Sophie is on a journey to understand how and why a doctor's visit for a mild fear of flying resulted in a blanket "mental health exclusion" when she applied for income protection insurance. We unpick how this happened, why, and what it tells us about the way we treat mental health.
Jon Duffy: And we're back. Consume This season two is a go.
Sophie Richardson: Whoo.
Jon Duffy: And I'm out of isolation and back in the studio. Unfortunately, my co-host Sophie is at home with a sore leg. You going all right, Soph?
Sophie Richardson: I am going all right. Basically, moral of the story: exercise is bad. Don't do it.
Jon Duffy: Yeah, word. Hey look, we hope you've missed us as much as we've missed doing this podcast.
This season, we're going to do things a little bit differently. We're doing fewer topics, but we're going to be going into them in a whole lot more detail. And that's all part of responding to the feedback you gave us at the end of last season. So this episode's about something pretty close to home for you. Sophie Richardson: Yeah, thanks, John. I'm actually really excited to share this story. The roots of the story stretch all the way back to 2017 and my doctor's office.
( walking up path into house.)
Dr Lesley Rothwell: Lovely to see you again.
Sophie Richardson: Yes.
Dr Lesley Rothwell: Come on down to the lounge.
Sophie Richardson: This is Dr Lesley Rothwell. She was my GP until she retired at the end of 2020. When we visited her at her home in Wellington, it was one of those rare, hot, windless days. Shocking for Wellington. And we needed a drink. So before we started, she made us fresh lime soda.
( Drinks being made)
Dr Lesley Rothwell: So maybe I could start by asking Sophie: can you refresh my memory about what you were experiencing?
Sophie Richardson: I was flying both internationally and domestically for work. I really did not enjoy it and I-
Dr Lesley Rothwell: Did not enjoy- what do you mean?
Sophie Richardson: I was feeling particularly anxious on the flights. I would be vigilantly watching the air hostesses’ reactions to see if the turbulence was really bad or just normal amounts of turbulence. Or if they had any looks of concern on their face, so I could know whether the plane was about to fall out of the sky. Obviously, that was irrational because plane journeys are very safe.
Dr Lesley Rothwell: When did it start in relation to your journey?
Sophie Richardson: Uh, like getting, when I was getting on the plane.
Dr Lesley Rothwell: Like, did it stop you sleeping the night before?
Sophie Richardson: Ah, no, I've always been a very good sleeper.
No, it would normally start when I would get- like, at the airport, basically. And I'd start getting anxious about getting on the plane and then get on the plane and I'd be vigilantly watching the safety video, and I'd read the safety card and refresh myself on the brace position.
Dr Lesley Rothwell: Okay. Were you able to work before you'd- say, the morning before you flew in the afternoon?
Sophie Richardson: Uh, Yes, but like probably would be slightly distracted.
Dr Lesley Rothwell: And what about say, if you arrived in Auckland at two o'clock, would you be able to go straight into a meeting?
Sophie Richardson: Yes. Because as soon as we landed, I felt immediately relieved.
Dr Lesley Rothwell: So it was a very mild condition.
Sophie Richardson: Yeah.
Dr Lesley Rothwell: Just actually the trip itself.
Sophie Richardson: Yeah.
Dr Lesley Rothwell: Nobody sort of had to drag you on to the planes kicking and screaming?
Sophie Richardson: No. Um, no, I got on the planes willingly by myself. And did some reading and stuff, but that was also the biggest thing was that I just couldn't distract myself from the flight, and what was going on on the flight.
So after I'd had a few trips of that, I, uh, came to see you and said, I'm feeling particularly anxious on these flights and it's not fun and – help. And I would like to not feel like this because it's impacting on my living. How can I be cured please, Dr. Rothwell?
Dr Lesley Rothwell: So we decided on a two-pronged attack: a desensitization program with a psychologist or therapist, and also something to sort of chill you out a bit, just a very short acting- something, for the flights themselves.
Sophie Richardson: The two-pronged approach was entirely effective because it basically meant I went onto the plane relaxed, having taken my medication. and then I had mechanisms in place with the psychotherapist, which was around listening to podcasts, because it was like having someone else on the flight with me talking to me, and distract myself from observing the flight going on.
Dr Lesley Rothwell: Yeah.
Sophie Richardson: So both of those were highly effective.
Sophie Richardson: So as you might've gathered, I had a mild anxiety around flying, but this story is really about what happened next.
About a year after I saw Dr. Lesley, I was single, living in a rental with a good job, but a poor amount of savings, and was concerned that if everything went tits up, I'd be up Shit Creek without a paddle.
My solution at the time was to take out income protection insurance. So I went to see my bank, ASB. They asked to see my health records. They asked me about my income and, after a couple of weeks, they came back to me and said they were happy to advise that they're able to offer me cover. But... there's a couple of exclusions. One for a childhood knee condition and one for my mental health condition.
The mental health condition was news to me. As far as I and Dr. Rothwell were concerned, I didn't have a mental health condition.
Sophie Richardson: Over the next two episodes I'm going to take you on a journey. A journey to get to the bottom of how this happened.
Naomi Ballantyne: Not all insurers do individualized underwriting. So we discriminate against people who tell us they've got a problem and have already sought treatment for it.
Alan Borthwick: It is the white collar disease, unfortunately. When income protection was invented and priced, it was on the basis that the premiums are more expensive for people in manual occupations. But actually, it was all the doctors and accountants and lawyers who are getting depressed.
Sophie Richardson: What it tells us about the way we treat mental health in this country…
Taimi Allan: If we treated exclusions in physical health the way we do in mental health... Then if you ever had a knee injury, then we just would never insure your legs.
Sophie Richardson: And how to make sure you have the best coverage possible…
Alan Borthwick: We tend to prefer covers that are difficult to get. But that means they're easy to claim on, versus the covers that are really easy to get - they do all the hard work at claim time.
Sophie Richardson: We're following a trail of breadcrumbs that will ultimately take us to the top of one of the country's biggest insurers.
Naomi Ballantyne: They don't assess you specifically, then they apply a blanket exclusion, which really reflects the risk of the worst person who might have one of those conditions.
Alan Borthwick: We have a lot of actuarial data on cancers. You can kind of pick within a certain range and a certain age of what should happen, but with mental health, there's just still so much unknown.
Naomi Ballantyne: That's the real challenge. We haven't got enough research to say which people will go on and have repeated cycles, and which won't.
Dr Lesley Rothwell: If you are treated for a mental health condition, you're actually much less likely for it to have an impact on both your longevity and your quality of life.
Naomi Ballantyne: We use an exclusion because it protects us and the rest of our customers. But it might be inherently unfair because a degree of those customers we're excluding were never going to be any different than people who've never had the problem before.
Taimi Allan: Surviving through those challenges and coming out the other side makes us stronger, more resilient people that are less likely to die sooner.
Sophie Richardson: There are three types of insurance that this issue affects. Health insurance, income protection insurance - that's what I was applying for – and life insurance.
Before we go any further into my story, why should you care about this? Does it really matter if your insurance covers mental health? This is just a one-off that happened to me. It's not going to affect you, right?
There's a stat that gets thrown around a lot. You might've even come across it. It's normally quoted as one-in-four or one-in-five of us will experience mental health issues at some point in our lives. That's over a million people, but even that's not the real picture.
Taimi Allan: The one-in-four is actually people who will experience mental health and addiction challenges in this year alone.
Sophie Richardson: This is Taimi Allan. She's the director of mental health organization, Ember Innovations, and a board member of the Mental Health and Wellbeing Commission.
Taimi Allan: The actual number of people who will experience and be involved in either a diagnosis or a service that needs to support them with their mental health and addiction challenges is closer to around 84%. We now are speaking about it more than we've ever spoken about it before. Some of that's great. Some of that's perhaps not so safe.
The positive part of talking about it more is not necessarily the headline – gnarly, horrible stories of what's gone wrong – but actually, the thing that I'm excited about is that people are talking about the value having challenging experiences can bring. And that value can translate into the workplace.
It can translate at home. It can translate into just the way we communicate and talk to people and keep each other safe, and feel safe in those conversations. And I think the reason why it's so important to be talking about insurance as part of that is: industries like our insurance industry have not caught up with these conversations in terms of value. They haven't caught up with society talking about mental health as if it's something worth valuing.
Sophie Richardson: For me, it was talking about my flying anxiety, which went on to cause my insurance issues. If I just kept it to myself, tried to struggle on, it would have never come up. ASB would've signed off my policy with no exclusions, and we wouldn't be talking about this now. But that is clearly not a sensible solution.
After I saw Dr. Lesley and went through a couple of counselling sessions, my anxiety around flying was totally remedied. Getting the help you need is always worthwhile.
Taimi Allan: Yeah. Uh, because what we also know is that those people who don't receive adequate care for their mental health and wellbeing end up dying up to 25 years earlier than the rest of the population. Not from mental health concerns, but from cancers, from heart disease, from physical elements that are not picked up, because the mental health is the most prevalent health concern that people are dealing with. So medical overshadowing comes in and those sorts of things are not picked up early enough. People die earlier.
Sophie Richardson: The logical conclusion is that by not covering mental health and helping clients to get the care that they need, insurance companies are just shifting problems further down the track.
There is also data to support this. World Health Organization research shows that every dollar invested in treatment returns four dollars in better health, and improved ability to work.
My big problem with all of this is that mental health exclusions are broad. Very broad. Rather than denying me all mental health coverage as they did, they could have been more targeted.
They could have excluded flying-related anxiety. They could have even excluded all anxiety. That would have been a reasonable interpretation and I may have brought their policy, but that's not how the industry operates with mental health. It's all in or all out. There's no middle ground.
All of this is a very different situation to the way they deal with our physical health.
Taimi Allan: If we've treated exclusions in physical health the way we're doing mental health, then if you had ever had a knee injury, we just would never insure your legs. You see, that seems ridiculous to me. And in mental health, if you have a specific concern about someone's anxiety, for example, but then you have a context about what leads up to that anxiety, and you can look at preventing that, then the exclusion should be far more refined.
Sophie Richardson: This one is actually particularly relevant to me. I do have an exclusion from my right knee. It's due to a pre-existing childhood condition. The exclusion is specific and you'll be happy to know the rest of my legs are indeed covered.
Although I didn't think they were worth insuring specifically, like Heidi Klum.
Taimi Allan: In terms of excluding specific things, most people with mental health and addiction problems don't mind exclusions. If they're specific. For example, having a history of suicidal ideation in my teens, I would not expect, even though I'm fully recovered from those experiences, and I know my way through those – even 20, 30 years down the track – I would not expect an insurance agency to cover me for a death by suicide. And most people would be okay with that.
And in fact, we know that people are far more likely to recover from mental health conditions – because of the fact that they are environmentally based, that they're trauma informed – than we are for physical health injuries.
Unless you eventually go on to get a full knee reconstruction, you're most likely to keep injuring that knee. So that's not the same in mental health. We know that if you get the right treatment and supports for depression, for example, then you will know, next time that you start that slippery slope down to depression, the people you'd need to see, the things you need to do, the medications - if that's part of your journey – that you might need to take, and the supports you need to get around you for the second time that happens. So I think insurance agents and companies really need to come to the table on that.
Sophie Richardson: Let's recap the story so far. I went to see my doctor, Dr. Leslie, about some mild anxiety surrounding flying. A year or so later I applied for some income protection insurance with ASB. That doctor's visit caused them to decide that my mental health was uninsurable. That decision came as a total shock to me. And that's not unusual.
Taimi Allan: To see your life in a hundred pages of clinical notes, of which you didn't have a part of writing or didn't see before that moment, is incredibly traumatizing, because you don't get the option to say, "Hey, this isn't how I saw it. This is not why these things happened."
I remember in one particular hospital admission for a broken leg, one of the people that I'd seen for less than five minutes had written down on the form that I was drunk, which was so not true. I had had one glass of champagne and I'd obviously passed that on. But they had written in those clinical notes that I was intoxicated. And so to not have a wherewithal to be able to go back and say, hang on, you didn't really understand that conversation, did you? And that happens quite a lot in clinical notes. And if those clinical notes are then extrapolated into a context, which is a money-making or a business opportunity to say, oh, well, this person then has a problem with alcohol, or then has a problem with chronicness of depression or stress, then they're likely to be excluded.
So, you know, that's some of the problems that we're facing. We're retraumatizing people, even by going through the insurance process, by having to see things that they've never seen written about them.
Sophie Richardson: Honestly, I felt a bit crazy. The insistence that I had a mental health condition felt like I was being gaslit by the insurance company. I was lucky I had a sensible, bad-ass GP like Dr. Lesley.
But there's still a missing piece to this puzzle. When I filled out the form to apply for the insurance, I didn't tick the box to declare any kind of mental health issue. I'd forgotten about it. If I'm honest, I hadn't even really considered it to be a mental health issue.
So how did they find out about that appointment and subsequently decide that I was a mental health risk? Well, it all comes down to my medical notes. That leads us back down the path we started on, towards lime sodas and my former favorite GP Dr. Lesley.
(🎵 Walking into house)
Sophie Richardson: Can you talk us through how the insurance company get those notes? Like what happens when that request comes through?
Dr Lesley Rothwell: So, the insurance company has a special platform and they send a request. It depends on how much money, I think, you're being insured for, as to whether they can request three years or five of notes. If you have any specific conditions that they are concerned about, they can request lifelong notes.
In those cases, I have to go back before the five years and select out specific consultations, which are about the pre-existing condition. For example, if somebody had a heart murmur, I have to go back through the notes, work out when it was first diagnosed. It might've been when they were three months old, six months, six weeks, and then go through all the rest of the records filtering only those records that pertain to that particular condition.
Sophie Richardson: Yeah. That sounds like quite a lengthy process.
Dr Lesley Rothwell: It can be, yeah, it can take hours.
Sophie Richardson: Do they have to pay for them?
Dr Lesley Rothwell: Yes, they do. In the format, there is a box that is automatically ticked that gives you a standard fee, which is I think $80. But you can actually untick that and bill them separately, which I must admit is what I used to do. And I used to bill them at my normal hourly rate.
Sophie Richardson: Um, do you recall me having any other mental health issues on my file?
Dr Lesley Rothwell: No, I don't.
Sophie Richardson: Yeah. So if the only thing on my file was this fear of flying, what grounds do you think they might have had to exclude me?
Dr Lesley Rothwell: I don't know. It seems bizarre to me. What sort of insurance had you applied for?
Sophie Richardson: Income protection.
Dr Lesley Rothwell: Okay. I really can only think that you could be compromised from traveling if it became overwhelming.
Sophie Richardson: Mmm, but from like our initial consultation, it's clear that it wasn't to such a serious extent, correct?
Dr Lesley Rothwell: Yes.
Sophie Richardson: Yeah. At the time I came back to you and I said, “What the fuck? Um, these people have told me I have a mental health disorder and you never told me that so...”
Dr Lesley Rothwell: “What?!”, I said.
Sophie Richardson: After this, Dr. Lesley wrote a letter to ASB.
Dr Lesley Rothwell: Re Ms. Sophie Richardson, To whom it may concern. The above was seen and examined by me today...
Sophie Richardson: In it, she explained the context and that I didn't have any ongoing mental health issues. But ASB didn't budge on the exclusion. There was no way they were going to give me the full insurance cover that I needed.
Interestingly, they also didn't offer to give me any discount on my premiums to reflect the more limited cover. So what's going on? Why have ASB assessed my mild and fully treated fear of flying as such a large risk? And why aren't they prepared to offer a more specific exclusion even after receiving Dr. Lesley's letter?
To find out, we rang up Christophe Bryant, the insurance manager who handled my application. He was affable and friendly on the phone, but he didn't remember me. He's also since left ASB, and as a result was unable to talk to us. So let's cross him off the list and move on to the next stop.
ASB answerphone: Thanks for calling ASB. As many of our people are working from home...
(🎵 Answerphone message fades)
Sophie Richardson: This is where things get complicated. It turns out ASB doesn't write the insurance policies. They're the middleman. When I finally got hold of the press officer, she told us that they hadn't made any decisions on my policy and didn't have any information that they could discuss with us.
Instead, she directed us to a company called Sovereign. As it turns out, they're the insurers who actually did the underwriting. Unfortunately, they no longer exist. Not one to let a dead end put me off, I did some digging. It turns out Sovereign were bought by global insurance giant AIA.
They're a big company with a team dedicated to media requests like ours, so I thought we'd be sure to get some answers this time. But alas, they also declined to talk to us. They did, however, send us a statement...
AIA statement: While we can't comment on Sophie's case specifically, at AIA, we recognize that mental ill health exists on a spectrum and periods of distress are a normal part of life.
However, like other health conditions, some mental health issues may present a higher claims risk. We manage these risks through premium loadings and exclusions, particularly for income protection products, where about 24% of claims relate to mental ill health.
Sophie Richardson: When we followed up, they didn't reply to any further questions. Instead, they passed us on to an external PR company, Pead, who reiterated that they wouldn't be commenting further.
So, where does this leave us? At this point in our story, I still haven't got any insurance. Dealing with the situation was taking up way too much of my time, and ironically, causing me a fair bit of mental distress.
We still don't understand why ASB or Sovereign declined me mental health cover. I was starting to doubt that we ever would. But then...
Alan Borthwick: So, nothing tends to surprise me with bank insurance products. I've seen a lot of exclusions for things that the main insurers that we deal with in the market wouldn't have done.
Sophie Richardson: Two members of the insurance industry finally agreed to talk to us.
Naomi Ballantyne: When you go to somewhere like a bank to buy insurance or even buy it direct, then there's this perception in those organizations that actually you just need fast and quick. And fast and quick insurance by default becomes very generalized.
Sophie Richardson: That's insurance broker Allan Borthwick and managing director of Partners Life Naomi Ballantyne.
Coming up in the next episode, we'll finally get a response from the industry…
Naomi Ballantyne: Oh my God. Wow. I, I don't know what to say. I don't know what to say.
Sophie Richardson: … and find out if I'm able to get insurance without exclusions. Plus, are all policies created equal?
Alan Borthwick: In general, the average person who walks into the branch who's done a mortgage, or just wasn't moving fast enough to get away, they'll be offered their basic line products.
Sophie Richardson: And what can you do to make sure that yours will protect you when it's needed most?
Naomi Ballantyne: Wanting it not to be complex is not necessarily a good thing. You know, these are hundreds of thousands, sometimes millions of dollars. Why would you want that process to be simple and easy? You'd want it to be right.
Sophie Richardson: Follow or subscribe to Consume This in your favorite podcast app now to make sure you don't miss part two.
If you're struggling with your mental health, you can call or text 1737 and talk to a trained counsellor. There's a link to other services in the show notes.
We are grateful to the Mental Health Foundation for their support of Consumer’s work in the area of insurance and mental health.
Our thanks also go to our Consumer NZ colleague investigative writer Rebecca Styles, on whose great work parts of this episode were based.
Consume This is brought to you by Consumer NZ. We are proud of our independence, which we can only achieve because we're a non-profit supported by our members. For more information on Consumer and becoming a member follow the link in the show notes.
This episode was hosted by me, Sophie Richardson, produced by Tom Riste-Smith, and executive produced by Gemma Rasmussen.