Evidence Alert: Risk of Psychiatric Co-Morbidity

Evidence Alert: Risk of Psychiatric Co-Morbidity

Diagnosed psychiatric conditions are common, with an estimated 20% of Australians aged 16-85 years old experiencing a mental health disorder in a given year. They are also associated with high levels of disability (the WHO now lists depression as the leading cause of disability in the world).

Assessing the risk associated with diagnosis of a past psychiatric condition in an individual is challenging but important. There are lots of factors to consider (personal, diagnosis related, and environmental factors). Some of the diagnosis related factors include: what the diagnosis was; its severity; treatment; risk of recurrence; and risk of psychiatric co-morbidity (or the development or later diagnosis of another psychiatric condition).

In January this year there was a fascinating and important study [1] published in JAMA Psychiatry, one that should be read by anyone in life underwriting or claims.

Importantly, the study found that if a patient was diagnosed with any prior mental health disorder, they were seemingly at risk for development of any other class of mental health disorder at a later stage. This risk was highest within the first year following the initial diagnosis (probably representing initial diagnostic uncertainty), but then remained elevated for the next 15 years.

The study also adds evidence to the shared factors model of mental health disorder development or pathogenesis. This model that proposes there are shared genetic and environmental risk factors underlying all mental health disorders.

The strengths of the study were its size (5.9 million Danish people) and the duration of follow up (up to 17 years of follow up for individuals, and 83 million years of follow up in aggregate). The researchers also grouped diagnoses by their ICD10 codes and looked at diagnostic clusters such as substance use disorders, eating disorders, mood disorders and personality disorders. To me, one of the major strengths of the study was that the researchers made their findings available to the public, and used an amazing data visualisation tool to let the public explore the methodology, the results, and conclusions.

The website to explore the study and findings is here:

https://holtzyan.shinyapps.io/the-nb-como-project/

It is worth time to work through the site, as it explains several core features of the study and their results really well. You can easily select a prior mental health disorder and see how the risk for other groups of mental health disorder changes over time.

A few considerations to note when interpreting the study: the subjects in the study were recruited from hospitals (either in-patients, out-patients, or from the emergency room). Many studies on mental health disorders recruit patients from hospitals, and it this probably means the subjects studied have a more severe mental health disorder than most. The researcher indicate they intend to consider people assessed and treated by their GPs in further work, the information from this study will be very interesting.

  1. Plana-Ripoll, O., et al., Exploring Comorbidity Within Mental Disorders Among a Danish National Population. JAMA Psychiatry, 2019.

 Dr Matthew Paul is an occupational physician with 20 years of clinical experience, and an interest in occupational disability and risk assessment. Working as CMO for Munich Re.

5 minutes with Samantha Norton, Executive General Manager, MLCOA

In this ReB edition we spend 5 minutes with Samantha Norton, Executive General Manager at mlcoa. 

mlcoa is part of the MedHealth Group.  MedHealth has grown to be Australia’s largest provider of independent medical advisory services. MedHealth’s expertise spans all major medical specialties and allied health disciplines, plus rich experience in all Australia personal injury, disability, health and employment schemes. It works with insurers, Government, lawyers, employers and other stakeholders.

Samantha Norton, Executive General Manager, mlcoa. She has over 20 years’ experience in the health industry in Australia and the UK. Sam is a qualified Pharmacist specialising in oncology before progressing into an Executive role for the Care Quality Commission UK responsible for the regulation of the quality and safety of care offered by healthcare within the UK. Sam then moved to Australia where she worked as a Senior Executive for the Health Quality and Complaints Commission (former HQCC) now Health Ombudsmen in QLD.



A day in the life of Samantha Norton is…….  
I am an early riser at 5:00am, I feed and rug my horses, buy a coffee and commute to the office by train to start my day. I was once told that in this job no two days are ever the same and I can say that this is very true! Most of my day consists of communication including meetings, seminars, emails, lots of phone calls, always making time in my day to chat to staff and clients. I also spend a lot of time talking to our doctors which is always interesting. I leave the office around 6-7pm most days and travel home to feed my horses.

How and why did you get into a career at MedHealth/mlcoa…. I have been working for MedHealth/mlcoa for just over 6 years, previously I worked for the Queensland Government as a senior executive. Initially I commenced at mlcoa as the General Manager for Queensland – the role interested me as I was looking for a challenge, I also wanted to diversify my skill set and broaden my exposure to other industries.

The biggest challenge for you at mlcoa is…. WOW! This a hard one as each day brings different challenges. If I had to pick one I would say trying to continuously reprioritise my tasks for the day, in the medico-legal business there are always new products or services being developed and operationalised which keeps me busy! I also try and remember to fit lunch into my schedule.

What most excites you about being a services provider in Australian Life insurance… I believe that now is the time for change and this gives mlcoa a great opportunity to partner with our Life insurance clients; listen to their challenges and work closely to reengineer the way mlcoa’s diverse capabilities are made available to support a better future for the life sector. We understand the need for customer centricity with the requirement of fast and fair decision making and transparency.

What excites you the most about mlcoa… the uniqueness and pace of the business, the endearing culture, the passion and commitment of the staff to ensure each of our clients receives the best customer experience.

Four words to describe the culture at mlcoa…. Passionate, innovative, loyal and hardworking (plus one for luck ….caring).

Four words to describe you… Passionate, thoughtful, ambitious, humorous.

Most passionate about….  Doing anything I do well. And being the greatest supporter of my daughter in her quest to be in the QLD dressage squad and ultimately represent Australia. I am also passionate about providing guidance and support to my son in completing his Chiropractic degree.

What most annoys you…..  Delays on my commute to work and not finding a car park at Woolworths!

A little-known fact about you that not many people know… I worked for 15 years as a medical trainer for an international airline.

What makes your job interesting… the diversity of work, the range of clients we provide services to, the amazing staff and of course our expert panel of specialists.

Who has been the biggest influence on your career and why… I am inspired by Richard Branson who in the face of adversity became a business magnate and entrepreneur. One of his quotes is my mantra: “Clients do not come first. Employees come first. If you take care of your employees they will take care of the clients.”

Your proudest career achievement to date is….. I have always followed my passion; each career move I have made has resulted in achievements big and small and I am proud of every single one of them.

5 years from now mlcoa will be… utilising the breadth and depth of all the MedHealth brands and our partners to be an industry disrupter, delivering innovative solutions to the life insurance industry.

Your best advice for young life insurance professionals looking to work in a medical advisory business…… Do what you do well. Be true to yourself, your ideas and focusing on the essentials.

If you were Chair of ALUCA, name one thing that you would love to do … Ensure that we don’t lose sight of the purpose of the life insurance industry which is to look after people in their time of need.

 

Business Expenses Insurance – What is Actually Covered?

Business Expenses Insurance – What is Actually Covered?

Business Expenses Insurance is an important offering provided by several insurers in the Australia market.  The purpose of Business Expenses Insurance is to assist our client’s that are Business Owner’s with meeting the daily running costs of their business, if they’re unable to work due to sickness or injury.

Using the employment measure of small business, there were 2,065,523 small businesses in Australia employing less than 19 people, accounting for 97 per cent of all Australian businesses by employee size (1). Businesses are stressful enough to run as is – but the financial ramifications on a business if an owner is rendered unable to work due to sickness or injury could be significant.

While the type of Business Expenses cover available in the market varies slightly, the fundamental nature of the product is to assist business owner’s with meeting the operating expenses of their business if they’re unable to work due to sickness or injury – up to the sum insured.

So what expenses are covered under a Business Expenses Insurance policy?

“Eligible expenses” that are covered are the Regular operating expenses of the business. Common examples are below:

  • Accounting and audit fees.
  • Electricity, gas, heating, water, telephone and cleaning costs.
  • Security costs.
  • Rent, property rates and taxes.
  • Membership fees, publications and subscriptions to professional
  • Leasing costs of plant and equipment.
  • Bank charges, interest on business loans.
  • Salaries and other related costs for non-income generating employees of the Life Insured’s business.

As you can see, the expenses listed above are all ongoing business costs.

On the flipside, examples of costs that are not covered are as follows:

  • Salaries and other related costs for the Life Insured and income generating employees of the Life Insured’s business.
  • Commissions or bonuses payable to the Life Insured.
  • Repayments of principal of any loan or other finance agreement
  • Any costs of a capital nature including the cost of any equipment, fittings, fixtures, furniture goods, implements, merchandise or stock
  • Depreciation
  • Losses on investments
  • Non-Cash Expenses i.e. Amortisation, Bad Debts etc

The common themes in the above examples are the exclusion of liability repayments, asset purchases, private expenditure & “one-off” type expenses.

Income generating Vs Non-Income Generating Employees

You will note that employee costs are classed as income generating and non-income generating within the policy documents of insurance firms.

Income generating staff are qualified & specially skilled staff who’s personal exertion contributes DIRECTLY towards income of the business e.g. lawyers, accountants, builders. Their costs are NOT eligible expenses. Whereas Non-income generating staff are non-qualified staff who’s personal exertion cannot DIRECTLY contribute towards income of the income of the business e.g. admin staff, receptionist, bookkeeper etc. Their costs are eligible expenses.

The rationale behind this is “Income producing staff” are able to generate income to cover their associated costs. Whereas non-income producing staff do not have the skills or qualification to contribute to the generation of business income to cover their associated costs.

In the above example of Ho’s Lawyer’s, the Legal staff are deemed to have the skills and knowledge to sign off and at least contribute to the earning of legal services income. Their salary and superannuation costs are deemed ineligible as per a Business Expenses Policy. Whereas the Practise manager, Bookkeeper & Cleaner are not qualified lawyers, nor have the legal skills and knowledge to contribute to the earning of legal services income. Their salary and superannuation costs are deemed eligible.

Calculating the Benefit Payable

Now that you are of the Eligible vs ineligible expenses of a business policy, let’s take a look at the assessment for Ho Lawyer’s for February 2019:

Ho Lawyer’s Pty Ltd
Business Expenses Claim
Profit/Loss statement for period 1/2/19 to 28/2/19
Account Eligible Not Eligible Notes
Accounting fees  $            1,000.00 business accounts
bank fees  $               200.00 business bank
loan repayments  $         6,000.00 repayment of liability
Private Expenditure  $         1,500.00 private – not business
Depreciation  $         2,100.00 non-cash expense
Rent  $            1,100.00 business premises
Purchase of Vehicle  $       18,000.00 capital (one-off) acquisition
Motor vehicle expenses  $               450.00 all business driving
Loss on sale of assets  $         8,000.00 non-cash expense
Wages  $            4,500.00  $       24,000.00 refer to payroll report
Superannuation  $               427.50  $         2,280.00 refer to payroll report
Bad debts  $            250.00 non-cash expense
GST paid  $         3,000.00 payment of liability to ATO
Sub Total  $            7,677.50
Sum Insured  $          15,000.00
Amount Payable  $            7,677.50

Ho’s Lawyer’s incurred $7,677.50 worth of eligible expenses for the period 1/2/19 to 28/2/19. Noting a Sum Insured of $15,000 per month, the amount payable to Mr Ho would be $7,677.50. Please note: some companies may apply offset’s where applicable.

Business expenses Insurance, at its core, is the promise of financial support at a time of disablement for a life insured that owns a business.  To determine the appropriate levels of cover or potential benefit payable, our clients really need to have a good understanding of the level of operating expenses they incur and how a period of disablement would affect their ability to meet these ongoing expenses.

Business owners are the heartbeat of our economy, and life insurers recognise the level of financial stress involved with running a business. The Business Expenses Insurance product exists to support business owner’s with covering their ongoing operating costs which will enable the business to stay afloat whilst a claimant is disabled so they can focus on getting themselves fit, healthy and ready to get back into running a successful business.

References:


Jason Noyahr is a degree qualified, chartered accountant with over 7 years’ experience. He started his career in a public sector accounting firm, moving on from his role of 5 years as a Senior Taxation Accountant, into the Life Insurance industry with AIA.

Since commencing with AIA in March 2017, Jason has been working as the Financial Specialist within the Retail Claims team, assisting the Claims department and other departments within AIA with the analysis & interpretation of financials, Forensic Accounting investigations and also being involved in the assessment of claims.

Ph: (03) 9009 4592 – Email: jason.noyahr@aia.com

 

 

ICLAM Mumbai 2019

Visit us @  www.iclammumbai2019.org

ICLAM is back to Asia!

The ICLAM (International Committee for Insurance Medicine) Congresses have become the international benchmark for congress aimed at scientific training, interactive discussion and networking on topics related to risk underwriting, claims assessment & medical trends and its significant to Life/Health/Disability insurance.

ICLAM has a very rich history over 100 years.

ICLAM 2019 will be only the second time that ICLAM will be coming to Asia (after a long gap of 32 years).

KEY SESSION FORMATS: https://www.iclammumbai2019.org/scientific-programme

ICLAM 2019 will bring many diverse formats of sharing knowledge via the Scientific Program

A. Preconference Workshops: 2 Masterclass workshops will be held with limited number of registrations to enable focused discussions and case studies.

Option 1: “Genetics and Genomics”: We will cover the advances & potential impact of Genetics and Genomics on the Life and Health insurance industry. Key technological breakthroughs (Liquid Biopsies, SNPs, Whole Genome Sequencing, CRISPR), Types of genetic testing (where, why and when are they used?), and general view of regulation and restrictions by various jurisdictions will be discussed with help of case studies.

Option 2: “Histopathology interpretation made easy- Every detail matters”:  Underwriting an applicant with cancer or assessment of CI claim of cancer requires up-to-date insight about the microscopic features of the underlying condition. In our day to day work, we seldom get a chance to brush upon our knowledge regarding the interpretation of Histopathology Reports. This interactive workshop is aimed at offering a bird’s-eye view on histopathology, starting with basics to a comprehensive updated review of few cancers followed by relevant case studies.

B. Concurrent Sessions: As part of the scientific program, Concurrent sessions with specialized themes like Cancer, Diabetes, Cardiovascular Diseases will be conducted to provide practical solutions to technical topics.

C. Technology Session: ICLAM Mumbai 2019 and The Digital Insurer are collaborating to deliver concurrent sessions on how InsurTech is changing the medical, underwriting and claims disciplines in the insurance industry. Each session will follow a fast-paced panel format where panellists deliver short mini-presentations allowing time to leverage the collective experience of both the panellists and audience in the room in an open floor Q&A

D. Satellite Sessions: The satellite programme will be provided by the where expert speakers from our main sponsors will address the “translation” of theory into practice. Topics like Mental Health, Disability and Health insurance will be covered.

E. Plenary Sessions: ICLAM Mumbai 2019 has invited speakers from all over the world to address on key topics relevant to Life & Health insurance industry. Some key speakers and their topics include

  1. Al Klein, Principal and Consulting Actuary, Milliman USA- Long Term Drivers of Mortality and Morbidity
  2. Eric Raymond and Maneul Plisson, SCOR- Cure for cancer: how far are we and how would it change insurance?
  3. Ronald Klein, Director, Global Ageing, Geneva Association, Genetic Regulations vs Direct to Consumer Genetics Test – What does the future hold?“
  4. Dr Kumar Prabash, Senior Medical Oncologist, Tata Memorial Hospital, Clinical Medicine- An Insiders’ view on Liquid Biopsy and Immunotherapy: Hype or Hope for the next decade
  5. Derek Yach, former World Health Organization (WHO) cabinet director and currently President of Foundation for a Smoke Free World- Smoking Harm Reduction: The myths vs facts and how it matters to insurers
  6. Prof Matthieu Allez, Hospital Saint-Louis, Paris, Dpt. Gastroenterology & Hepatology- Looking into Future of IBD (Inflammatory Bowel Disease)
  7. Dr Andreas Armuss, Chief Medical Officer (Asia Pacific, Middle East and Africa), Munich Re- Advances in Cancer Diagnosis and Treatment: What does all mean for Underwriting and Claims (CI/DI)?
  8. Takesumi Yoshimura, Director, Emergency Life-Saving Technique Academy of Kyushu- Radiation and its impact on Cancer- What we can learn from Japan about the long-term impact of cosmic ray and radiation exposure on cancer?
  9. Dr Yash Lokhandwala, Cardiologist and Electrophysiologist- Risk Stratifying Asymptomatic Arrythmias
  10. Dr Paul Davis, Chief Medical Officer,RGA Australia- 4th Universal Definition of Myocardial Infarction and its impact on insurers
  11. Lawerence Tsui, Director of Life & Health Products, Swiss Re- Cancer Only Product experience around the globe!
  12. Dr John O’brien, Life/Health Chief Medical Officer, London- Sweetening the deal- Products for Diabetics and its experience

WHATS IN IT FOR ME?

The Audiences: The ICLAM Congresses traditionally bring together over 300-400 insurance doctors, underwriters, claim evaluators and actuaries in scientific debate and social activities. ICLAM Mumbai 2019 will bring in a large audience from India and various countries in the East (South East and Far East), Australasia, Europe and Americas.

The academic event:  By being part of this one event, the audience will be able to engage with the experts across the region on the most relevant topics in an interactive manner.

The social events:  While we all love intellectually stimulating discussions, there is no harm in having some fun along with it. The social events we plan will bring everyone together to highlight the culture and food of different regions and make this event a memorable one for all participants and their partners.

Is ICLAM accepting any Abstracts/Essays?

Thinking creatively and out of the box are attributes that are essential for the creation of world-class companies. A culture encouraging Original research will inspire, solutions been identified for day-to-day challenges as well as broader issues faced by the insurance industry

With an aim to encourage original and scientific thinking, ICLAM 2019 invites Abstracts/Essay papers from Insurance and related institutions/ organizations. Submission deadline is August 15 2019. Abstracts may only be submitted online: www.iclammumbai2019.org

There will be two prize winning Abstracts and one Essay paper winner.  The winners will be declared in September 2019 and will be allocated a slot for presentation

The First prize Abstract winner will be eligible for free registration for the ICLAM 2022 which will be held at an International location (to be announced at ICLAM Mumbai 2019)

We look forward to your participation in this premier industry event, and to welcoming you in Mumbai in 2019.

Dr. Himanshu Bhatia                                                               Dr. Detloff Rump

President, ICLAM Mumbai 2019                                             President, ICLAM

www.iclammumbai2019.org                                                  www.iclam.org

The Genetic Testing Moratorium Balancing Act by Shane Burdack

Since FSC press releases during the back half of 2018 announcing the industry’s proposed moratorium on Genetic Testing, I’ve been asked by a number of market colleagues for my views as to where we’ve landed and if this is the right steps forward for our industry with regard the right to underwrite? That is, our right to continue to manage risk to ensure our underlying offer remains as accessible as possible to as many members of the population at a sustainably affordable price.

These have all been very reasonable questions to ask. There are and continue to be aspects of the proposed moratorium that remain a concern to me and the future of our industry and how we select and price risk. This article has been written with a view to providing an update to technical professionals across both underwriting and claims disciplines on the journey so far and provide responses to the commonly asked questions as the Australian life insurance industry moratorium has gained momentum.

 

Isn’t the current FSC Standard 11 sufficient?

FSC Standard 11 has fulfilled a critical purpose for our industry since its inception on 1 January 2002.1 It demonstrated our industry’s willingness to self-regulate, work with government, genetic counsellors and other professionals in a transparent way so insurance customers were informed not only about their legal obligation to notify an insurer about genetic tests they had undertaken, but also importantly how this information would be used and why.

We should also not forget the updates to both Standard 11 and 16 (Family History) in 2011. We provided consistency in the wording of the genetic test question asked of an insurance applicant to ensure only tests where an individual result had or was being obtained was required to be disclosed (to assist consumers who participated in medical research where individual genetic test results were not provided to participants or the participant had indicated they did not want to receive their result).  Additionally, as an industry we provided greater clarity with regard to the family history questions we ask by articulating that only family history information with regard first degree blood relatives needed to be provided.

Australia was indeed in a unique position globally as our Standard stipulated that we would not request or coerce an applicant for insurance to undergo a genetic test for the purposes of obtaining a life insurance product but an individual who had previously undergone genetic testing and received an individual result for any purpose was required to disclose this to an insurer under their contractual Duty of Disclosure and that the genetic test result could be used by an insurer in their underwriting of the applicant. Our market was also unique globally in that we diligently recorded (de-identified) all applicant’s where a genetic test had been disclosed in a common data base and the final underwriting decision made with respect to each person. This data and in particular how often an applicant disclosed a genetic test and were accepted for life insurance cover at Standard rates (even with a positive genetic test for conditions like haemochromatosis) were and remain invaluable for our industry to continue to demonstrate transparency and to educate consumers in what we do and why.

Despite these initiatives, professional bodies, lobby-groups and politicians have continued to challenge our industry (often-times with no sound basis or simply misinformation) with regard our approach to individuals with a known genetic predisposition. This discontent has been constant in the growing area of medical research but meanwhile these parties have continued to keep abreast of the legislative state of play in countries around the world on this hot-topic. In particular, the United Kingdom’s position where a moratorium existed and was replaced by a Code on Genetics in October 20182 and in Canada who after introducing a genetic test industry Standard similar to that of Australia’s, had legislation passed during 2017 that makes it unlawful to use genetic test results in the underwriting of life insurance products.3 This legislation is currently being challenged in the Canadian Supreme court.4

Why didn’t Australia simply adopt the U.K moratorium model much earlier?

There are numerous compelling reasons why Australia has not followed the path of the U.K. These arguments can essentially be categorised into one of either legislative or product feature reasons unique to Australia.

Firstly, the argument that has long been used in Australia by insurance industry detractors, that someone with a known genetic predisposition to a disease / disorder cannot obtain life insurance is simply incorrect. This has been demonstrated by our industry’s de-identified genetic test data collection as highlighted above. Additionally, Australia has unique legislation in the form of the Guaranteed Superannuation Contribution (GSC) levy which requires an employer to make a contribution equivalent to 9.5% of an employee’s salary into a complying superannuation fund for the individual’s retirement. The vast majority of employer superannuation funds also provide life insurance benefits (Death, T.P.D and even Group Salary Continuance cover) within this arrangement where generous “free cover” limits (Automatic Acceptance Levels) are provided to every employee who meet eligibility criteria such as being at work doing their normal duties. That is, there is no underwriting of the risk up to these generous free cover levels. The overwhelming majority of working Australians have access to this form of life insurance cover.

Australia is one of few countries that do not offer an applicant a set policy term for life insurance cover. That is, Australian policies are long term duration with most life insurance covers ceasing at age 100. This feature is further underpinned by the Life Insurance Contracts Act requiring a contract to be of a non-cancellable, guaranteed renewable nature.

Whilst Canada is similar in that it does offer longer duration coverage (albeit not to age 100 but commonly a 30-40 year term), the U.K policy offerings generally have the following features:

  • Limited term duration. This is selected by the applicant as part of the insurance application. Terms as short as 10-15 years are available. When the policy coverage ceases, cover is re-underwritten if continuing insurance is required by the insured life / policy owner. Note, longer duration policies are written, (30 – 40 year duration) particularly for mortgage purposes but a policy duration of 25 years is more common.
  • Product features for mortgage protection are usually of a decreasing sum insured nature. That is the policy sum insured reduces in line with the mortgage as it is paid.
  • Product features do not include automatic indexations to the level of cover.

To expand on these points then, a U.K insurer who accepts a life insurance policy on an individual not required to disclose a genetic test result, will have the opportunity to re-underwrite the cover at the conclusion of the policy duration where continuity of cover is required – and where the underlying genetic mutation has expressed itself in some identifiable way during this time, this could be a material factor used by the underwriter which may result in an offer of modified terms during the selection process for the new term requested. An opportunity an Australian insurer is not provided due to the nature of our products and legislation.

Continuing with product design, Australian life insurance products are increasing in nature with most insurers offering a guaranteed 5% indexation option (increase) annually even in low inflationary economic times. That is, the actual increase in policy sum insured is in real terms then currently growing at a greater rate than the reported Consumer Price Index (CPI) figure used to measure inflation.

The above product design features and legislative facts, underpin our industry’s current position when we are challenged to offer higher moratorium sum insured levels that are equivalent to the British Pound conversion rate.

Interestingly, the U.K Code on Genetics sum insured levels have not moved since the U.K moratorium inception 15+ years ago, so effectively with inflation over time the level of cover currently being offered if anything, has reduced from a policy proceeds ‘buying-power’ perspective.5

So where to from here?

There is still much to be done including addressing feedback from all bodies and individuals who have provided a formal submission as part of the scheduled public feedback period. Whilst some of the submissions I have seen as part of the FSC Genomics Working Group have been well balanced, others have been far from balanced and this only reinforces the importance of our industry becoming more pro-active with regard the education of the wider community as to what it is we do as a life insurance industry and even more importantly why we do what we do.

Literature suggests that we need to repeat simple facts on a topic that an individual or group is familiar with multiple times (on average up to 7) before it becomes part of a learning process.6 The conveying of our message then needs to be ongoing, even more so to our audience who are generally not well informed on the topic of life insurance. This is only magnified further in the political space where Ministers and Members of Parliament seem to be changing more frequently than perhaps in the past.

It is indeed a balancing act. Our industry remains at a very important cross-road and whether we like it or not, one that has and will continue to challenge us to prove that we are listening, have nothing to hide and that we are capable of operating under an agreed equitable framework without the real risk of having legislation forced upon us. Legislation likely to be significantly influenced by individuals and parties who do not understand (or have not yet heard it enough) the tremendous community service that our industry provides.

As we trek forward, our industry’s ability to be able to substantiate our position via the reporting of de-identified genetic test data will continue to be critical. We need to continue to embrace this aspect of our important technical roles and register each case you see containing a genetic test in the FSC genetic test data-base. I also encourage you to engage fully in the implementation of the genetic test moratorium (which will be introduced initially as an amendment to the respective FSC Standard(s) rather than an inclusion in the Life Insurance Code of Practice (LICOP) due to the delay of (LICOP) 2.0 which was due for release 1 July this year.

Each one of us needs to be responsible for becoming familiar with the mechanics of the moratorium, strive to be a ‘Champion’ for your employer and indeed the industry and ensure it can and does work for all, from both a risk management and administration perspective.

References

  1. Financial Services Council: https://www.fsc.org.au/
  2. https://www.abi.org.uk/globalassets/files/publications/public/genetics/code-on-genetic-testing-and-insurance-final.pdf
  3. Genetic Non-Discrimination Act: https://laws-lois.justice.gc.ca/eng/annualstatutes/2017_3/
  4. CBC News : https://www.cbc.ca/news/health/genetic-non-discrimination-act-challenge-quebec-1.4658432
  5. Association of British Insurers (ABI): https://www.abi.org.uk/
  6. Ebbinghaus – Memory 1885. http://www.keytostudy.com/many-repetitions-long-term-retention/

 


Shane Burdack

Shane Burdack is a Senior Underwriting Consultant with Swiss Re Australia and New Zealand. Shane is a member of the FSC Genomics Working Group and represented the Life Insurance Industry as a member of the Australian Government appointed Human Genetics Advisory Committee (HGAC) for the triennium 2009 – 2012.

ALUCA Briefing Report: Findings from the Royal Commission report

ALUCA proudly launched the working party final briefing report into findings from the Royal Commission report specific to life insurance underwriters, claims and rehabilitation professionals on Thursday April 11th at an Executive Leaders briefing in Sydney. A copy of this report was also sent via email to all members.  For those of you who may have missed it we are delighted to share this with you. Click here for the link for your complimentary copy.

The analysis provided has been designed to be of assistance to you and your organisation highlighting key relevant areas with possible solutions for moving forward.

ALUCA, anticipating greater regulatory scrutiny of the industry some 18 months ago, proactively took steps to strengthen professionalisation of life insurance underwriters, claims and rehabilitation professionals via the launch in November 2017 of ALUCA’s life insurance competency model that is freely available to all members and the industry, and ALUCA’s Certified Professional Life Insurance (CPLI) accreditation program. These measures were taken to demonstrate the commitment of ALUCA’s life insurance members to professionalise through an industry led competency framework that underpins ALUCA’s robust industry accreditation and ongoing professional development program to meet compliance with these competencies. You will see that an industry wide competency framework and accreditation program are some of the key recommendations in the report.

Please note this report provides the view of ALUCA at this point in time based on the information that was available to us via the Hayne report.

We’d like to thank and acknowledge all members of ALUCA’s working party led by Tony O’Leary for so generously providing their time and insights. We’d also like to thank all ALUCA members who put their hand up to help on this important project.

 

Name Main Discipline
Helen Barnett Legal
Angela Bolt Claims
Simon Cranley Underwriting
Sam Fortey Claims
Katherine Matterson Underwriting
Margaret Mozian Claims
Tony O’Leary (Chair) Underwriting & Claims
Debra Pitcher Underwriting
Mitu Ray Rehabilitation & Claims
Brian Sussman Underwriting & Claims
Darren Woolley Claims

 

As always, we welcome your thoughts and views and look forward to hearing from you.

 

In remembrance of Terry Devereaux

In remembrance of Terry Devereaux

 

 

 

ALUCA passes our deepest sympathy and regards to the family and friends of former ALUCA stalwart Terry Devereaux  who passed away in March this year. He was a highly regarded and well-known underwriting professional who retired from Swiss Re back in 1997.  Terry was heavily involved in the early years and development of ALUCA and well know in the life insurance industry. We would like to acknowledge all that he did for ALUCA.

ALUCA’s CPLI accreditation Program and CPD Requirements

ALUCA’s Certified Professional Life Insurance (CPLI) accreditation scheme was successfully launched at the end of November 2017, along with ALUCA’s competency framework.

CPLI accreditation demonstrates an industry wide commitment to continuous professional development aimed at raising the professional standards of life insurance underwriters, claims and rehabilitation professionals.  It’s never been more important to demonstrate the commitment to a peak professional life insurance benchmark for underwriters, claims and rehabilitation professionals that underpins and maintains high standards for the profession while at the same time enhancing the value that life insurance underwriters, claims and rehabilitation professionals provide to business, and the community more broadly.

To qualify for CPLI accreditation members  are invited to apply and provide proof of their educational qualifications – this could be a medical terminology course, degree or diploma amongst other key educational qualification in addition they must have been working in the life insurance industry for a number of years specific to the accredited level they are applying for in either underwriting claims or rehabilitation areas and are committed to their ongoing continuous professional development.

A CPLI panel meet  3 times each year to assess each new or pending application.  In 2019 the panel met on April 3rd to review both new CPLI applications and the randomly audited accredited members.

The next CPLI application panel review dates will be in early July and November

The CPLI committee is currently exploring some additional pathways to make the scheme accessible to more members.

How ALUCA’s continuous professional development (CPD) requirements work

All ALUCA accredited CPLI members will need to complete a minimum of 35 hours’ compulsory CPD in a 12 month period . However 35 hours is the minimum most people will exceed this, as the actual requirement will be determined by an individual’s development needs in any 12-month period and will also be a discussion that the member needs to have with their organisation. It is important to note that this CPD requirement is not generally an additional requirement to development activity ordinarily undertaken in the course of an individual’s employment, but incorporates this. We have shown this in the example below.

Using the ALUCA PD Activity summary sheet below, if you undertook 3 days of internal training (see #11) in your organisation at 8 hours each day that would be 24 ALUCA CPD points, watching the ALUCA regulatory webinar (see #14 – this is mandatory for all accredited members) is an additional 10 points. You may also undertake some business capabilities training  see #15 – say 3 hours of a leadership course = 3CPD points – you are already up to 37 CPD points and this is without attending any ALUCA or non ALUCA seminars or events.

ALUCA’s CPD diary – to keep track of your annual ongoing professional development.

We have just undertaken a random CPD audit of accredited members and the members who completed this provided their 2018 CPD record showing:

  1. The CPD activities they undertook in 2018
  2. The points they achieved ( 35 is the minimum)
  3. A statement/reflection of the objectives achieved against each activity.

They also provided proof of all non ALUCA activities such as a record of attendance at an internal training course, a certificate of attendance, conference registration etc.

It’s that easy. However if members cannot provide proof of compliance with their ongoing professional development they will not be able to maintain their ALUCA CPLI accreditation. This is an annual requirement of all accredited members and demonstrates the rigorous ongoing professional development and compliance to ALUCA’s competency standards.

ALUCA’s CPLI program is underpinned by ALUCA’s best practice, industry led life insurance competency framework that is specific to life insurance underwriters, claims and rehabilitation professionals. Given the current environment of increased regulator expectations and greater transparency and professionalism in the Life Insurance industry it is important for all ALUCA members not just accredited members to demonstrate compliance with these via ongoing CPD.  

The above diagram shows how each ALUCA membership level complies with the different ALUCA competency levels and what is required of each.  ALUCA CPLI accreditation levels start from an Affiliate member with core competency skills right through to an expert level of competency demonstrated by a Fellow accredited CPLI member.

For further information, you can read more about this on ALUCA’s website under the professional development tab : www.aluca.com/professional-development/cpli-framework/

If you have any questions please do not hesitate to contact us: SecretariatOfficer@aluca.com
T: 02 9431 8654

Sub Group Updates – Autumn 2019

WESTERN AUSTRALIA

What a busy and productive start to 2019 since I last wrote to you all. ALUCA WA have found a new home to host our events this year and we were extremely delighted to be joined by Dr John Cummins, Consultant Chief Medical Officer from SCOR to begin proceedings in our new home.

Dr Cummins delivered a very comprehensive presentation covering ‘The Future of Medicine’ which included a look back on some of the changes that have occurred over the past 30 years for good measure. This session allowed us all to gain a greater understanding of contemporary trends in medicine which will and are disrupting the insurance industry, Dr Cummins covered topics including anti-aging, cardiovascular and cancer trends. It would seem that the Vampires knew something about anti-aging after all, and we can all expect to visit a blood bank in the future to collect a regular donation to reduce the ravages of time. Thank you Dr Cummins, and SCOR.

 

We’ve seen our membership grow in the off-season and it was nice to see some new faces at our latest event. If you know of someone in your workplace that would benefit from becoming an ALUCA member, please encourage them to join or to contact me for further details.

Your committee are currently finalising details for our second Seminar towards the end of May and plans are already on track to deliver a mini-ALUCA event in August. Save The Dates have already been added to the Members Section.

 

 


See you in May.

Stephen Chapman
Chair – WA ALUCA Committee


SOUTH AUSTRALIA

For SA’s first ALUCA event for the year we were joined by Dr Cummings from SCOR with an insightful presentation on the Transformation of Medicine, it’s impacts not only to Underwriting and Claims but also policy definitions.

In his presentation he also had talked about HIV resistant donors being able to cure AIDS in HIV positive recipients to reversing the aging process which sparked some healthy conversations around the moral implications.

Our next ALUCA meeting (MiniLuca) will be in late August, this will be a full afternoon event with a no. of speakers.

Ashley Hicks
Chair – South Australia ALUCA Committee

 


The ALUCA Rehabilitation Committee

The ALUCA Rehabilitation Committee continues to support the strategic and operational direction of the Board in 2019. We do this by promoting best practice rehabilitation standards across the life insurance industry. Through the provision of high quality events and seminars, the committee offers rehabilitation professionals opportunities for evidenced based professional development, industry networking and up-skilling of knowledge. The committee continues to be a collective voice, represented by professionals with allied health or medical qualifications to ensure life insurance continues to be a lead in the delivery of best practice rehabilitation.

Planning and preparation for our 2019 events is underway! The committee has had the opportunity to share innovative ideas to support rehabilitation professionals in the industry post the Royal Commission findings and recommendations. We are finalising plans for our first events in May across both Sydney and Melbourne. Our theme will be on the holistic management of mental health conditions, with a key focus for early intervention support. We have engaged with a number of subject matter experts in mental health to be our key speakers at our events. The goal of the professional development day is to empower with new insights and provide Practical ideas for supporting customers with mental health conditions as early as they need further details will be available shortly.

Preparations for the ALUCA Life Insurance Excellence Awards are also underway, in Melbourne on 22nd May. It is great to see there will be such a strong presence from rehabilitation at The TPD Working Group are excited to resume their focus on best practice standards in employability assessments in 2019. The final version of the position statement will be released on the ALUCA website later this year.

It has been a steady start to 2019 for the ALUCA Rehabilitation Committee and we look forward to another successful year ahead.

Amlan Sharma
Chair – ALUCA Rehabilitation Committee


CMG ALUCA

Welcome back for the first edition for 2019, seems like this year is flying along.

At the end of last year we bid farewell to a number of our committee. In NSW: Taveet Garabedian, Paul Bennell, Carmel Myers and in Victoria Lana Collaris and Emy Vamos. The ALUCA CMG would like to thank all of them for all their work over the years.

The ALUCA CMG is currently planning our first event for the year which will be our Legal Sessions to take place in Sydney 6th May at the Westin and Melbourne on 8th May at the AMP offices. Our speakers this year will be from HWL Ebsworths and Australian Financial Complaints Authority (AFCA). Further details for this event will be sent out in late March.

Together with ALUCA NSW we are in the process of planning the NSW PD Day to be held in October 2019.
We look forward to seeing you at our events in 2019.

Myles Kennedy
Chair –  CMG ALUCA


ALUCA VICTORIA

It is hard to believe that we are nearing the end of the first quarter of the year.  It has been a quick 3 months.

There have been a couple of changes to the Committee post our last update.  Gail Jones our Communications Officer has hung up her boots after a period of approx. 3 years.  Gail has been a tremendous support during her tenure, providing amazing ideas and updates on our behalf.  She will be missed but certainly not forgotten.  As one door closes, another one opens…we are delighted to welcome Isaac Cracknell to the role of Treasurer.  Welcome aboard Isaac !

We hosted our first event on Wednesday 27th March at AMP to a record breaking attendance for an early morning session.  Thank you to everyone who set their alarms early to attend this breakfast event.

 

 

Renada Lee (Impact Manager – Insurance) and Tom Notley (Program Manager) of SuperFriend, presented the latest National Workplace data findings following an assessment of the mental health and wellbeing of more than 5,000 people within Australian workplaces.  From the financial services perspective this was a very timely study as it was conducted shortly after the Royal Commission in the banking, superannuation and financial services industry was established.  Renada and Nick provided very meaningful insights into what the data highlighted, including the extent of mental health in the industry, the types of mental health issues experienced at work and what is preventing employers from taking action.  Additionally they discussed opportunities for creating and sustaining thriving, mentally healthy workplaces and positive customer outcomes.  There were a number of take-aways from this event and it will be great see how the findings of this data progress as SuperFriend continue to add to the existing information.  Further information in relation to this study and other helpful information can be found on the SuperFriend website  https://www.superfriend.com.au/

 

The Committee are currently working on our events for the rest of the year and we expect to have these locked in shortly with further details to follow.  We can confirm that we will be holding our flagship MiniALICA conference on 17th October 2019.  This event sold out last year so keep your eye out for details and ensure you save the date to avoid missing out.

Suzanne Whyte
Chair – Victoria ALUCA Committee


ALUCA QUEENSLAND

With four seminars planned, 2019 promises to be a full year for ALUCA QLD.

Our first ALUCA seminar is set for Thursday April 11th.  Leading legal consultant, Paul Hastings will examine the current life insurance landscape post PJC and RC, and provide a Plain English assessment of what it means for Underwriting and Claims professionals.  With the industry under unprecedented scrutiny, Paul will also use case studies to demonstrate some tips and pitfalls when looking at claims involving non-disclosure.

For those who like to plan ahead, our calendar of events for the remainder of 2019 is listed below;

Event 2 – Wed July 24 (Breakfast seminar – 7.30am to 9am)

Event 3 – Thurs Sept 12 – Triple Treat Event (Half day seminar 12.30pm-5pm followed by drinks/canapes)

Event 4 – Fri Nov 29 – End of year event (5pm to 8pm)

We’d also like to update you on some changes to the QLD ALUCA Sub Group as there has been a couple of changes since 2018.  Our committee for the year ahead is;

  • President: Matthew Swanson
  • Secretary:  Jody O’Sullivan
  • Treasurer: Gretel Spizick
  • Committee Members: Karyn Bradford, Daniel Devine and Karl Bird

We would like take this opportunity to acknowledge Peter Crawford and Jenny Thompson for their time and valuable contributions over recent years and also welcome Karl Bird onto the Qld committee.

Look forward to seeing you soon in 2019.

Jody O’Sullivan
Secretary – Queensland ALUCA Committee


ALUCA NEW SOUTH WALES

Greetings from the NSW Committee.

After a successful 2018 with record event attendances, we are excited to present a great year of education and development to our members. We farewelled a number of committee members at end of last year and advertised for new volunteers.

Many thanks to all who have applied. I am excited to share our 2019 Committee:

  • Chair: Lisa-Marie McKechnie
  • Deputy Chair: Gabriella Siefert
  • Treasurer: Stephen Connolly
  • Event Co-ordinator: Tonja Nachman
  • Marketing and Comms Lead: Ami Barua
  • Working Group Lead: Catherine McAdam
  • Committee member: Erin Touzell
  • Committee member: Jacqueline Little
  • Committee member: Simon Andrew.

Our new committee members bring in expertise and wealth of knowledge from underwriting, claims, legal and product background. The committee is busy planning all the activities for the rest of the year.

There will be 4 events in May, August, October and December. The first one for 2019 is on Thursday 23 May 12-2pm at Rydges Hotel World Square. We very much hope you can join us for a special session with Pacific Life Re’s CMO Dr Bill Monday on “A rare insight into mental health”. The most popular professional development day (MiniALUCA) has been locked for 16th October. Please save this date in your calendar, the committee is working hard to deliver an exceptional day.

Watch this space for the rest of the events and keep an eye out for ALUCA email invitations.

We look forward to another successful year ahead and hoping to see you all at the events this year.

Have a great Easter.

Regards

Ami Barua
Marketing and Comms Lead- ALUCA NSW

A Potential Treatment for Spinal Cord Paralysis by Sheree Chandra

Driving a car, riding a bike, diving into water, playing sport, riding a horse or even a low fall; these are some of the everyday activities that have irrevocably changed the lives of more than 12,000 Australians through injury to their spinal cord leading to paralysis. A further 300 Australians will end up with a spinal cord injury this year alone. The impacts of spinal cord injury are usually life-long and devastating, costing patients anywhere between $5 and $9.5 million over a lifetime, and costing the Australian economy billions of dollars annually. Spinal cord injury results in a lack of control, independence and freedom for the patient and a successful cure would not only transform the lives of sufferers, but also create substantial savings for the entire Australian health system.

Research into finding a cure for paralysis has been undertaken across the world for decades. There have been many dead ends, many partial discoveries and a lot of hope. But now, the pathway to ending paralysis is illuminated. The potential answer? Taking a special type of cell from a patient’s olfactory (sense of smell) system, called an Olfactory Ensheathing Cell (OEC), and transplanting it into the spinal cord injury site.

Research pioneered by 2017 Australian of the Year—Professor Emeritus Alan Mackay- Sim and a world-first Phase I clinical trial led by scientists at the Griffith Institute for Drug Discovery (GRIDD), Griffith University, in 2002, demonstrated that the therapy is safe for use in humans. That trial led to a recent human trial by British/Polish researchers demonstrating that restoration of function after severing of the human spinal cord is indeed possible. In this study, a mix of olfactory cells together with a nerve bridge were transplanted into the injured spinal cord. Within 6-12 months after transplantation, the patient, who had been paralysed for several years prior to the treatment, regained some motor function of his legs, bladder control, and, most importantly, sensation. These exciting proof-of-principle results give hope that patients may regain function after spinal cord injury. What is now needed is to improve the transplantation therapy to make it more effective.

In partnership with the Perry Cross Spinal Research Foundation, The Queensland Government (MAIC) and the Clem Jones Foundation, the team at Griffith University’s GRIDD and Menzies Health Institute Queensland (MHIQ) –  the Clem Jones Centre for Neurobiology and Stem Cell Research (CJCNSCR)/Spinal Injury Project (SIP) led by Associate Professor James St John is currently conducting preclinical research and plans to undertake a clinical trial in 2020 to progress this journey and show that this therapy can further regenerate patients’ sensory and motor function. The method used has the potential to be the first widely available treatment for spinal cord injury, aiming to make the therapy more effective, available and affordable. It will establish Griffith University, Queensland, and Australia as world-leaders in spinal cord injury treatment.

050419-2

The complete team of researchers at Griffith with the notable Mr Perry Cross, an SCI survivor of 25 years whose foundation directly supports the project

 

So what is so special about Olfactory Ensheathing Cells (OECs)? The olfactory system—or sense of smell—is unique in mammals in that its nerve cells are able to constantly regenerate. It’s the only part of our nervous system that regenerates every single day as part of its normal function. And it’s lucky that it does: every time we breathe in, the nerve cells in our nose are exposed to the bacteria and toxins and get killed off. If these didn’t regenerate, humans would lose their sense of smell in around a month. Olfactory ensheathing cells (OECs) are crucial to this process of regeneration. They prevent scarring and protect and guide the growing nerve cells. It is these special properties of OECs that we aim to exploit in our therapy for spinal cord injury. OECs should provide the same guidance and supportive function when transplanted into an injured spinal cord, helping to create an environment that allows for neuronal regrowth.

050419-3

“A heart-shaped spheroid of OECs” – we use a newly developed technique called ‘naked liquid marbles’ to form a 3 dimensional aggregation of cells from the olfactory system that naturally assemble into layers.

The journey to preparing OECs for transplantation is a difficult one and involves a multi-team approach. The cells need to be purified from the olfactory mucosa of the nose and then assembled into a three-dimensional (3D) “nerve-bridge” suitable for transplantation.

However, transplanting OECs into an injury site wont alone cure spinal cord paralysis. While the cell transplantation aspect is the critical component of the therapy, its success relies on the patients undertaking long-term intensive activity-based rehabilitation to allow the nervous system to make new connections and to re-learn the necessary fine-control needed for proper motor and sensory function. Without the long-term activity-based rehabilitation, the cell transplantation alone will not be successful.

 

With support of the Perry Cross Spinal Research Foundation, Griffith University has developed a framework for this sustained functional therapy and an App that supports patients to do their activity-based rehabilitation every day for many months and perhaps years. Activity-based rehabilitation combines a range of physical motor and sensory gym-based activities provided by specialist exercise physiologists and physiotherapists trained in spinal cord rehabilitation. We need to test the feasibility of delivering the rehabilitation program prior to the commencement of the cell transplantation clinical trial. A feasibility study is important to identify barriers and improvements that can be made in preparation for the Phase I/IIa clinical trial.

The Spinal Injury Project at Griffith University is now well underway to progress the pre-clinical research into a Phase I/IIa human clinical trial and to develop a treatment for paralysis caused by spinal cord injury.

For more information, contact: A/Prof James St John, j.stjohn@griffith.edu.au.

____________________________________________________________________________

Sheree Chandra has worked in the Life Insurance industry for ten years across multiple operational and project management roles, and currently holds the position of Group Claims Manager at MetLife.

She is adept at leading and motivating her team of claims assessors to deliver the best outcomes in a customer’s time of need.

She also has experience in creating new products, building eclaims management tools and providing teleclaims solutions to improve customer engagement.

Sheree specialises in claims and people management, believing that supporting and empowering her assessors to grow and develop into strong contributors in the business and wider industry will lead to better claims assessment and customer experience.

Sheree Chandra