Mental Health in Life Insurance: How the claims process for income protection supports mental health vulnerability
By design, income protection (IP) has a crucial role to play when it comes to supporting those who are ‘vulnerable’. And that applies whether the condition is physical or psychological or, often, a combination of both. The NHS can be amazing when it comes to dealing with diagnosis and treatment but assessing the ability to function in the workplace and return to work hasn’t and never will be their job. Plus, access to talking therapies, the most suitable first line of treatment for many mental health conditions according to the National Institute for Health & Care Excellence (NICE),(1) comes with a significant wait on the NHS. The trouble is, the longer people are absent, the more deconditioned they become to the idea of returning to work and they are more likely to develop long-term psychological issues.(2)
There is now abundant evidence from the group IP market, to show that the key to better outcomes is early intervention. For example, 92% of Legal & General’s group IP mental health claimants were able to return to work within the deferred period in 2020, an increase of 9% on 2019 (3).
It’s clear that the support we can provide as insurance companies is invaluable, and there is even more opportunity to help others to benefit in the individual IP market where awareness of this type of support tends to be lower.
In the group IP market this isn’t such a problem. Employers have a vested interest so notifications by week four of absence have generally become the norm. However, with individual IP, that notification might be much later, if at all. People forget they have the policy or forget what’s included and how it works.
This is our opportunity. How the product is sold or distributed is irrelevant to service accessibility; everyone gets access to the same care pathways, obviously allowing for slight variations from insurer to insurer. But how early in the absence the insurer is notified is what makes a big difference to the outcomes.
NHS targets for Improving Access to Psychological Therapies (IAPT) services are for 75% of those referred to be receiving treatment within six weeks. (4) However, actual wait times for first treatment vary hugely depending on location, according to latest government data, anytime from 4 days to 86 days.(4) And it is not just as simple as getting started but about regular treatment intervals. Unfortunately, in most areas of England, patients waited three times longer between their first and second treatments than they waited for their first treatment.
In the absence of any other alternative, these long waits lead to GPs resorting to putting people on medication while they wait.
Via IP’s person-centred care pathways, people can access talking therapies within two weeks. What’s more, all insurers should abide by the NHS’s clinical governance framework, so individuals can feel fully confident in the support they are receiving.
Touchpoints begin the moment the absence is notified, either by the employer, in the case of group IP, or by the individual.
The first step is a referral to the clinical team, in our case at Legal & General we carry out an interview with the individual to learn more about their diagnosis and, crucially, to investigate their functioning; in other words, what they can and cannot do on a daily basis. From that very first point of contact, the clinicians make it clear that they will help with a return to life and workability. This is about setting expectations from the outset.
The next step is for the clinical team to work with a claims assessor. Together with the claimant, they will design a person-centred care pathway, with a focus on both the physical and psychological outcomes.
As part of this, if the initial interview indicated a clear mental illness need, the team will use recognised psychometric evaluation tools (GAD-7 and PHQ-9) (5) to analyse the extent of the problem. From this, they can determine if the individual is suitable for any talking therapies.
Generally, as per NICE guidelines, talking therapies will be beneficial, for conditions, such as depression, post-natal depression, adjustment disorders and generalised anxiety disorder.(1)
It's only where severe mental illnesses are concerned (around 1% of the population) where such therapies wouldn’t be suitable.(6) Schizophrenia and bipolar disorder are often referred to as severe mental illness.
Obviously, there’s also a strong case to be made for helping to prevent absence in the first place; for doing more as an industry to help keep the individual happy and healthy through better use of all the embedded value services that come with the products.
It could be argued that this aspect is less within our control, with regards to spotting the signs and looking at what people could or should be doing at various times in their lives, in response to day-to-day pressures and stressors.
Prevention does indeed rest with the individual. Our role here is not to medicalise normal stress reactions to adverse events and circumstances, especially during a pandemic!
Instead, we can help by equipping people to make their own sensible decisions about what’s good for them. In the group market, this can involve helping Human Resources design an integrated benefit and wellbeing communication plan that is purpose-led, targeted, and engaging.
IP is arguably more relevant than ever in today’s world. And particularly when it comes to mental health service equality and accessibility. But there are still opportunities for us to do even more to help individuals get the most out of what firms can offer.
1 NICE, Psychosis and schizophrenia in adults: prevention and management, [Last updated March 2014 – this represents the most up-to-date guidance from NICE at the time of writing) https://www.nice.org.uk/guidance/cg178/ifp/chapter/Treatment-options
2 Dame Carol Black and David Frost CBE, Health at Work – an independent review of sickness absence, Nov 2011, found that 1 in 5 people will not return to work after just 4 weeks of absence in the absence of early intervention https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/181060/health-at-work.pdf
3 Legal & General annual claims announcement, May 2021.
4 House of Commons Library, Mental health statistics: prevalence, services and funding in England, Dec 2021 https://commonslibrary.parliament.uk/research-briefings/sn06988/
5 Office for National Statistics (ONS), PHQ and GAD-7 Instruction Manual, [Accessed Dec 2021] https://www.ons.org/sites/default/files/PHQandGAD7_InstructionManual.pdf
6 Public Health England (PHE), Severe mental illness (SMI) and physical health inequalities: briefing, Sept 2018 (most up to date version available from PHE) https://www.gov.uk/government/publications/severe-mental-illness-smi-physical-health-inequalities/severe-mental-illness-and-physical-health-inequalities-briefing#smi-prevalence
