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Pre-existing Medical Conditions

A pre-existing medical condition is a condition that you are currently or have in the past been treated for by a doctor, specialist or other medical professional prior to your application for insurance.

We are specialists in getting clients income protection cover who have a pre-existing condition.

We have put together this guide on some of the most common myths surrounding pre-existing medical conditions to help you get a better understanding of how they are generally treated by insurance companies.

Myth 1: "My pre-existing medical condition rules me out from receiving income protection insurance"

This is definitely not the case and depends on your medical history. At application time, your insurer will ask you to complete an application form that will ask questions regarding any pre-existing medical condition.

They will generally ask five questions:

  • What is the condition?
  • Who you have consulted for the condition, i.e. doctors, specialists, etc?
  • What treatment have you had for the condition?
  • What has been the outcome of your treatment? 
  • Is the condition ongoing? If so, how well controlled is it?

Depending on your condition, the insurer will either write to your doctor to provide more information around your pre-existing medical condition, or they might ask you to do a blood test (with all costs incurred paid for by the income protection provider).

After they have received the appropriate information, they will then assess how your condition will affect you going forward. This is assessed on a case by case basis.

In general, after assessing your medical condition, your insurer will decide to either:

  • Offer you standard cover, giving you cover including your pre-existing medical condition, or

  • Offer you standard cover but exclude your pre-existing medical condition from your policy, or

  • Offer you cover with a “loading”, which is an industry term for an adjustment in premiums to take into account your pre-existing medical condition. If you are offered cover with a loading, you will be notified of this at the time and are within your rights to decline the offer if it does not suit you.

  • Be declined

Generally, the more recent the condition, or the more recently you recovered from the condition, the more chance there will be an exclusion.

For example, if you have completely recovered from a broken leg, there shouldn’t be any exclusion applied depending on the time that has passed between recovery and your application. If you only recently fully recovered, you may expect to see an exclusion for at least 12 months. Exclusions are generally reviewable every 12 months, however this depends on the condition as some may not be able to be reviewed. 

Myth 2: "If I am provided with income protection cover, my pre-existing medical condition will not be covered"

This is not always true and depends on what the pre-existing medical condition is, how recent it was, and whether it has been resolved or not.

Generally, if your condition has been resolved or is ongoing but well controlled, it will generally be covered. If your condition is still an outstanding issue, for example, if you are still receiving treatment for it, your condition will more than likely receive an exclusion at application time.

With regards to conditions that you will have for the rest of your life, such as high blood pressure or asthma, if the condition is well controlled you will more than likely be covered on standard rates.

For example, if you are suffering from high blood pressure, the income protection company will look at your key markers to see how well you control high blood pressure, such as looking at your blood pressure reading.

After assessing these key markers and finding that they are within acceptable limits, your insurer will generally offer you cover at standard rates.

In general, the expectations of income protection companies for pre-existing medical conditions are becoming easier to meet, so it is definitely worthwhile making an enquiry.

Myth 3: "If I have a pre-existing medical condition I will be required to take a medical examination"

Generally this is not the case. Depending on what your condition is, you may only be required to fill out a simple application form, which will help the income protection company acquire an understanding of when the condition occurred, who you saw for the condition, the treatment, and the outcome.

Alternatively, the income protection company may write to your doctor and have them complete a questionnaire on your behalf (the cost of which would be incurred by the income protection company).

If you have a particular condition such as diabetes or high cholesterol, the income protection company may ask you for a blood test or medical if they need a current reading (paid for by the life insurer).

Myth 4: "I was diagnosed over 5 years ago, so there’s no need to disclose my condition"

Your duty of disclosure goes back to the day you were born, therefore you are obliged to disclose all medical conditions that may influence the insurers’ decision on whether to provide you with cover or not.

Failure to do so can give the insurance company the opportunity to either void your contract, cancel it, or give you a modified offering if it was issued within three years.

You can find a full outline of your duty of disclosure at the beginning of your insurance policy application form.

Myth 5: "I don’t have to tell the insurer about every medical condition I have ever had"

This is true for medical conditions that won’t influence the income protection company’s decision, for example, if you’ve had a cold or flu 2 years ago that you have 100% recovered from.

The general rule is that if you’re not sure if you should tell the insurer, tell them. Telling them more is definitely favourable to both yourself and your insurance company as opposed to telling them less.

You would rather your income protection company have a clear picture of your medical history, as when you claim on your policy you do not want them to find out about previously undisclosed medical conditions by viewing your medicare file or when they write to your doctor. 

We specialise in getting income protection for people with pre-existing medical conditions. Please call us on 1300 135 205 for a comprehensive quote comparison of the major income protection companies to help you find affordable cover.