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Streamlining the Pre-Underwriting Process: October Protection Forum Part 4

Streamlining the Pre-Underwriting Process: October Protection Forum Part 4

This is the final post in our series recounting the conversations from our October Protection Forum, focusing on the discussion around making underwriting a better process for clients and getting the best outcomes possible.

We now have an underwriter that collates all evidence for us, we have our own contract for medical screening so we own the medical and the GPR which takes a lot of the pain out of the process for us.

If the case is more complex where we know there will be additional underwriting, we own all of it.

Lee Thomas:

All it is, I think, we do a lot of business protection. So we probably have, I guess on average, probably about 70 percent of our policies would refer just because of nonmedical underwriting limits. And so we had a lot of experience of, you do the pre underwriting based on what you know, and then you send them off for a full medical and when you get the full GPR and three months later, you get terms which are 100 percent right, and 75 percent right, or a decline. And because you don’t own that evidence, you have to go through it again and you can switch the medical but you know, you can’t switch the GPR. And we had cases that would sometimes take eight or nine months to get on risk.

So more recently, we’ve now adopted approach, where we have an underwriter that collates all the evidence for us. We have our own contract with medical screening solutions, so we own the medical, we own the GPR. We then package that up. We go to all the insurers. We get the best terms first time and it just saves all of that horrendous back and forth that sometimes we were having to go to two or three different insurers, and it taking months and months and months and months. It takes a lot of the pain out of it for us.

So that’s what we do, and the insurers reimburse us all the costs for the medical screening and the GPR once we put it on risk and sometimes with an uplift, so it doesn’t really, apart from what we’re paying, the underwriter, doesn’t really cost us anything, but it does mean that large cases, we get best terms first time.

Pre-underwriting is fine if nothing else comes out of it other than their original disclosures. But once you get a GPR in, they forgot to mention something and then they go for a medical and all sorts of horrible things are found. All of a sudden, what was the best insurer is no longer. They may be right down the list and you have to start all over again and you can’t just get, the insurers won’t share the GDPR. They will share the medical, but they won’t share the GPR. So that can take months. So we just had enough of that. So, yeah, big cases, which we think might be complex where we know there’s going to be a lot of additional underwriting, we own it.

We always let clients know that we will adjust the cover to suit what they can afford over time.

We let clients know that their insurance can be adjusted as their circumstances change.

Emma Astley: What we do is we’d never do a sale there and then, we just get the information, chat with the client and then we email everything over. So if we have to pre-underwrite it, we will then put in the email the approximate rating and the approximate premium for them. And we always let them know that we will have a final decision once an application has been done. But this is how much it’s going to cost you, approximately. And we also reassure them just to say, “you know, please don’t be worried about the premiums increasing,” because that’s the fear. They’re scared insurance is going to be hundreds of pounds, but we let them know we’ll just adjust the cover to suit your affordability and your needs. And like Paul said earlier, by having that journey with the client, your retentions and your conversions are a lot, lot higher because they know what’s coming. They know how much it’s going to be, approximately, and it makes a massive difference with conversion.

There are so many postponements at the moment, it’s all about managing client expectations.

Tim Bell: It’s about managing the expectation, particularly when the COVID crisis came in expectations that maybe we couldn’t get Medicals Direct, to go and do a medical. I had several cases where there was no availability of their staff. They ended up having to go to their own GP for a medicals concession with the insurance company. The delays in getting GPRs back if it wasn’t an iGPR, which is still rarer than unicorns, sometimes we were getting, 8 weeks, 10 weeks before we could get the GPR back for a few cases. I had 8 weeks waiting for Medicals Direct to contact a client of mine to make an appointment because they hadn’t got the resources. So, you know, I was chasing that up all the time to try and get alternative. All the while you’re managing the client’s expectation, you’re saying to them in the current times, and that’s still now, I’m still getting postponements because people who have been in hospital with COVID are having their cases postponed for six months. Whatever their outcome they could have had a two week stay or six weeks stay in hospital. But you know, they’re still postponing those applications. So that’s ongoing. So managing expectation, keeping the client informed, I do a fortnightly update email to the client just to make sure what we’re waiting for, this is what I’ve done to chase it. There’s no need for you to do anything more or I get the client involved to speak to the GP if I need to and just manage it the whole way through to get these cases issued.

The GPR report system is very old fashioned, we should have something like open-banking where the information can be shared without needing to go through the GP.

Charly Higman: We’ve got a surgery in Cornwall at the moment who just refused to do GPR medical reports on the basis they don’t have the staff and they don’t have the time and it won’t happen. And that’s been their closing comment. So that’s pretty shocking. But it’s not that unusual at the moment, particularly considering a lot of the surgeries are still working under COVID regulations and all the rest of it. So I think my point really is what the industry, the larger industry, the protection industry are doing in terms of trying to come up with ways that we can do this that are not including what is really quite an old fashioned GPR report now. I personally have an NHS app on my phone and on my NHS app are my medical records. Now that’s packaged on my phone, in an app at the moment, and I feel sure there must be ways that we can, like open banking. I know I’ve harped on about this before, but like open banking that somebody’s medical records can be packaged and sent to a provider electronically, so it doesn’t actually go anywhere near the GP. And there is some way that this can be sort of caught up with the 21st century because I do feel– I’ve been in the industry 35 years and this is exactly what happened 35 years ago. We wrote out the medical reports. It doesn’t seem to have moved with the times at all, and now we are in the situation where actually we’re still trying to knock the door down of GPs, which do not appreciate having their door knocked down, particularly in a global pandemic, so that we can get people insurance. So I’ve gone off-piste a bit, Robert, but that’s I feel quite passionate that technology should be trying to open the door for people to have a medical passport that is electronically available to providers.

We’ve employed our own team of Vitality nurses to get the screenings done.

Andy Philo: I think you’re spot on in terms of some of the challenges that we have as insurers. I mean, one of the things that we’ve done is try to take control of that underwriting journey a little bit more. And I wouldn’t say we’ve absolutely got it cracked yet to be perfectly frank. But we’ve employed our own team of Vitality nurses up and down the country. So we’ve got just under 20 now that are based around the country. So we prefer to utilise our own resource and they’re obviously medically trained and can do a bit more sort of [inaudible] or when they’re with the with the client so we can actually get some screenings done, some blood tests, etc. So that’s sort of helping us a bit. I wouldn’t say we’ve absolutely got it cracked yet, but that’s what we’ve done. Rather than outsource to MSS or whatever, who we’ve got also a good relationship with, we’ve employed our own nurses and it seems to be working for us.

Sometimes you just need to give the underwriters some context for the information and ask the questions you need to in order to get the best outcome.

Even with GP information that needs to be revised it’s worth checking.

Emma Astley: Just I think when you chat to your clients and you obtain all that information, you get a good understanding of what the outcome is going to be. So say we had a client who actually got rated 50 percent due to his putting down that he had five months off work. So a system would automatically rate that you’d think, right, fine, that’s all that’s offered to me. But that was £16 a month to that family. So I then went to the underwriter to give them more information about what had happened. The twins came early at twenty eight weeks. Unfortunately, one of the daughters passed away and then his wife and his other daughter was in hospital, and that’s why he needed to be off work for five months. He didn’t have anxiety, wasn’t on any medication. It was just there for his wife. And that actually then came back as standard terms. So I think just the other flip side of it, really, pre-underwriting is so important, but also if there is ratings or exclusions and things that you don’t think are right just speak to an underwriter again on the opposite side of it, because again, you’re doing better for the client and they’re more likely to stay on board with you because of what you’ve done. Don’t just think “oh £16, brilliant, that’s all that the client can have.” No, ask the questions. Go back to the underwriter and, just challenge it because you’re getting the clients a better outcome, really.

We’ve had a lady who again was rated 75 percent. But that’s because the last time the GP did her weight, she had just had a baby weeks before. So the weight that they actually had on there was quite a high BMI where actually she was down to like a 31 instead of 41, so it made a massive difference. So we just forced out for a medical to be done on that client, and the rating was reduced. So many examples.

I’ve had so many cases overturned just by following up with the insurer and arguing the case.

Adam Kaplan:

I think we could probably sit here and share stories for hours about contesting decisions. A lot of it to me and Emma is obviously very different to a lot of advisers out there, certainly who do mortgages.

So this is more sort of sharing with them kind of what we do well. But again, I’ve had so many cases over the years overturned. I had two in particular in a row with one insurer. I won’t mention who they are, and these were the exact words they used. They put a precautionary rating on after you had a medical for limits because he had what we know as ‘white coat syndrome’. So there was no history of high blood pressure, got rated 50 percent, by then, had to place it elsewhere and same thing happened. He was more nervous this time because of what happened the first time, but because we were able to evidence there was no history of high blood pressure, it was purely that there was no other medical issues, they offered him standard rates.

And I had two cases, literally in the same month where that same particular insurer put a precautionary rating on for high blood pressure. But if it wasn’t for the fact that we challenged it, yes, it was a pain in the bum to have to go and redo the applications and do all the suits. It was a nightmare, but the point is we did the best thing for the client and we got those ratings overturned and we got them both standard rates, which they should have had with the other insurer in the first place, if that makes sense.

So there is a lot to be said for challenging underwriting decisions. I’ve got one at the moment I challenged yesterday where the reasons why letter said we’ve postponed your application for two years due to your recent diagnosis of Polycythemia vera. Yet his medical records show that he hasn’t been diagnosed with it. So it’s a massive misinterpretation from the insurer or the underwriter that he’s been diagnosed with something when he hasn’t.

About The Author


Originally from New Jersey, Emma has worked as a writer, researcher, digital content creator and podcast producer for leading fintech consulting firm Ezra group for several years. She recently graduated from London Contemporary Dance School and is pursuing a career in dance alongside her work in Forum administration and digital content creation at FTRC.

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