What medical conditions and circumstances are typically excluded from Income Protection?

Retail Income Protection policies on the panel apply a short list of standard exclusions: intentional self-injury, criminal acts, war, normal pregnancy and childbirth, and similar. Pre-existing conditions are handled differently in retail versus direct contracts, and this distinction often surprises consumers.

Understanding which list applies to your contract type is critical before assuming any condition is or is not covered.

Standard policy-level exclusions across the 9 panel insurers

• Intentional self-inflicted act or attempted suicide.
• Participation in a criminal act, and periods of incarceration due to participation in a criminal act.
• War or act of war (with terrorism usually excluded from the war definition).
• Normal and uncomplicated pregnancy, miscarriage, or childbirth (complications are typically covered; see the dedicated FAQ).
• Illicit drug use (most insurers exclude losses caused by illicit drug use).

Some insurers add narrower items such as elective cosmetic surgery (unless medically required), service in armed forces, or specific high-risk pursuits disclosed at underwriting.

Per-insurer policy-exclusion references

| Insurer | PDS section | Source | |---------|-------------|--------| | AIA | Section 5.2.4 / 5.2.5 'When we will not pay' | AIA Priority Protection PDS Version 32, 9 November 2025 | | TAL | Section 2.6.4 'When we will not pay' | TAL Accelerated Protection PDS, 12 December 2024 | | Zurich | Income Protection 'When we will not pay' | Zurich Wealth Protection PDS, 1 November 2025 | | OnePath | Income Secure Cover 'When we will not pay' | OnePath OneCare PDS, October 2025 | | ClearView | Income Protection Flex exclusions | ClearView ClearChoice PDS, 13 May 2024 (Update 5 June 2025) | | NEOS | Income Support Cover 'When we will not pay' | NEOS Protection PDS, 6 December 2024 | | Encompass | Income Protection Cover exclusions | Encompass Protection PDS, 26 September 2025 | | Acenda | Income Protection exclusions | Acenda Insurance PDS, 27 September 2025 | | Futura | Income Protection Cover exclusions | Futura Protection PDS, 1 October 2025, Income Protection Cover 'When we will not pay' |

The critical retail-vs-direct distinction on pre-existing conditions

Retail panel IP policies do not impose a blanket pre-existing condition exclusion at the policy level. Pre-existing conditions are handled through underwriting at application. If a condition is disclosed, the insurer may apply a personal exclusion to your policy schedule, load the premium, accept the condition with no special terms, or in rare cases decline cover for that condition.

This is different from direct (DTC) Income Protection contracts (often sold by banks, comparison sites, or non-broker channels). Direct policies frequently impose a blanket 12 or 24 month pre-existing condition exclusion that prevents claims for any condition you had symptoms of, treatment for, or were reasonably aware of before the policy started.

If the existing FAQ corpus has ever described retail policies as having pre-existing condition limitations, that wording aligns with direct contracts, not retail panel contracts. The panel cite supporting this position is that no PDS across the 9 panel insurers documents a blanket pre-existing exclusion.

Personal exclusions on your retail policy schedule

When you apply for retail IP, the insurer underwrites your health, occupation, hobbies, and lifestyle. If something needs to be excluded, the exclusion appears on your policy schedule as a specific endorsement (for example, back injuries arising from a pre-existing lumbar disc condition are excluded for 24 months). After the specified period, the exclusion may lift; check the wording.

Activities that are commonly excluded or loaded

• Aviation other than as a fare-paying passenger.
• Motor sports.
• Scuba diving beyond recreational limits.
• High-altitude mountaineering.
• Some occupations involving offshore work, explosives, or high-altitude rigging.

These are usually handled by personal exclusion or premium loading at application, not a blanket policy-level exclusion.

Honesty at application

The Insurance Contracts Act 1984 and APRA's Duty to Take Reasonable Care frameworks place a positive duty on the insured to take reasonable care not to make a misrepresentation. Non-disclosure of relevant medical history can result in claim reduction or policy avoidance. When in doubt, disclose.

General advice only. Read your policy schedule alongside the current PDS to identify any personal exclusions and confirm policy-level exclusions.