Copy below is taken from a Financial Adviser Guide relevant to persons DECLINED, POSTPONED or offered cover on SPECIAL TERMS

 

Special terms are that:

your customers either has to pay an extra premium charge;

accept an exclusion; or

we may have deferred cover at this time.

What does this mean?

 

This means that we feel we need to charge an extra premium

or exclude part of the cover because of past health or we

cannot offer the cover applied for. A customers past health,

in this context, could also include family medical history.

 

How did you reach this decision?

 

We came to this decision only after very carefully considering

the details in the application for cover and perhaps details

from your customers GP or following a medical examination

done on our behalf. We have access to and use large banks

of statistical information in arriving at these decisions. Most

decisions are based on known medical histories such as

asthma, raised blood pressure and so on, rather than new

previously unrecognised findings. Please remember that we

made the decision, and not any doctor who examined the

customer.

 

Suggested next steps

 

Tell the customer we have made a decision.

 It is generally better to do this in person rather than by phoning.

Do not avoid letting the customers know about our decision. In

a lot of cases the customer may be expecting us to make this

decision if they have a known health history. This is particularly

true if you told them about the possibility of adverse terms at

the time they filled in the application form. (Talking to an

Irish Life underwriter or using our laptop or PC underwriting

guide before sending us a potentially difficult case can help).

If we have offered terms

Go through the actual special terms acceptance letter in

detail.

Explain how we have amended the original application or

what the new premium will be. In some cases we will

have offered two different options.

Give the customer a copy of the leaflet ‘Special terms –

your questions answered’.

In some cases the actual special terms acceptance letter

will give the medical reason for our decision.

If not, ask the customer if they want our Chief Medical

Officer to write to their GP to explain the medical basis

for the terms we have offered. Once requested, we will

do this immediately even if the customer decides to

accept the terms offered.

Ask the customer to sign and date the bottom of the

special term’s acceptance letter to say whether they

accept the terms.

Point out to the customer that if they have had any

change of health since they signed their application form

they have a duty to tell us about this change.

If the customer is not satisfied with the terms we have

offered, explore the other combinations of premium, sum assured or type of cover that may be more acceptable.

You can get quotes for other combinations by e-mailing

or phoning your normal contact.

 

If we have postponed cover or refused to provide cover

Explain what this means in terms of the application for

cover, particularly if it was a dual life application.

Give the customer a copy of either of the leaflets

‘Postponing cover’ or ‘When we have turned down your

application for cover’.

Remind the customer that in these situations our Chief

Medical Officer will generally have written to their GP to

explain the medical basis for the decision. You should

encourage the customer to speak to their doctor quickly

to see why we have made our decision.

If we are postponing cover, ask the customer to make sure

that their GP realises that if new relevant details or perhaps

results of extra investigations are provided, we can

sometimes review the decision more quickly than having to

wait until the actual end of the postponement period.

Discuss any other options or forms of insurance cover that

Will the customer have to tell other life

assurance companies about this decision

 

Yes, they should give other life assurance companies this

information, as there will usually be a question on the

application form covering this point. The other life assurance

company will make its own decision based on their

assessment of the medical evidence available at that time.

Some details of this customer may be shared with other Irish

Insurance Federation life-assurance companies as a general

protection against any customers who may withhold

important information from a life assurance company.