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ALUCA / Turks Legal Mental Health In Life Insurance Panel Session

ALUCA was very proud to co-host with gold education sponsor partner Turks Legal a special mental health in life insurance panel session on October 31st at Turks Legal’s offices in Sydney.  A range of senior industry speakers spoke on the panel providing their insights and key perspectives.

The esteemed panel included the co-author of the Actuaries Institute paper on Mental Health & Insurance, Geoff Atkins, Principal, Finity Consulting, Margo Lydon, CEO of  Superfriends, Nick Kirwan, Senior Policy Manager, Life Insurance  from the FSC, Carly Van Den Akker, Head of Life & Health Solutions at SwissRe and Glenn Baird, Head of Mental Health at TAL and moderated by John Myatt from Turks Legal.

The session and topic came about from the Life Insurance Future Thinking group (LIFT) session held and hosted by Turks Legal. The Life Insurance Future Thinking group consists of the finalists and winners of the ALUCA and TurksLegal’s scholarship alumni program. They were joined by several key thought leaders with the topic being Mental Health in life Insurance. Geoff Atkins, co-author of the Actuaries Institute paper on “Mental Health & Insurance” joined the session. A key view about mental health and insurance in this paper was:

“…..this is a genuine issue in our society and our economy, and it behoves the insurance industry to pull its weight……Many have been working hard and improvements have been made, but some aspects would be more effectively developed on an industry-wide basis.”

The LIFT session discussed this and more, providing many relevant insights about the challenges that we face in life insurance with the growth in mental health looking at the key issues and solutions from a product design, new business and underwriting and a claims perspective. The panel speakers all further explored these.

The panel reflected on how mental illness is now the leading cause of work absence and long-term work incapacity in the developed world. The value of mental health claims is far higher than in most other claims type. For TPD the average amount paid for mental health claims is almost 65% higher than other claims types. This ties in with the recently released FSC/KPMG Australia data that reveals that life insurers pay out more TPD claims caused by mental health conditions than for any other cause – accounting for 24.1 per cent of all TPD claims.

While many insurance products respond to Mental Health, there is a growing burden of claims being made with the proportion of mental health claims reported to the insurer increasing steadily between 2011 and 2015.

It was a really stimulating and highly relevant session touching on the need for the industry to collaborate further to address mental health and life insurance.

A paper will shortly be distributed from this session to all members. Many thanks again to Turks Legal and all the panel speakers.

2019 ALUCA TurksLegal Scholarship Winner And Finalists

L-R: Jim Welsh, Chair, ALUCA; Amanda McKernan, CEO, ALUCA; 2nd Runner-up Honor Grant-Hennessy, OnePath; 2019 Scholarship Winner, Cy Lindeberg, BT Financial Group; 1st Runner-up, Celeste McFadyen, CommInsure; Alph Edwards, Partner TurksLegal and Scholarship Judge; Darryl Pereira, Partner TurksLegal and Scholarship Judge.
(2nd Runner-up Torrent Woodard, BT Financial Group not pictured above accepted his award at the VIC ALUCA PD Day on 17 October 2019).

We are delighted to share the winner and runners up of the ALUCA Turks Legal scholarship award now in its 13th year. The winners were announced by Turks Legal at the NSW Professional Development Day at Darling Harbour with 3 of the finalists being present. Many thanks to Turks Legal and to everyone involved, including all of the industry judges and entrants. Congratulations to all who submitted a paper. There was a great cross selection of entries and the judges commented on the high quality of papers submitted.

2019 Winner of the 2019

Cy Lindeberg, Health Support Consultant, BT Financial Group
For her paper on ‘The Role of Rehab Advisors in Improving Customer Outcomes’.
Prize: An overseas conference package valued up to AU$8,000 including return travel, accommodation, $1,000 cash and registration to an industry overseas conference of Cy’s choice

1st place runner-up

Celeste McFadyen, Case Manager, CommInsure
For her paper on ‘‘Developing Empathy Skills’.
Prize: AU$1,000 Visa pre-paid gift card

Two x 2nd place runners-up

Honor Grant-Hennessy, Senior Underwriter, OnePath and
Torrent Woodard, Senior Research and Development Underwriter, BT Financial Group
Honor’s paper was on ‘Will we really miss the duty of disclosure when it is gone?’  and Torrent’s paper on ‘The origins of Protecting Your Superannuation’.
Prize: AU$250 restaurant voucher

Well done to Cy, Celeste, Honor and Torrent  – they should all be very proud of what they have achieved.  You can read the winning paper from Cy in the Spring edition of RiskeBusiness and the runners up papers in the ReB Summer edition.

Alph Edwards, Partner of TurksLegal’s Life Insurance, Superannuation & Advice practice and member of the scholarship’s judging panel for the last thirteen years mentioned that all the papers were of an extremely high standard (it was a vintage year) so the competition was tight but Cy’s paper ultimately stood out in the judges’ eyes for its balance of empowering optimism and  innovative thinking but with a solid and empathetic understanding of the great challenges facing injured and ill customers.

ALUCA Deputy Chairperson, Devi Uka who was also a member of the scholarship’s judging panel said how the high standard of submissions had made the judging challenging. She was also pleased to see the ALUCA TurksLegal Scholarship highlighting the talent that is in the Life Insurance industry.

The 2020 ALUCA TurksLegal Scholarship will open in July 2020.

About The Scholarship

The ALUCA TurksLegal Scholarship, now in its 13th year, offers life insurance professionals a unique educational opportunity to attend one of three major international life insurance conferences of their choice, while contributing to the ongoing debate on cutting-edge issues affecting the future of risk insurance in Australia.

The scholarship is open to financial members of the Australasian Life Underwriting and Claims Association Inc. (ALUCA) working in the life insurance industry including superannuation trustees and administrators. It was developed through a partnership between ALUCA and specialist insurance law firm TurksLegal.

This year’s cutting edge questions were derived by the judges from a list of suggestions made by lawyers in the Life Insurance, Superannuation & Advice team at TurksLegal who threw their ideas in the pot to get everyone thinking.

The successful applicant is selected on a range of criteria including understanding and insight of the topic, sound evidence, research, and presentation skills.

The judging panel is drawn from the ranks of the industry’s senior leadership and includes:

  • Brett Clark, Chief Executive Officer, TAL
  • Gavin Pearce, Chief Operating Officer, Life & Investments, Zurich
  • David Campbell, Chief Operating Officer, MetLife
  • Malcolm Weir, General Manager, Life Customer Services, CommInsure
  • Jeremy Houghton, Head of Strategy and Corporate Affairs, AIA
  • Linda Winterbottom, Claims Rehabilitation Consultant, RGA Reinsurance
  • Evgeney Schkola, Case Manager Income Protection Claims, CommInsure (2018 Scholarship winner)
  • John Myatt, Partner and Practice Head of Life Insurance, Superannuation & Advice, TurksLegal
  • Alph Edwards, Partner, TurksLegal
  • Darryl Pereira, Partner, TurksLegal
  • Devi Uka, ALUCA Vice-Chair

2020 ALUCA Life Insurance Excellence Awards…Opening in November

In the meantime, don’t forget ALUCA will be opening up later next month for nominations for the 3rd annual ALUCA Life Insurance Excellence awards.  So stay tuned.

Chatter From The Chair – Spring 2019

2019 has been a big year for both the industry and ALUCA. Tying in with Amanda’ s update, I wanted to provide a quick update on the key headlines from our strategy day.  We want all members and stakeholders to be clear about who we are and what we do, which remains fundamentally unchanged. We remain a wholly and resolutely independent, not-for-profit member association, run by members for members. Education and professional development remains core to what we do and who we are, and we are happy to be working closely with the Life CEOs, other associations and ANZIIF to further evolve our CPLI program, the Life Insurance competency framework, for the good of our members and industry, and will continue to provide this open sourced to both.  This is something we acted on when we saw the need for a competency framework back in 2016, long before the Royal Commission was mooted, and we will continue to hold people to the highest standards.

We’ve continued to grow year on year, and we have now almost reached 2000 members.  As part of our ongoing good governance processes, we have been advised that we will need to transition to “a Not-For-Profit company limited by guarantee”.   This will not change who ALUCA is, or what we do, but helps futureproof our association and simplify our governance requirements.  More information and consultation with our members will be coming out before the end of the year.

We’ve been working hard to ensure the working party recommendations into the Hayne Report specific to Life Insurance underwriters, claims and rehabilitation professionals are understood and actioned. This has included updating the life insurance competency framework earlier this year. We are working closely with Executive Leaders to encourage more members to not only gain professional education but to also become ALUCA accredited CPLI members.

A key strategic focus is continuing to invest and evolve our competency framework that underpins ALUCA’s accredited Certified Professional Life Insurance membership which is continuing to grow as you will have read in Amanda’s update.

I encourage you all to become an accredited CPLI member and invest in your ongoing education. Personally, I am proud of my technical knowledge and learning of my own life insurance discipline.  I’m proud of the hours I have spent securing formal qualifications, the hours I have spent at (many!) ALUCA seminars, and the new things I learn daily from my colleagues and peers across the industry. I am sure that each and every one of you is similarly proud of your own education, technical knowledge and capabilities.   There has never been a better time for you as individuals, or us as an industry, to show we are proud of who we are and what we do, and to give our customers peace of mind that they are dealing with a true professional throughout all of their interactions with us

Before I sign off, I’m delighted to share the news about the 2019 winners from our two key gold education partnerships which you can read more about in this edition of ReB. Firstly, the prestigious ALUCA Turks Legal scholarship, which is now in its 13th year. The 2019 winners were announced at ALUCA’s NSW Professional Development Day. Congratulations to the winners and everyone who was involved and who applied you should all feel very proud of your achievements.

Thanks and congratulations to our other gold education sponsor MLC and to Monash for partnering with ALUCA once more to deliver the ALUCA MLC Monash scholarship award that recognises up and coming allied health student talent and the crucial role that they play in the life insurance industry. I had the pleasure of judging this and was impressed by the talent that shone through.  Well done to the winners and all involved. Thanks again to both Turks Legal and MLC’s dedication and commitment to the ongoing education and professional development of both the industry and ALUCA members.

Best regards,

Jim Welsh
ALUCA Board Chair

Jim_Welsh@amp.com.au
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CEO Corner – Spring 2019

We are well and truly into Spring, fast approaching summer, and ALUCA has had a very busy quarter. Each ALUCA Sub-Group have held their Professional Development Days. My congratulations and thanks to everyone involved in making these events such a success. I personally valued the many relevant insights and learnings in addition to the networking opportunities with other Life Insurance professionals who are all facing the same industry challenges. These events showcase what ALUCA is all about educating, developing and connecting ALUCA members.

Strategy

There are a lot of exciting things happening at ALUCA right now which we’ve been sharing via our recent emails, leading on from our strategy day. ALUCA is committed to being wholly independent and member-led, and believe that the time is right for us to share the significant IP we have invested in the ALUCA life insurance competency framework so that the industry can respond positively and pragmatically to the recommendations contained in the Hayne Royal Commission report. We are not only dedicated to the ongoing education and professionalism of our members but also to raising the professionalism of the industry. I’ll let Jim, our Chair comment more about this.

Education

Education is key to what we do. We are committed to continuing to invest and evolve our competency framework that underpins ALUCA’s accredited Certified Professional Life Insurance membership which is continuing to grow. Some organisations now have 54% of their members who are accredited – congratulations to them – and Victoria have more accredited members than NSW with WA, being the state with the most accredited members ,so the challenges is on!

We still get a lot of enquiries about how ALUCA’s accredited Certified Professional Life Insurance (CPLI)  membership works – it provides recognition for both your formal education and for the competencies, knowledge and skills you have gained during your years as a life insurance underwriting, claims and or rehabilitation professional. Starting as an affiliate member, moving to an associate, associate fellow and fellow.  We’ve worked on updating this to ensure that members wanting to upgrade understand that they need to have both educational qualifications which tie back to the Australian Skills Qualifications and standards – in addition to years spent building their competencies in Life Insurance. You need both to qualify and if you have more years of experience than education you can apply for the lower of the 2 or the other way around, so if an Allied Health graduate comes in with only 3 years LI experience then they can only apply for the lower level. Fellow level is the highest and hardest – we have defined what the paper should be versus an article which you can view on the website or just call or email us to answer any questions you may have.

We’re doing a lot of work to help encourage members to gain professional educational qualifications. You can learn more about where to gain qualifications on the ALUCA website. We’re also working on developing a training plan template to assist members identify their capability gaps and complete these via 5 key CPD areas similar to the FASEA requirements for advisers.  We’ll be sharing more about this over the coming months.

Other exciting developments include the Board signing off on further evolving and updating the ALUCA website and Member centre as well as providing a Learning Management System to provide 24/7 educational content in partnership with our key sponsors. In addition to a Womens Forum, Educational Advisory committee and mentoring program.

I look forward to catching up with you all at an ALUCA end of year event or at the upcoming ALUCA AGM on November 21st.

Warm regards

Amanda McKernan
ALUCA CEO
ceo@aluca.com.au
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2019 ALUCA TurksLegal Scholarship Winner’s Paper

12019 ALUCA TurksLegal Scholarship
Winner’s Paper

Cy Lindeberg

Health Support Consultant,
BT Financial Group

 

The role of rehab advisors in improving customer outcomes
Increasingly companies are designing products that will either provide opportunities for their customers to obtain the benefit of rehabilitation advice in the event of a claim or that will involve a rehab professional being part of the claims assessment process.
What are the respective roles of rehabilitation and claims professionals working on a claim? What is the ideal dynamic for companies to achieve between them as they work together?
In addition to a discussion on the engagement model for rehab professionals, your answer should explore the evidence surrounding the intrinsic value of rehabilitation in assisting people to make a recovery and a return to health and work and the positive impacts, financial and otherwise, that rehabilitation can have for customers and for companies that integrate rehabilitation well in their response to a claim.
Your answer should also address the evidence in the recent debate before the Parliamentary Joint Committee on Corporations and Financial Services which ultimately rejected the FSC’s proposal to fund rehab costs and discuss whether the industry could achieve even better outcomes for customers if it were allowed to do so.

 

Functional Restoration – Industry or Individual?

The life insurance industry acknowledges customers need support in times of illness and injury and has shifted over the past 10 years to take a rehabilitation focus via the inclusion of allied health professionals within claims teams promoting recovery and wellness. Despite effective tailored rehabilitation solutions being part of claims management, recent debate has been sparked by the Financial Services Council’s (FSC) submission to the Parliamentary Joint Committee (PJC) to consider legislative reform promoting even better health outcomes. Some advocated for the reform highlighting the industry had already taken the first step in the shift but there is a growth opportunity to promote even better outcomes for individuals and the community; others countering with the argument of it being naïve to think the proposal was altruistic in nature (Uribe 2018).
With more than 11 million Australians having at least one of the top eight chronic conditions, 5.3 million of these with two or more in 2014-15, the incidence of claims and reliance on the 22 million life insurance policies in force to protect people’s future is increasing (ABS 2015, FSC 2019).

What if, we as an industry could deliver on both; the altruistic ‘warm and fuzzy’ of supporting  our customers to be well, AND be a good, socially responsible, profitable industry.

The majority of life insurers and reinsurers have rehabilitation professionals within their organisations. Teams range from 26 rehabilitation professionals to a single resource responsible for the coordination of wellbeing initiatives. Despite the inconsistency in resource allocation, the industry has recognised the need for this skill set within their businesses as they provide opportunities to support customers through tailored recovery and vocational solutions. Rehabilitation has been integrated into claims management to promote recovery largely via the biopsychosocial (BPS) model as identified in the below figure:

2019 ALUCA Turkslegal Scholarship Winner's Paper - Cy Lindeberg (1)-2
The BPS model by Engel in 1977 is utilized in claims assessment and rehabilitation activities to devise a holistic understanding of the customer and their life. By understanding the customer at an individual level, we come to understand what they deem as valuable at an intrinsic level. Miller and Rollnic (2002) found that “constructive behavior change happens when the person connects it with something of intrinsic value to them, something important, something cherished. Intrinsic motivation happens in an accepting, empowering atmosphere that makes it safe for the person to explore their painful present situation and what they really want and value”. These concepts of understanding the customer and creating an environment to thrive is how rehabilitation and claims professionals can influence claims outcomes.
Traditionally the role of a claims professional involves an analytical review of information to consider a claim within the confines of the policy wording.
A rehabilitation professionals’ role is focused on working directly with customers and their treating professionals, to coordinate recovery programs based on individual needs.
The below figure describes how rehabilitation professionals add value across the different levels of the industry.


A current pilot being conducted by an Australian life insurer, BT, looked at enhancing the skills of their claims professionals, to ensure a more holistic claims management approach, using effective communication, collaboration and trust. The ultimate goal being to understand the whole customer and their needs outside just consideration of financial support.

The impacts of this approach were:

  • Claims professionals being more empowered to waive claim form requirements, reducing the administrative burden, but more importantly, the unnecessary requirement of customers to provide this information, therefore making quicker decisions on claims to benefit the customer;
  • Improved understanding and earlier access to rehabilitation benefits;
  • 100% customer participation in rehabilitation programs, with all customers maintaining full engagement through the full duration of the programs, due to best-practice, tailored services being offered at the right time;
  • 80% of customers achieved a full Return to Work (RtW) via completion of the rehabilitation program or their RtW timeframes enabled appropriate opportunities for pay and finalization;
  • 48% of open cases have a current medically endorsed work capacity;
  • Internal quality assurance scores increased for Claims Consultants, particularly in areas of communication, strategy and milestone management;
  • The participating claims professionals self-rated an increase in their perceived capability to execute their roles and a best-practice rehabilitation strategy by an average of 42%;
  • Customer feedback sought through various internal and external surveys such as Beddoes resulted in positive customer sentiment and affirmation of claims handling the experience.

The pilot created a culture shift away from a linear application of skills to a dynamic, bespoke approach to customer needs.
This outcome is extremely valuable considering the pending decision following the

Royal Commission for the claims handling exception to be lifted and the regulatory scrutiny that will follow. Similarly, the recent proposal from ALUCA and their competency framework for claims professionals highlights the expectations for understanding, communicating and negotiating with customers to promote recovery (ALUCA 2019).
In addition, as stated in LICOP 8.26, claims consultants are required to identify, collaborate, ensure and promote best-practice rehabilitation and RtW programs for policyholders. The below figure represents the claims professionals continual review of the different elements enabling their bespoke customer strategy.

The ideal dynamic between rehabilitation and claims professionals facilitates the claims professionals’ proficiency in relationship management and rehabilitation strategy.
Enabling rehabilitation professionals to take a broader scope of influence over the claims lifecycle, developing wider initiatives for cohorts of customers rather than individual solutions. By creating a more dynamic relationship between claims and rehabilitation professionals we are helping to enhance recovery and RtW outcomes, whilst meeting customer, service and regulatory expectations.
So why should insurers advocate for rehabilitation intervention?
Let’s talk dollars and sense…
Effective rehabilitation intervention is confirmed as leading to a healthier, more resilient society, not only benefiting the customer but the sustainability and affordability of the life insurance sector (SwissRe 2017).
The Royal Australasian College of Physicians (RACP) endorsed the Health Benefits of Good Work which advocates for RtW promoting individual self-efficacy and highlighted incidence of RtW and durations out of the workplace (RACP 2015), with the research demonstrating:


Considering typical waiting periods of Income Protection policies is 30 days or greater, the opportunity to achieve RtW rates is greatly reduced.
A 2014 comparison of the Australian life insurance rehabilitation spend in comparison with the UK market identified 67% in Australia and 78% in the UK of insurers were funding rehabilitation interventions within the waiting periods, the epitome of early intervention (EI) (SwissRe 2014). Limited rehabilitation engagement is not only isolated to insurers offering the intervention but also on the uptake by customers. A comparison of data supplied by the 2014 and 2016 Rehabilitation Watch by Swiss Re indicated customers were participating in either an internal or external rehabilitation program 11.9% in 2014 compared with 52.2% in 2016 (Actuaries Institute 2017).
There are substantial financial and non-financial benefits to both the insurer and the customer to offer targeted rehabilitation solutions. “Return to work programs that are based on a good understanding of injury outcomes and potential risks is paramount to achieve high impact in health benefits and speed of recovery” (Alavi & Oxley 2013). Well integrated rehabilitation including EI services into claims assessment practices can lead to the positive outcomes identified below:

While having claims consultants and effective rehabilitation programs which have the capability to understand the customer and effect positive change, the legislative frameworks constrain their scope of influence. Insurers have been limited to initiating interventions largely within the realms of psychological and social function to promote recovery and wellness within the BPS model. The biological aspect is largely left to the customer and their treating team to navigate.
Leaving the customer to navigate a system which is ‘fragmented, works in isolation, provides uncoordinated care and difficult to find services’ (PHCAG 2015:5), is not the ideal solution.

Is targeted intervention of only 66% of what is considered to influence wellness enough to effect a positive recovery, OR, do we need to consider opportunities for intervention in this biological space?

“Private personal disability income insurance is a means for individuals to protect themselves from economic losses that arise from both mental and physical disability. However, only viewing this type of insurance as providing income protection ignores the wider benefits that this insurance could provide to consumers, society and public finances” FSC 2017.
The FSC proposal to the PJC on behalf of the life insurance industry regarding the amendment to the current five pieces of legislation led to a divide in the industry. The way the legislations interact inhibit life insurers from financially supporting any expense that has a Medicare or private health care rebate regardless if the benefit had been exhausted or a gap is payable. The FSC proposed that the ability for life insurers to fund treatment where it supports or aids in a RtW would result in increased RtW rates, translating to lower claims costs (in net present value terms IP claims), therefore enabling insurers to have more stable premiums on products (FSC 2017). This assertion and suggestion sparked debate amongst life insurers, patient advocacy groups, consumer action groups and the legal fraternity.
Submissions from Metlife, MLC Insurance, Australian Super, The Commonwealth Bank and ASFA were all in support of the FSC in exploring the opportunities enabling life insurers to fund treatment assisting customers returning to work (PJC 2018, Metlife 2018, MLC Insurance 2018). “Those changes would result in more such members returning to work earlier than is currently the case, thus improving their future earnings and superannuation contributions” as was highlighted by Australian Super in their submission to the PJC (Uribe 2018). The FSC identified the “changes would enable life insurers to make a material difference to what is often inequitable or substandard access to treatment for already vulnerable sectors of the community” (FSC 2019).

As part of the PJC submission, the FSC, BT and Metlife commissioned a report by Cadence Economics to examine the economic impact reforms that allow EI. The Cadence report (2018) highlighted:

  • Restrictions on funding treatment applied to approximately 10,000 individuals on claim, EI would be beneficial and cost effective for more than 1,400 of these individuals;
  • EI would result in improved RtW durations by greater than 5 weeks;
  • Reforms could prevent 8% of people from becoming totally and permanently disabled by allowing them better and earlier access to treatment;
  • By 2040, the government is estimated to save $1.12billion in net present value terms as a result of reducing spending on health.

Despite the financial viability to the Australian economy and intrinsic value to customers and the community, many organisations were opposed to the reforms. The main concern highlighted in the debate against legislative reforms was the “clear conflict of interest and perverse incentives” (Beyond Blue 2018, CHOICE 2018). CHOICE 2018, highlighted they were of the opinion the change to the regulations would enable insurers to pressure treaters and customers into returning to work prematurely. The pressure exacerbating the condition in circumstances of mental health or those feeling like their recovery is being rushed.

CHOICE 2018 indicated they were of the opinion that life insurers were seeking amendment to regulations to enable the recommendation and arrangement of medical treatment. This however is inaccurate based on the submissions proposed by Metlife and MLC Insurance who indicate reforms are aimed at EI with the support for life insurers to be a ‘supplementary funder’ meaning any funding would be an additive to existing funding sources thus for a continuity of care, treaters would not be at the direction, recommendation or arrangement of the insurer (MLC Insurance 2018, MetLife 2018).

The ultimate outcome from the PJC report was that more investigation and analysis was required prior to any recommendation being put forward for a review of the various legislation.

Following the required due diligence enabling legislative reform, what are the options to customers in accessing funding for treatment? There may be an industry or insurer solution.
Industry: The industry can look to adopt a consistent framework similar to that which exists within the workers compensation and motor accidents schemes where treatment is currently funded. The current state, territory and national workers compensation schemes in Australia and New Zealand financially support the provision of medical, hospital, rehabilitation and related expenses. A comparison of the various schemes identify a consistent approach to the management of the treatment related expenses – a test for reasonableness and necessity. Treatment is reviewed and pre- approved to be in line with best practice treatment guidelines for the recovery of the condition (therefore reasonable) and in the absence of this treatment, recovery would be grossly hindered (necessary) (Safe Work Australia 2017).

Insurer: Insurers could consider offering treatment as a product enhancement for those taking out new retail policies. Under these circumstances, insurers could cap treatment expenditure, define treatment related expenses i.e. allied health and pharmaceutics only and maintain the criteria as previously outlined for the assessment of treatment expenses and utilise AMA gazetted rates. This approach would enable appropriate product pricing as well as consumer discretion and choice if they want this level of cover. This approach however, only achieves the desired impact of better health outcomes to those that can financially afford to pay for the enhancement and may not provide the desired outcome of fairness across the industry.
The adoption of any framework and support for reforms within life insurance is not as easy as changing legislation and approving treatment on the basis of it being reasonable and necessary. Based on the limited data available there appears to be customer, industry and community benefits for life insurance to further examine funding treatment and lobbying for legislative reform. However, like any good rehabilitation plan, a graded, considered and tailored approach to the issues is required.

Data collection and analysis is an area where the life insurance industry has acknowledged their approach has been substandard to address current challenges (Kanhai 2014). There is currently limited data available on the number of customers impacted by not being able to access appropriate medical interventions and the impact this is having on their wellbeing.
The below figure demonstrates how insurers can generate data to quantify how a lack of access to effective treatment is likely to impact on wellbeing outcomes, duration and expenditure on claim.

A review of the risks associated with funding treatment along with an examination of controls would need to be examined.

 

Following effective data generation and analysis with clear risk assessment identifying controls both stages completed under industry consultation, industry consensus can be identified. Without industry consensus legislative reform becomes more challenging. Following legislative reform, insurers will need to be provided a lead time to support technology, internal procedures and resource allocation to make them fit to undertake the approval process.
Only after the successful completion of each stage of the graded action plan along with creating a dynamic relationship between claims and rehabilitation professionals and a greater investment in rehabilitation programs can the industry successfully achieve their intrinsic value of supporting even more Australians’ return to wellness.

References

ABS 2008. Health literacy, Australia, 2006. ABS cat. no. 4233.0. Canberra: ABS. https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/chapter-7- indicators-of-australias-health
Actuaries Institue (2017) Emerging trends and practices in Life insurance claims management. Presentation 9/10/2017 https://actuaries.asn.au/Library/Events/Insights/2017/InsightsEmergingTrendsandPractices.pdf
Alavi. H., Oxley. A (2013) Return to work and Occupational Illness and Injury Rehabilitation: A snapshot Review. Monash University Accident Research Centre
Australian Life Insurance Underwriting, Claims and Rehabilitation Competency Framework, Version 2. (2019) The Australiasian Life Underwriting and Claims Association Inc. (ALUCA).
Badadur. W., Aziz. S., Zulfiqar. S (2018) Effect of employee empathy on customer satisfaction and loyalty during employee – customer interactions: The mediating role of customer affective commitment and perceived service quality. Cogent Business and Management
BeyondBlue (2016). Inquiry into the Scrutiny of Financial Advice – Life Insurance. Senate Economics Reference Committee
Beyond Blue (2019) Submission to the Productivity Commission Inquiry into the economic impacts of mental ill health. Published 5/4/2019
Cadence Economics (2018) Falling Through the Cracks. Report for the Financial Services Council
CHOICE, Financial Rights Legal Centre, Consumer Action Law Centre (2018). Submission: Options of greater involvement by private Sector life insurers in woearlyrker rehabilitation
Financial Services Council (2019) Life Insurance Code of Practice
Financial Services Council (2017) Submission 24 – Competition in the Australian Financial Industry – Public Enquiry
Gandy, G. martin, E. and Hardy. R (1999) Counselling in the Rehabilitation Process: Community Services for Mental and Physical Disabilities. Charles Thomas Publishing Ltd.
Kanhai.R (2014) Life Claims Management – Insights from General Insurance. ANZIIF Journal 37, Issue 4 p.24-28 https://www.finity.com.au/wp-content/uploads/2014/11/Finity-ANZIIF- Journal37_Issue04-Life-Claims-Management.pdf
Mc Inerney. S (2002) Introducing the Biopsychosocial Model for good medicine and good doctors. https://www.bmj.com/rapid-response/2011/10/29/introducing-biopsychosocial-model-good- medicine-and-good-doctors
Metlife (2018) Metlife Submission to Parliamentary Inquiry into worker rehabilitation
Miller, W. and Rollnic, S. (2002) Motivational Interviewing, Preparing People for Change. Second Edition. New York. Gilford Press p 4-6,8-12
MLC Life (2018). Options for greater involvement by private sector life insurers in worker rehabilitation.
MLC Life Insurance submission to the Parliamentary Joint Committee on Corporations and Financial Services.
Parliamentary Joint Committee on Corporations and Financial Services. Life Insurance Industry 2018.
Primary Health Care Advisory Group (PHCAG). Canberra: Department of Health.
https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/health- system>
Safe Work Australia (2017). 25th Edition. Comparison of workers compensation arrangements in Australia and New Zealand.
https://www.safeworkaustralia.gov.au/system/files/documents/1801/comparison-of-workers- compensation-arrangements-australia-new-zealand-2017_0_1.pdf
Swiss Re (2014) Swiss Re Australian Study finds every 1 AUD spent on rehabilitation saves between AUD 24 and AUD 39 on claims costs. Published online 10/7/2014
https://www.swissre.com/media/news-releases/2014/nr_20140710_aust_rehab_watch_2014.html
Swiss Re (2017) Rehabilitation Watch 2016 Launched
https://www.swissre.com/australia_newzealand/rehabilitation_watch_2016.html
The Royal Australian College of Physicians (2015) Realising the health benefits of work – an evidence update. The Australasian Faculty of Occupational and Environmental Medicine https://www.racp.edu.au/docs/default-source/advocacy-library/pa-health-benefits-of-work- evidence-update.pdf?sfvrsn=4
Uribe. A. Life Insurers angle for rehab role, claiming it could save the government $1.1b. Australian Financial Review. Published 4 June 2018.
Zimmerman, M., Bradley, B (2019). Intrinsic Vs. Extrinsic Value. Stanford Encyclopaedia of Philosophy.
https://plato.stanford.edu/entries/value-intrinsic-extrinsic/

2019 ALUCA-MLC-Monash Award Scholarship Program

Picture: The six finalist students attended an ‘Insurance 101’ welcome event hosted by Josh Agar at MLC Life Insurance’s office on 1st August 2019, attended by ALUCA Board members Mark Raberger and Amanda Stow along with Amanda Ide from MLC Life Insurance.

The 2019 ALUCA – MLC- Monash prize winners for industry collaboration for Allied Health Students was announced at a special final awards presentation and prize night at MLC Life Insurance’s office on 10th October. It was attended by ALUCA Chair, Jim Welsh who was part of the awards panel along with key MLC and Monash staff including Professor Marilyn Baird.

The six finalists prepared a (written and verbal) response to key questions facing underwriting and claims professionals today. They were each supported by their MLC mentors from the insurance underwriting and claims business units provided by MLC.  The MLC mentors assisting in developing the students understanding of the life insurance industry and supported them for the duration of the award process.

A huge thanks to all of the judges involved:

  • Marilyn Baird Associated Dean, Learning and Teaching (Monash University)
  • Natalie Cameron Chief of Customer Operations (MLC life Insurance)
  • Mick Jones Chief Underwriter (MLC Life Insurance)
  • Lyndon Kirk Executive Lead, Wellness (MLC Life Insurance)
  • Amanda Ide Executive Lead, Retail Claims (MLC Life Insurance)
  • Jim Welsh Board Chair (ALUCA)

Congratulations to the 2019 winner of the ALUCA – MLC – Monash prize for industry collaboration for health students, Monash University student Charles Chu with his winning submission: Beyond a binocular view: the interface between behavioural economics and income protection packages.

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Recent New Trends in Thyroid Cancer

riskebusinessmagazine1

New trends in thyroid cancer – a true incidence rise or over-diagnosis?

Thyroid cancer (TC) is the most prevalent endocrine cancer,
accounting for about 95% of all such malignancies. The
incidence of this cancer has increased dramatically in the
last three decades.

Types

Traditionally, thyroid cancers are classified according to
their histological cell of origin (see box) as well as whether
they are well differentiated (papillary and follicular) or poorly
differentiated (medullary and anaplastic), with the latter
having a poorer prognosis.

Recent New Trends in Thyroid Cancer-1

Papillary carcinoma is the most common thyroid cancer (70–80%). It is also the most common type in women and lives under 45. Usually has an excellent prognosis and tends to be localised.
Follicular carcinoma causes about 10% of all thyroid cancers. Typical age of diagnosis is older than the papillary type, and again affects more female lives than male. Hürthle cell carcinoma is an aggressive subtype.
Medullary carcinoma represents about 3–10% of all thyroid cancers. Around 70% of cases occur in older lives (>50). In those younger, it is nearly always associated with a strong family history.
Anaplastic carcinoma is an extremely aggressive tumour that represents less than 5% of all thyroid cancers. It generally occurs in older individuals.
Primary lymphoma represents less than 5% of all thyroid malignancies, with Non-Hodgkin’s B cell tumours being the most common.
Causes/risks Exposure to ionising radiation is the most established direct cause of thyroid cancer, and it was the first solid tumour type noted in Japanese atomic bomb survivors; similar tumours have been seen in areas exposed to radioactive fallout from the test sites in the Pacific as well as in Ukraine in the aftermath of the Chernobyl disaster in 1986. The thyroid isparticularly sensitive to irradiation because it concentrates radioactive fallout iodine as it creates thyroid hormones1. Many tools used in medicine also require radiation exposure, notably x-rays and CT scans, and the risk of triggering cancers in later life is particularly problematic in children, with an estimated 1,000 future thyroid cancer cases attributed to undergoing such scans in the US in 2007, for example2. Consequently, in many health jurisdictions thyroid shielding is required when undergoing ‘routine’ but required radiological investigations. Diet may play a role in two ways: iodine deficiency, if prolonged, triggers a rise in thyroid-stimulating hormone (TSH), which in turn results in more thyroid follicular cell formation. In regions with extensive iodine deficiency, more follicular cell than papillary cell carcinomas are reported. TSH plays a critical role here, as demonstrated by improved survival and reduced recurrence of thyroid cancer in patients treated with TSH suppressors such as L-T4. Obesity and its associated issue of insulin derangement also seem to be distinct risk factors. One study found that 50% of papillary carcinoma patients had insulin resistance. Overall, it appears that for every 1kg/m2 in BMI the risk of thyroid cancer increases by 1% and the risk is particularly elevated for females3. One of the primary functions of the thyroid gland is to produce and regulate the secretions of hormones (thyroxine (T4) and triiodothyronine (T3) used to regulate our metabolism. Given the gender disparity, many researchers have speculated whether other hormones, notably oestrogen and progesterone, could play a part in carcinogenesis in the thyroid gland; recent studies have begun to suggest an imbalance between the two oestrogen receptor (ER) isoforms, α and β, that may indeed be responsible for triggering cellular abnormalities in the gland.

Genetics

Genetic factors also increase the risk for developing thyroid tumours. About 6% of malignant papillary tumours are familial and up to 30% of medullary cancers have a hereditary component. Certain syndromes are associated with a higher likelihood of developing thyroid cancer. These include Gardner’s syndrome, Cowden’s disease, familial medullary cancer and multiple endocrine neoplasia (MEN) types 2a and 2b4.

Environmental factors

Other environmental factors, especially chemicals, could explain a rise in mutations – most notably nitrate contamination of drinking water and the use of pesticides such as polybrominated diphenyl ethers, exposure to which may either increase the cancer risk or induce thyroid cell proliferation5

Incidence

Globally, TC is the 16th most common cancer diagnosed, with 298,000 cases diagnosed in 2012; female lives constitute 70–75% of the diagnoses 6 . Curiously, of all cancers that can occur in both sexes it is thyroid cancer (apart from breast cancer) that has the biggest gender disparity. That said however, the cancer presents at a later stage and has a worse prognosis in men.

Future projections

It is projected that by 2035 the diagnostic incidence rate in the UK will rise by 74% in males and 77% in females, the largest rate of increase across all cancers. However, it will remain a rare cancer in the UK (only 1–2% of all cancer diagnoses), with only around 6,800 people affected, up from 3,388 in 2014 7.This pattern of incidence rise is repeated across the world. In the United States the number of cases has tripled since the 1980s to over 57,000 8, in France rates have increased by 8–9% per year over the same period and in Japan rates have grown by 52% in men and 86% in women in the period since the mid-1970s 9. China has seen the most dramatic rises,where TC is now the second-most frequently diagnosed cancer in both sexes in ages 15–4410.

Why?

Over two-thirds of adults will be found to have nodules in their thyroid when undergoing an ultrasound scan (almost all of them are benign), an example of ‘look and you’ll find’ 11 .Therefore, it is perhaps unsurprising that when South Korea introduced a programme in 1999 under which patients could elect to purchase such a service incidence rates of thyroid cancer exploded, with the result that by 2011 the thyroid cancer diagnosis rate was 15 times the rate seen at the beginning of the programme. This prompted a pressure group within the Korean medical community (the “Physician Coalition for Prevention of Over-diagnosis of Thyroid Cancer”) to call for an immediate halt to the screening in 2014, a move which was followed by a decrease in diagnostic incidence of 40% in 3 months12 .This trend has also been observed globally, with an estimated 50–90% of thyroid cancer (particularly in women) being the result of over-diagnosis. This over-diagnosis has been particularly problematic in countries that rely on an ‘insured model’ of health care provision. Loehrer et al. reported a 26% rise in thyroidectomies to treat thyroid cancer in Massachusetts once the state insurance scheme there was expanded to cover treatment of the disease. In an effort to combat this, the US Preventive Services Task Force (USPSTF) issued a recommendation against screening for thyroid cancer (in particular the use of ultrasonography),stating in effect that the harm from treatments outweighs any long-term benefit. If the over-diagnosis hypothesis was the only cause of the incidence rise, we should see rates increasing solely in the lower and less aggressive types. Yet the incidence has
increased for all types by 3% annually in the last 30 years,with mortality increasing by 1.1% per year for all types and by 2.9% p.a. for advanced-stage papillary in the same period 13.

Recent New Trends in Thyroid Cancer-3

*Korean screening data derived from Hyeong Sik Ahn: Quarterly average number of patients who underwent surgery for thyroid cancer.

Mortality

In the US, the 5-year survival rate for thyroid cancer overall is 98.1% and varies from 99.9% (68% of cases) for localised disease to 55.3% for distant disease (4% of cases) 14 . Papillary thyroid cancer, the most common subtype of well differentiated thyroid cancer, causes nearly 90% of cases, and has by far the best prognosis, with universal 5-year survival and 10-year survival rates of 92–95%15 . In 2007, Pelizzo et al. demonstrated that survival continues into the second decade and beyond16 . However, some histological forms, notably the anaplastic type, cause symptoms, and grow and spread very rapidly. The median survival is 5 months and less than 20% live longer than a year. The 5- year survival rate is around 10%17,18 .

Recent New Trends in Thyroid Cancer-4

Claims

This rise in incidence in the population is being reflected in claims in certain markets, particularly for products like critical illness. This is indeed the case in South Korea given the screening issue discussed above, and it is also evident in China. In China TC accounts for 30–42% of all cancer claims in some portfolios, overtaking breast cancer as the number 1 cause of cancer claims. There is evidence that this trend may also be emerging elsewhere for some CI claim portfolios; in the UK, for example, it is the sixth most common cause of female cancer claims – so at least our experience from the numbers of our branches in Shanghai and UK. It is perhaps unsurprising, then, that the Association of British Insurers is recommending in its 2018 CI minimum standards that stage 1 papillary tumours should be excluded from the cancer benefit.

Conclusion

Product developers, actuaries, underwriters and claims assessors should expect to see thyroid cancer cases with increasing frequency, particularly in markets where presymptomatic screening is prevalent. This rise is predominantly a result of over-diagnosis of indolent tumours, although emerging environmental issues may also be contributing to the incidence rise. While certain types of thyroid cancer can be life-limiting and aggressive, in many instances the disease has little impact on life expectancy and should not be considered a ‘critical illness’.

Contact

Paul Edwards
Manager, Medical Risk Research
Tel. + 44 20 3206-1736
paul.edwards@hannover-re.com

 

 

 

 

 

 

Bibliography

BIBBINS-DOMINGO, K. et al. Screening for Thyroid Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force JAMA May 9, 2017 Volume 317, Number 18 BROWN, T. et al Occupation cancer in Britain: Remaining cancer sites: brain, bone, soft tissue sarcoma and thyroid British Journal of Cancer, 2012, 107, S85-S91 BUTLER, C. ‘Thyroid Cancer: evidence-based review’ Internal Hannover Re UK Life Branch document, March 2014 CANCER RESEARCH UK, http://www.cancerresearchuk.org, Accessed May 2018. DAVIES, L. The USPSTF recommendation on Thyroid cancer, don’t check your neck; editorial JAMA Otolaryngology–Head & Neck Surgery August 2017, Vol 143, No 8 HYEONG SIK AHN & GILBERT WELCH, H., ‘South Korea’s Thyroid-Cancer “Epidemic” — Turning the Tide N Engl J Med 2015; 373:2389-2390 December 10, 2015 IGLESIAS, M.L. Radiation-induced thyroid cancer Arch Endocrinol Metab 2017 Mar-Apr; 61(2):180-187 LOEHRER AP Association of Insurance Expansion With Surgical Management of Thyroid Cancer JAMA Surg. 2017 Aug 1;152(8):734-740 O’NEILL, J.P. et al. Anaplastic thyroid cancer Oral Oncology, 2013, 49, 702-706 PELIZZO, M.R. et al. Natural History, diagnosis, treatment and outcome of medullary thyroid cancer, 37 years of experience on 157 patients EJSO, 2007, 33, 493-497 PELLEGRITI, G. et al. Worldwide increasing incidence of thyroid cancer; an update on epidemiology, Journal of Cancer Epidemiology, vol 2013,965212 SCHARPF. J. Achieving active surveillance for thyroid cancer – not a euphemism for watching a ticking time bomb JAMA Otolaryngology–Head & Neck Surgery, August 31 2017 SOSA, J. Striving for Clarity about the Best Approach to Thyroid Cancer Screening and Treatment: an Editorial JAMA Surgery August 2017 Volume 152, Number 8 STEELE CB, THOMAS CC, HENLEY SJ, et al. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005–2014. MMWR Morb Mortal Wkly Rep 2017; 66:1052–1058. DOI WANQING CHEN, et al. Cancer incidence and mortality in China, 2014 Chinese Journal of Cancer Research


1 See IGLESIAS, 2017
2 See PELLEGRITI, G. et al., vol 2013
3 See STEELE CB, et al., 2005–2014.
4 See BUTLER, C, 2014
5 See PELLEGRITI, G. et al., vol 2013
6 See CANCER RESEARCH UK, 2018.
7 See CANCER RESEARCH UK, 2018
8 See SCHARPF. J., 2017
9 See PELLEGRITI, G. et al., vol. 2013
10 See WANQING CHEN, et al., 2014
11 See DAVIES, L., 2017
12 See HYEONG SIK AHN & GILBERT WELCH, H., 2015
13 See SOSA, J., 2017
14 See BIBBINS-DOMINGO K. et al., 2017
15 See SOSA, J.,2017
16 See PELIZZO, M.R. et al., 2007
17 See BROWN, T, et al., 2012
18 See O’NEILL, J.P. et al., 2013

 

EVIDENCE ALERT / Mental Disorders and associated mortality

Dr Oleguer Plana-Ripoll has published another high impact article, this time in The Lancet. For those that don’t know he and his team published an article in JAMA Psychiatry earlier this year on psychiatric co-morbidity[1]. This previous paper was discussed in an earlier edition of ReB.

The new article published on the 25th of October 2019 explores the association between mental disorders and mortality[2]. It is understood that those suffering from mental disorders can have an increased risk of early death compared to those without mental disorders.

The paper by Plana-Ripoll et al analysed data from over 7.3 million people from Danish health registries. They found that people with a mental disorder had higher mortality rates compared to the general population, and that all types of disorder were associated with higher mortality (all cause). They also looked at specific cause of death and observed those with any mental disorder had elevated risk of death for all analysed specific causes (with the highest risk due associated with suicide and substance misuse). They also analysed mortality rates for specific groups of mental disorders. It should be noted those diagnosed with a mental disorder included in the study were seen by a psychiatrist in a hospital (inpatient, outpatient, or emergency department) and so probably represent more severe cases.

The study is rich with detail and worth exploring, it is fantastic that Dr Plana-Ripoll has made a website available to explore the study and the findings. https://nbepi.com/mortality

Dr Plana-Ripoll was kind enough to present his findings at a breakfast meeting held at Munich Re on the 22nd October.

  1. Plana-Ripoll, O., et al., Exploring Comorbidity Within Mental Disorders Among a Danish National Population. JAMA Psychiatry, 2019.
  2. Plana-Ripoll, O., et al., A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. The Lancet, 2019.

 

 

Mental Health Month & Beyond Blue

Supporting Small Business Owners To Improve Their Mental Health & Wellbeing At Work Guide

October is mental health month with World Mental Health Day observed on Oct 10 each year with the main objective to raise awareness of mental health issues around the world, mobilizing efforts in support of mental health.

Beyond Blue have launched a campaign to support the mental health and wellbeing of Australia’s 2.26 million small business owners through a free Beyond Blue guide available online. The Supporting small business owners to improve their mental health and wellbeing at work guide provides business advisers such as accountants, industry associations, bookkeepers, tax agents and representative bodies, or family and friends, with practical tips about how to provide support without needing to be trained counsellors or clinicians.

Advisers, family and friends can support the mental health and wellbeing of Australia’s 2.26 million small business owners through this free Beyond Blue guide available online.

The Supporting small business owners to improve their mental health and wellbeing at work guide includes information such as:

  • How to provide immediate support to a small business owner who is distressed;
  • Recognising the signs of poor mental health;
  • Planning and having a conversation with someone you’re concerned about;
  • What to do if the person doesn’t want to talk about their mental health; and,
  • How small business owners can improve their situation.

Did you know that Ninety-seven (97) per cent of businesses in Australia are small businesses employing up to 19 people. Small business owners can face a number of challenges in starting and running a business, which can impact their mental health.

Beyond Blue CEO Georgie Harman said the guide was designed for advisers, industry associations, families and friends because they were often the first to notice when small business owners experience mental health challenges.

“Almost one third of small business owners report having high levels of psychological distress, mainly due to long working hours, social isolation, customer demands, cash flow issues and conflicting demands between home and work,” Ms Harman said.

“These factors can sometimes increase the risk of developing mental health conditions such as anxiety or depression. Small business owners have told Beyond Blue they want mental health resources to be available through their business networks so they can access the information through established and trusted contacts.

“The guide allows advisers and others, who often see first-hand how stress can affect small business owners, to play an important support role that goes beyond advice on accounts and assets. It can also help the loved ones of small business owners to provide support when work is getting on top of them.”

The guide’s ease of navigation makes it a very powerful tool that not only supports mental health, but it will also help their client’s business. The guide also provides links to resources such as personal and workplace wellbeing plans, actions that small business owners can take themselves, and tips on how small business advisers can look after their own mental health. It is available for download at bb.org.au/supportingsmallbusiness. The guide complements Everymind’s Ahead for Business website and app for small business owners.

Mental health professionals are available at the Beyond Blue Support Service via phone 24/7 on 1300 22 4636 or via www.beyondblue.org.au/get-support for online chat (3PM – 12AM AEST or email responses within 24 hours).

Talk to small business owners about their mental health.  Download the Beyond Blue support guide at bb.org.au/SupportingSmallBusiness

ALUCA is also very proud to be co-hosting with Turks Legal a special mental health in life insurance panel session on October 31st. you can read more about this in this edition of ReB.

CMO Breakfast 

ALUCA CMO BREAKFAST / medical journal club and peer review

In August this year ALUCA kindly convened a ‘CMO breakfast’, bringing together medical staff working in the life insurance industry. The events are intended to occur every two months and will rotate around insurer and reinsurer offices.

The goal of the meeting is to promote evidence-based insurance medicine through discussion of evidence (a journal club), and to promote peer review and support through discussion of cases. There is a huge need to provide a forum to discuss relevant new evidence and provide peer support.

20 CMO’s or medically trained staff working in life insurance attended the first event held at Munich Re. The first meeting had a cardiac theme with discussion around the updated fourth universal definition of myocardial infarction, introduced in 2018. There was also discussion of the diagnostic challenges faced associated with type II myocardial infarctions (supply demand infarctions). There was also discussion of recent evidence indicating there should be caution interpreting the 99th percentile upper reference limit for cardiac troponins. All highly relevant to life insurance.

The breakfast case discussion revolved around a TPD claim (de-identified), a health professional suffering from fibromyalgia, a challenging condition. The group discussed the challenges associated with assessing claims like these, and inconsistencies in what is apparently reported to claims assessors and what appears to be reported to AHPRA (Australian Health Practitioner Regulation Agency) in terms of impairment preventing practice.

The next meeting is scheduled for the 7th of November, it will be held at the offices of SCOR in Sydney. We have a guest speaker, Associate Professor Les Barnsley, a rheumatologist (kindly provided by ALUCA platinum sponsor MLCOA). The theme will be rheumatoid arthritis, the course of the condition, newer treatments and how effective they are.

Dr Matt Paul is an Occupational and Environmental Physician with 20 years’ clinical experience and is the Chief Medical Officer at Munich Re (Australia)