Multiple Sclerosis
August 2006
What causes multiple sclerosis (MS)?
The exact cause of MS is still not known but it is thought that the disease is triggered by both environmental and genetic factors that cause the body’s immune system to begin attacking the protective coating around the body’s nerves, known as the myelin sheath.
How does the disease develop?
The body transmits messages through its network of nerves between the brain, spinal cord and different parts of the body. The messages take the form of electrical impulses that are transported through nerve fibres that are protected by the myelin sheath. This shield is composed of layers of fat called myelin that facilitate the speed and accuracy of message transmission. In MS, the body sends antibodies and white blood cells to attack proteins in the sheath. The resulting scarring or hardening (sclerosis) stops electrical messages that control coordination, strength, sensation, and vision from transmitting normally.
Who is at risk and what are the symptoms?
The disease affects women more than men and most sufferers experience their first symptoms between the ages of 20 and 40. These are likely to include problems with vision, difficulties with coordination and balance, abnormal sensory feelings such as “pins and needles”, speech impediments, tremors, dizziness, and/or hearing loss. Half of all sufferers also experience cognitive problems like difficulties with concentration, attention span, memory or judgement.
Diagnosis
MS is difficult to diagnose because it can affect many different parts of the body in a range of ways and because symptoms can flare up and then retreat. Doctors may use MRI scans of the brain and spinal cord, lumbar puncture to sample cerebrospinal fluid, electric current to test brain response, and tests to check cognitive reactions.
The Association of British Insurers (ABI) has worked to make diagnosis under a critical illness (CI) policy easier. It says claimants must have a “current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least six months.”
In April the ABI re-issued its “Statement of Best Practice for Critical Illness Cover” to make CI definitions clearer by replacing technical wording with more layman’s terms. The new definition of MS essentially deleted the requirement for the diagnosis “to be confirmed by diagnostic techniques current at the time of the claim”.
Now diagnosis relies purely on the view of the consultant neurologist, which should therefore make the process easier.
Because of the difficulty of diagnosing MS, issues around non-disclosure by policyholders arise. In Scotland the case brought by Valerie Cuthbertson against Friends Provident challenged the non-payment of a claim due to non-disclosure. A judge at the Scottish Court of Sessions held that Ms Cuthbertson was entitled to a £50,000 payout on her CI policy after developing MS, even though her medical notes show that before she took the policy out, she had already complained of eye pain and tingling.
Treatment
There is currently no complete cure for MS, but beta interferon – which has recently been used in treating the disease – and steroids can reduce the frequency and severity of relapses. Copolymer provides basic myelin protection, and immuno-depressants can be useful in treating advanced MS. Physical therapy and exercise can prolong patients’ physical mobility and antidepressants can be used to treat depression or apathy.
Underwriting implications
“MS is the second biggest cause of female CI claims in the UK but for men it’s nowhere near as common,” says Matt Rann, head of underwriting and claims at Scottish Equitable.
People diagnosed with MS account for 10% of all CI claims received by Scottish Equitable from women in the UK, second only to cancer, which accounts for 67% of claims.
It is “highly unlikely” people already diagnosed with MS will be able to get income protection (IP) or CI cover but for those with no symptoms, history, or family incidence both products are available, Rann continues.
“At the moment there is no definitive genetic test available to diagnose MS,” he says. “We do rate on family history though and even if a person does not have symptoms, if the mother or father has a history of MS, we will rate the policy accordingly, or even exclude MS.”
Recent advances in medical technology – such as the use of beta interferon to reduce the frequency and severity of MS relapses – have not yet made a difference to the underwriting of CI and IP products, Rann says.
“Under an IP policy the person needs to be off work for a certain length of time (before the coverage applies). By the nature of MS, the person is probably off for a very long time and advances have not made a big difference to the way we look at new business in terms of giving people who currently have symptoms, new policies,” Rann continues.
“Technological advances have helped our ability to get people back to work but although the results are good the statistics are not credible enough yet to start adjusting premiums,” he says, adding that underwriters would probably need to look at statistics over a five-year period.
This article is from Health Insurance and Protection in England.