Life Insurance With Arthritis

Osteoarthritis And Rheumatoid Arthritis Are Two Different Applications

"Arthritis" covers conditions that have very little in common from an insurer's point of view. The first thing an underwriter wants to know is which kind you have, because it decides which questions follow and which products are likely to be affected.

Osteoarthritis is wear and change in a joint. It can be painful and limiting, but it is local to the joints involved and does not affect life expectancy in any meaningful way. For life cover it is usually a non-event. Its real effect is on your ability to work, which is why it shows up in income protection rather than anywhere else.

Rheumatoid arthritis is an autoimmune disease. The immune system attacks the lining of the joints, but the inflammation is not confined to them: it is linked with a higher risk of heart disease, and in some people it involves the lungs, eyes or blood vessels. The treatments that control it also have effects of their own. That is why an insurer pricing life or critical illness cover asks far more about rheumatoid arthritis than about osteoarthritis, even when the joint symptoms feel similar to you.

Psoriatic arthritis and ankylosing spondylitis are also inflammatory, and are generally assessed along the same lines as rheumatoid arthritis, with some differences covered below.

What Moves The Answer For Rheumatoid Arthritis

Two people with rheumatoid arthritis can be offered quite different terms, and the reasons are usually predictable. Underwriters are trying to judge how active the disease is and whether it has gone beyond the joints.

• Disease activity. Stable disease with few flares is a different risk from frequent flares or disease that has not yet settled on treatment.
• Number of joints and any deformity. Widespread involvement and joint damage suggest more aggressive disease.
• Treatment. Which DMARDs or biologics you take, and whether you need steroids regularly rather than occasionally.
• Extra-articular features. Any lung involvement, vasculitis, nodules, eye inflammation or heart problems carry the most weight of all.
• Other cardiovascular risk. Because rheumatoid arthritis already raises heart risk, smoking, blood pressure and cholesterol are read alongside it rather than separately.

Mild, stable rheumatoid arthritis with no complications is often accepted for life cover at or close to standard rates. Severe or poorly controlled disease, or disease with lung or heart involvement, is where premiums rise and where choosing the right insurer matters most.

DMARDs, Biologics And Steroids: What Each Tells An Underwriter

Medication is one of the clearest signals of severity, which is why insurers ask for names, doses and dates rather than just "on treatment".

Conventional DMARDs such as methotrexate, sulfasalazine, hydroxychloroquine and leflunomide are standard first-line treatment for inflammatory arthritis. Being on one is expected, and on its own it is not a reason for concern. Biologic and targeted drugs, such as anti-TNF treatments, are usually started when conventional DMARDs have not been enough. An underwriter reads that as more significant disease, but also asks whether the biologic is working. Stable disease on a biologic can be a better application than active disease that is barely treated.

Steroids are where insurers are most careful. An occasional short course or a joint injection during a flare is common and is read that way. Long-term oral steroids are a different matter, partly because they suggest the disease is hard to control and partly because prolonged steroid use carries its own effects on bones, blood sugar and the heart. If you have reduced or stopped steroids, say when.

Psoriatic Arthritis And Ankylosing Spondylitis

Psoriatic arthritis is usually assessed in a similar way to rheumatoid arthritis: how many joints, how active, which treatment. Insurers will also ask about the psoriasis, and the two are underwritten as one picture. Our page on skin conditions covers the psoriasis side.

Ankylosing spondylitis mainly affects the spine and the joints where the spine meets the pelvis. Life cover is often available at or near standard terms where it is well managed. Income protection is the harder product, because spinal conditions are among the most common reasons for long absences from work, and insurers often respond with an exclusion. The same logic applies as on our back pain page.

Income Protection Is Where Arthritis Matters Most

Income protection pays if you cannot work because of illness or injury. Joint problems are a common reason people cannot work, so this is the product where arthritis, including osteoarthritis, most often changes the terms.

The usual outcome is an exclusion. For osteoarthritis that is often limited to the affected joints, for example "any condition of the knees". For inflammatory arthritis it may cover the condition as a whole. With severe rheumatoid arthritis or significant recent time off, some insurers will decline. What decides it:

• Your occupation. A plumber with knee osteoarthritis is a very different risk from an accountant with the same knees, because the policy pays on your ability to do your own job.
• Time off work. How many days or weeks in the last few years, and when the most recent absence was.
• Deferred period. A longer deferred period means short flares are less likely to lead to a claim, and some insurers may view the application more favourably as a result.

An exclusion does not make the policy worthless. It still pays for everything else, from cancer to mental health to an accident. Some insurers also offer to review an exclusion after a period without symptoms or time off, so it is worth asking whether that is available when terms are offered.

Joint Replacements And Surgery

Hip and knee replacements are common and, once recovered from, usually have little effect on life cover. For income protection, insurers want to know the date of surgery, the reason for it, whether you are back to normal activity and back at work, and whether other joints are affected. A replacement that is recent, still in rehabilitation or awaiting a revision is often postponed until recovery is complete.

If you are on a waiting list for joint surgery, insurers will usually want to know, and some will postpone income protection until after the operation. Life cover is less often affected. A broker can tell you whether it makes sense to apply now or after surgery.

Critical Illness Cover: Usually Available, Read The Detail

Arthritis itself is not usually one of the conditions a critical illness policy pays out for. For osteoarthritis, cover is generally unaffected. For rheumatoid arthritis, the higher risk of heart attack and stroke is what an insurer is pricing, so a higher premium is more likely than for life cover alone. Severe disease may be declined by some insurers.

Watch for total permanent disability. Some critical illness policies include it, and it may be restricted or excluded where arthritis already limits what you can do. Check exactly how it is worded before you accept.

What To Have Ready, And Mistakes To Avoid

An arthritis application goes faster and is priced more fairly when the detail is complete. Underwriters commonly ask for:

• The type of arthritis, the date of diagnosis and whether a rheumatologist manages it
• Which joints are affected and whether there is any damage or deformity
• Current medication with doses and start dates, and any steroid courses in recent years
• Any lung, heart, eye or blood vessel involvement
• Joint injections, surgery or replacements, with dates
• Time off work in recent years, and whether your duties have had to change

The most expensive mistake is leaving arthritis off the form because it feels minor or unrelated. You are required to answer the questions honestly and with reasonable care, and an insurer that later finds an undisclosed condition may reduce or refuse a claim. The second is applying to several insurers direct: declines and postponements are recorded and later forms ask about them. Our guide to using a broker or going direct explains why, and our pre-existing conditions hub covers the general process.