

The intention of the original revisions to the definition was to provide clarity on this point and to ensure that the definition was future-proofed against adverse trends in medical opinion. Life insurers, of course, have no problem in accepting that, where ET or PRV undergo leukemic to change, this would immediately qualify as a valid claim under both the old and the revised cancer definition.

During the latter stages of the review process, resulting in the April 2006 statement, these two exclusions were combined because of concerns regarding the complexity of the wording and issues with consumer understanding. The effect of combining these exclusions, and therefore the problem with the current wording, is to imply that ET and PRV are automatically pre-malignant. This clearly conflicts with one body of medical opinion and increases the potential for claims disputes.

Swiss Re is asking the ABI to consider amending the Statement so that a specific exclusion relating to ET and PRV is put back into the cancer definition – the pre-malignancy exclusion omits the two examples cited alongside.

We are asking for these changes to be made because, as currently drafted, part of the exclusion could be ineffective and viewed as technically incorrect. More importantly, there is increased potential for consumer misunderstanding and claims disputes

There is a limited time window for this to occur, because insurers must change their literature and systems ready to implement the revised Code of Practice early next year. We look forward to continuing our dialogue with the ABI and, we hope, to securing amendments to the April 2006 code to remove the ambiguity and improving clarity.

Jerry Brown

UK Head of Underwriting and Claims, Life & Health

Swiss Re, London

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