Any illness, injury, symptom, or medical condition that existed, was diagnosed, showed symptoms, or for which treatment was received or recommended before the policy commencement date or during applicable waiting periods. Coverage for pre-existing conditions depends on disclosure, underwriting assessment, and policy terms.
A pre-existing condition is any illness, injury, symptom, or medical condition that existed, was diagnosed, showed symptoms, or for which treatment was received or recommended before the policy commencement date or during applicable waiting periods. Coverage depends on disclosure, underwriting, and policy terms.
Insurers' definitions vary slightly but generally include:
Under section 21 of the Insurance Contracts Act 1984, you must disclose all pre-existing conditions and medical history that are relevant to the insurer's decision. Disclosure must occur even if:
A disclosed pre-existing condition can result in:
Non-disclosed pre-existing conditions create real claim risk:
Medical advances are widening what is insurable: HIV on antiretroviral therapy is now accepted with loadings, some cancers are insurable after specific remission periods, and improved mental health risk assessment is enabling more nuanced underwriting.
An applicant discloses well-controlled Type 2 diabetes. Underwriter applies 25% premium loading but provides full coverage with no exclusions. Ten years later, death from cancer claim pays in full despite diabetes loading, as coverage was comprehensive.
A policyholder fails to disclose previous episodes of depression. Three years later, TPD claim for severe psychiatric disability is submitted. Insurer investigates, discovers non-disclosure, and declines claim under Section 54 as non-disclosed depression directly relates to current mental health disability claim.
An applicant discloses previous lower back surgery. Insurer offers coverage with specific exclusion for 'any claims arising from or relating to lower back conditions.' Five years later, neck injury causing permanent disability results in TPD claim. Despite back exclusion, claim pays as neck injury is separate condition not related to excluded lower back area.
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