Why do I need to declare pre-existing medical conditions?

Published 09 May 2015

When applying for an insurance policy that is in any way linked to your health, it’s essential that you are up front about any pre-existing medical conditions you might have.

It doesn’t matter whether you’re applying for income protection insurance, critical illness cover or any other related policy. Your insurer will calculate your premiums based on the information you’ve given them – and they’ll be reluctant to pay out if you haven’t been honest.

What constitutes a pre-existing medical condition?

Insurers will categorise a pre-existing medical condition as any health complaint that occurred before a policy was put in place. This encompasses a wide range of conditions, so it’s advisable that you provide too much information, rather than too little.

Pre-existing medical conditions often fall into three categories. These are:

  • Any diagnosed condition that you have or have not received treatment for. This could include cancer, stroke, a heart or respiratory problem.
  • Any diagnosed psychiatric or psychological condition. Examples include schizophrenia, paranoia or depression.
  • Any illness, disease or injury you have suffered from. This includes anything you have received treatment for, or for which you have been prescribed medication.

What happens if you don’t declare a condition?

In the event that you haven’t made your pre-existing medical condition known to your insurance company, it is highly likely that any claims you make will be rejected. The cover has been given to you on the basis that the information you have provided is accurate, truthful and correct, which isn’t the case if you have withheld some key facts.

It is therefore worth being honest from the start, otherwise you’re unlikely to reap the benefits you had hoped for from a policy. The financial protection you had thought you were providing for your family will no longer be in place, meaning they could struggle in the event that you’re unable to work.

There are some situations where insurers will turn down cases that are, at face value, legitimate. If you feel that this has happened to you – and you’ve declared your pre-existing medical conditions – then seeking compensation could be an option.

A dedicated superannuation lawyer will go through your case and determine whether there is a likelihood of you being awarded compensation. They will then set to work on compiling the necessary evidence to support your case.

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