Nic Mitchell, 54, used to have a busy life before she contracted Covid-19 three years ago. She worked as a PR and marketing executive for a leading insurer. She enjoyed the outdoors and was into her fitness regime.
Now she’s mostly housebound, suffering from a host of debilitating health problems linked to her long Covid diagnosis.
My kidneys are impaired. I’ve got rheumatoid arthritis and a neurological problem. I’m always out of breath and fatigued
Mitchell is one of the estimated two million people, or 3% of the UK population, living with long Covid, according to data from the Office for National Statistics (ONS). And nearly half of those reporting symptoms beyond four weeks have suffered for over a year. The ONS says these numbers have been rising steadily since the middle of 2021.
Long Covid, or post-Covid syndrome, is one of the riddles of the pandemic. It is a new condition that can have a significant impact on a person’s quality of life. The most common symptoms include fatigue, brain fog, breathlessness and muscle pain.
Medical experts are still investigating why long Covid affects some people more than others. There is no internationally agreed clinical definition or clear treatment pathway as it is still an evolving condition.
However, the National Institute for Health and Care Excellence defines long Covid as symptoms experienced during or after infection that continue for more than 12 weeks and are not explained by an alternative diagnosis.
Claims for TPD are not assessed against any list of defined conditions
There is no direct link between the severity of long Covid and the severity of the initial infection, according to clinicians. Although hospitalised patients run a greater risk of contracting it, most long Covid sufferers experienced only a mild initial infection.
And sufferers are more likely to have a pre-existing health condition, to be female and to be middle aged, a study by the Institute for Fiscal Studies has found.
Labour market
The research, which was undertaken last year to explore the impact of long Covid on the labour market, found that one in 10 people who developed long Covid had to stop working, with sufferers generally going on sick leave.
The number of adults not working in the UK due to long-term sickness continues to rise steadily. Last month (May), the ONS published data showing that more than two and a half million people were not working due to health problems. To put this number into perspective, for every 13 people currently working, one person is on long-term sick leave.
We don’t have enough information yet to understand whether long Covid is permanent
The ONS attributed this to the record rise in mental health conditions in younger people, workers suffering from back and neck pain experienced when working from home, and incidences of ‘post-viral fatigue’, including long Covid.
The increase in the number of people too ill to work is affecting the UK’s bottom line as the economy fares badly in comparison to those of other developed nations.
The government has taken notice and in the recent Budget in March it outlined plans to reinvigorate the economy by getting the economically inactive, including some retirees, back to work.
Forgotten victims
It is reassuring that the acute phase of the pandemic is over. Last month, the World Health Organization (WHO) announced that it no longer considered Covid-19 to be an international public health emergency.
I won’t expect TPD to pay out for long Covid. If it does, the whole market will get repriced
Covid killed nearly seven million people over three years. At its peak, in January 2021, the global death rate topped 100,000 individuals a week. And, despite the WHO announcement, the condition has not gone away. Clinicians say it will be with us for many years, in terms of both new cases and those already suffering from long Covid.
The latter believe they have become the forgotten victims of the pandemic. Nic Mitchell, who has battled the symptoms for three years, thinks her deteriorating health has left her permanently unable to work.
She says: “I have been diagnosed with myocarditis, which means I am on medication to stop my heart beating too quickly. I’m constantly out of breath because, every time I try to do something, even small tasks like going to my kitchen, I’m out of breath quickly and fatigued.
We are trying to retrofit a claim to a policy that was never designed for it
“My kidneys are impaired. I’ve got rheumatoid arthritis and on top of that there is a neurological problem with brain fog, confusion and lack of memory. And I still have no sense of smell or taste, have lost a lot of eyesight and constantly get different infections.”
Seeking help
Mitchell has a life insurance and critical-illness (CI) policy with Aviva. It was underwritten in 1994. While the CI section does not include cover for long Covid (which hadn’t been identified three decades ago), it does allow for a claim against any illness or injury that causes a “total and permanent disability” (TPD).
In late July 2020 and at the end of 2022, Mitchell made a claim for TPD on her CI policy. On both occasions her claim was declined by Aviva.
Group risk products have evolved quickly in the past three years and now have a huge range of additional benefits and services embedded into their products
An Aviva spokesperson told Money Marketing: “After reviewing [Nic Mitchell’s] medical records in detail at each of these times, there was unfortunately no medical evidence to support a claim that she was unable to perform her work on a permanent basis as a result of long-term symptoms she was experiencing from a Covid-19 infection or for any other condition.
“We recognise that our decision to decline the claim again will be disappointing for the customer.
“Claims for TPD are not assessed against any list of defined conditions. Instead, they are assessed for medical evidence that supports that symptoms of any condition have led to the customer being totally and permanently unable to carry on any part of their occupation.”
The insurer stressed that Mitchell could not prove she had become “permanently and totally unable to work because of her illness, with no prospect of improvement in the future”.
She’s got the wrong policy. She’s trying to get a CI policy to pay out for IP. And you can’t do that
It added that, while her policy remained in force, it would reassess her claim if in the future there was any new medical evidence that would support a valid claim of “being permanently unable to perform her work”.
Mitchell, understandably, is disappointed with Aviva’s decision.
“It’s shocking that an insurer of Aviva’s calibre is turning down long Covid claims. It’s not as though I’m your average long Covid sufferer. I don’t know if I am the very longest but certainly I’m one of the very first people in the UK to have this. There are very few people that have been ill for three years.”
She currently receives the Personal Independence Payment (PIP): the government’s financial support for people with a long-term physical or mental health condition or disability. She has been assessed for the PIP payment by a nurse, who concluded that she is disabled.
We don’t know whether we are going to get some treatment for long Covid in the future. It’s all very grey
Alan Lakey, an expert in TPD and a director at CIExpert, tells Money Marketing that most TPD claims are declined “because it’s so difficult to meet the claims criteria”.
For the claimant to be successful, he says, they must prove they are disabled and unable to perform two or three tasks from a range, such as getting in and out of a car, climbing 12 stairs or walking 200 yards on a flat surface without stopping due to pain.
“If the medical expert can’t confirm permanence, the claim won’t be met,” says Lakey. “For things like long Covid, we don’t have enough information yet to understand whether it is permanent.
“A claimant could be denied at the moment but if, in a year or two years’ time, they are still unable to go back to work, or still unable to perform two or three tasks, it might be agreed then because after two or three years that might be considered permanent.”
The claims process is an obstacle course and it takes a long time to complete. It is very offputting for a lot of people
Reassured director of corporate strategy Phil Jeynes agrees.
“The thing with making any claim is to have as much information as you can. As much as there’s a public perception that insurers are looking for ways to not pay claims, in my experience it’s the opposite.
“The people who are assessing these claims are extremely empathetic, and start from the position of, ‘How can we make a case that this claim meets the definitions of this policy?’”
Critical illness and TPD claims
The Association of British Insurers (ABI) has a strict definition of ‘total and permanent disability’ in the context of CI policies. It states that the condition should “last throughout life with no prospect of improvement”.
The TPD definition was effectively added to be a catch-all for people who were seriously ill but didn’t fall into one of the definitions of a CI policy
Dr Adam Hazell, a general practitioner and founder of The Tyburn Medical Practice, says insurers expect a qualifying CI condition to last not to the end of the policy but rather to the end of life, with no prospect of improvement.
He adds: “There are not many diseases you can really say that about, except these horrible neurological problems that we have no cure for and are only going to go in one direction.
“This would be very difficult with long Covid because we have only three years of data. And I don’t think there is any doctor who could say, ‘This is going to last with no improvement for the rest of your life.’ And that’s what they need a specialist to say. It’s difficult because we haven’t got any data.”
The ABI, which does not collect data on long Covid specifically, says most protection claims are paid out.
An ABI spokesperson says: “Protection insurance policies will vary and it’s important that people understand what they’re covered for. Some products, such as income protection (IP), do provide cover for customers who cannot work because of an illness or disability, until they’re able to return to work.
I’ll doubt any doctor, given how new long Covid is, would diagnose it as permanent. There isn’t enough medical evidence
“CI insurance may also include cover for any disabilities that are expected to have a life-long impact on the policyholder’s ability to do their job, or a similar job, ever again.
“Insurers will look at each individual case depending on the circumstances but, if the symptoms meet the policy definition, claims will be covered in accordance with the terms and conditions and subject to any initial waiting period.”
Meanwhile, Group Risk Development, the trade body for operators in the UK group risk market, recently published its Covid-19 claims for 2022. These show that Covid claims accounted for 3.7% of all group life claims last year, down from 11.7% in 2021.
In 2022 the UK group risk market, which includes employer-sponsored life assurance, IP and CI protection benefits, paid out 464 claims where Covid-19 was the reported cause of death.
Catch-all
When Nic Mitchell’s story came to light in April this year, an adviser contacted Money Marketing.
Although wishing to remain anonymous, they said the case had resonated with them because their partner, who like Mitchell suffered from a debilitating illness, had had a similar experience with another mainstream insurer that had resisted a claim for TPD.
As much as there’s a public perception that insurers are looking for ways to not pay claims, in my experience it’s the opposite
“I think a lot of the time people with health conditions, if you look at the way they are treated in terms of claims processes, it’s an absolute disgrace. It’s an obstacle course and it takes a long time to complete. And it is very offputting for a lot of people,” said the adviser.
The key problem for many TPD claimants, they said, was the phrase ‘total and permanent’ disability. They added that fewer TPD claims were paid than were other types of CI, and in their experience about a third were declined.
Protection Guru head of products Adam Higgs says of the TPD definition: “It was effectively added to try and be a catch-all for those people who were seriously ill but didn’t fall into one of the definitions of a CI policy.
“This was the definition that was added to try and sweep them up. Generally, across the market around 50% of TPD claims get paid; the reason being it is very hard for a doctor to say something is going to be permanent.”
A claimant could be denied now but if, in a year or two years’ time, they are still unable to go back to work, that might be considered permanent
And this is the crux of the matter, agrees Dr Hazell, who says: “We are still learning about long Covid. We don’t fully know the causes behind it, which makes it difficult to give a prognosis. We’re drawing conclusions from other diseases like chronic fatigue syndrome.
“The majority of people will recover by the end. So the latest figure says it’s about 15% of people who have long Covid who will go on past a year.
“Chances are you will recover, but we don’t know whether these people going past a year will fully recover or if they are going to plateau or not improve at all. And we don’t know whether we are going to get some treatment for it in the future. It’s all very grey.”
Which is it?
Is long Covid a CI or an IP issue? Protection Review CEO and leading industry commentator Kevin Carr believes it is the latter.
If the medical expert can’t confirm permanence, the claim won’t be met
He says: “I’d expect long Covid to be paid under an IP policy because that is what IP exists to do. It exists to pay if you can’t work and don’t have a list of conditions. It doesn’t say, ‘You must have these conditions, or you don’t have that condition.’ The condition you’ve got is irrelevant to IP.”
He adds: “TPD is a completely different kettle of fish. I’m not a medical expert but I’ll doubt any doctor, given how new long Covid is, would diagnose it as permanent. There isn’t enough medical evidence.
“I consider myself a consumer champion in all this stuff, but I won’t expect TPD to pay out for long Covid. And if it does the whole market will get repriced. It wasn’t designed to pay for that.
It’s shocking that an insurer of Aviva’s calibre is turning down long Covid claims. It’s not as though I’m your average long Covid sufferer
“Talking about the person in question, she’s got the wrong policy. As lots of people are saying on social media, she’s trying to get a CI policy to pay out for IP. And you can’t do that.”
Aviva pays out long Covid claims in the context of group and individual IP. The insurer says it introduced its specialist long Covid IP claims pathway in August 2020 for both individuals and group scheme members. It offers bespoke support to customers depending on the severity of symptoms, looking at needs on a case-by-case basis.
Aviva says in 2022 it paid out £374m, equivalent to more than £1m every day, in group protection claims to thousands of employees and their dependants.
Rethinking TPD?
Should the protection sector rethink the definition of TPD? And should more clarification be given on terms such as ‘permanent’? Industry opinion is divided, but Lakey wants to see more clarity.
There was unfortunately no medical evidence to support a claim that she was unable to perform her work on a permanent basis
“The word ‘permanent’ can be misconstrued and consultants or claims handlers and product designers may all have different understandings of what it actually means,” he says.
“One third of all TPD claims are declined for not meeting the claims wording, and this rises to two-thirds for activity-based wordings. This highlights the problem with the words ‘permanent’ and ‘total’.”
Jeynes believes more needs to be done at the point of sale, ensuring the right product is selected.
“If someone is in the mindset that CI cover means every type of illness that keeps you off work for a long time, they misunderstood the policy. And that isn’t what that product is setting out to do in the first place. We are trying to retrofit a claim to a policy that was never designed for it,” he says.
Towergate Health & Protection head of group risk David Williams thinks existing group protection products are “fit for purpose” in any pandemic.
I still have no sense of smell or taste, have lost a lot of eyesight and constantly get different infections
“Group risk products have evolved quickly in the past three years and now have a huge range of additional benefits and services embedded into their products. As a result, employees can remotely access support for mental, physical, financial and social problems.”
With just three years’ worth of data and analysis on Covid and its after-effects, and with more being gathered all the time, the debate about the protection sector’s position on long Covid is likely to continue.
But this means Mitchell and other long-term sufferers may still face an uncertain future.
This article featured in the June 2023 edition of MM.
If you would like to subscribe to the monthly magazine, please click here.
Comments