A pre-existing condition is a health condition that has been diagnosed or is being investigated by a medical professional.
You could face higher premiums in order to cover the condition. An insurer may see you as posing a greater risk of making a claim.
An exclusion may be applied to your cover, meaning you cannot make a claim for the condition. Or, you may have to serve a qualifying period, after which time the illness would become a claimable event.
If you suffer from a pre-existing condition, it's still possible to take out income protection. Each insurer will have its own rules about which conditions it will and won't cover, so if your application gets knocked back by one, it doesn't necessarily mean you can't get covered by another provider.
How to get income protection if you have a pre-existing medical condition
Apply for cover and disclose details involving your pre-existing conditions
Accept a greater premium, waiting period or exclusions on your policy
If an insurer accepts your application for income protection, you may pay higher premiums due to the increased risk that you are exposing them to. This added risk may result in you having to serve a longer waiting period, such as 60 or 90 days. Or, your insurer may impose exclusions on your policy (when claims arise from your pre-existing conditions).
Make sure you understand what happens when you make a claim relating to your pre-existing condition. We explain this below.
Does income protection cover pre-existing conditions?
Yes, you can get income protection if you have a pre-existing condition. In most cases, you will have to do one of the following:
Pay more
Some income protection insurance providers will cover you for the pre-existing condition but there will be a loading – this is an increase to the cost of your premiums.
Accept an exclusion
In some cases, if you have a more serious pre-existing condition, such as lung cancer, the insurer might cover you but not for any claims related to your pre-existing condition.
Be honest about your health
20% of Australians – equivalent to over 3.8 million people – have lied in order to get a cheaper policy. But if you aren't truthful, your claim is likely to be refused.
Finder survey: Have Australians from different states lied on their income protection insurance policy?
Response
WA
VIC
SA
QLD
NSW
I've never lied on an insurance policy
7.21%
10.96%
9.88%
10.45%
11.14%
I've lied on a past policy
2.7%
I lied on my current policy
0.9%
0.45%
0.56%
Source: Finder survey by Pure Profile of 1110 Australians, December 2023 Data for ACT, NT, TAS not shown due to insufficient sample size. Some other states may also be excluded for this reason.
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What is a pre-existing medical condition?
While the definition of a pre-existing condition can vary, it generally refers to the following:
A health condition that was diagnosed or investigated by a medical practitioner
The appearance of certain symptoms leading to a diagnosis
A condition that occurred prior to the commencement or reinstatement of your insurance policy
Financial adviser Brenton Tong on income protection for pre-existing conditions
Why is it difficult to get income protection with a pre-existing condition?
"There are many things that could knock you out of the workplace for a time, so insurance companies will be very cautious to offer income protection insurance to anyone with a difficult medical background.
If you could imagine the types of things that would stop you from working for 6-12 months – a car accident, a fall on the sports field, chronic fatigue, glandular fever, long COVID, the list goes on. This is especially difficult for those that have a history of mental health issues – even minor."
The bottom line
"The silver lining with income protection and pre-existing medical conditions is that the insurer is more likely to exclude a medical condition rather than flat out refuse to insure you. This means while you're not covered for your particular ailment, you're still covered for all other events and illnesses."
Brenton Tong is the managing director and senior financial adviser at Financial Spectrum.
Common pre-existing medical conditions that can affect your income protection application
Examples of pre-existing medical conditions include the following:
Diabetes type I and II. If you suffer from either type I or type II diabetes, you'll be required to undergo a medical examination and can expect to pay a premium loading.
Epilepsy. You may pay higher premium rates depending on the type of epilepsy you have: idiopathic, symptomatic or focal.
Heart-related conditions. If you have a heart condition, your insurance provider will want to find more information on whether the condition is treated, the response to treatment or if it is malignant.
Hepatitis. A declaration of hepatitis on your application will prompt your insurance provider to carry out further investigations. Depending on the type of hepatitis, whether it was a single attack, if you have had a full recovery and it was more than 2 years ago since it occurred, you may be eligible for standard premium rates when you apply for income protection.
Mental illness. Mental conditions such as depression, anxiety and bipolar disorder are difficult to assess by insurance providers due to a variety of forms, degrees of severity and their unpredictable nature. A medical attendant’s report will always be required in this case.
Sleep apnoea. If you have a history of sleep apnoea, your insurer will request more information on your condition and a detailed medical attendant’s report. In some cases, you may be required to complete a medical examination and a high premium loading may be applicable.
Why do you need to declare pre-existing conditions?
To ensure that your income protection policy is tailored specifically to your needs and condition should they provide you with cover, you need to be upfront and honest about any pre-existing conditions you may have. If you withhold information from your insurance provider, it has the right to deny any claim that may arise as a result of your condition and refuse to provide cover.
With so many different income protection policies available in the Australian market, it isn't easy to determine which cover is most suitable for your needs. If you have a pre-existing condition, you should do the following:
Avoid "automatic acceptance" or "no medical examination" policies unless you are after a policy that won't cover your pre-existing condition.
Consider speaking to an insurance adviser who can provide tailored recommendations based on your specific needs and requirements. An insurance consultant can minimise the time and effort required in securing an income protection policy, especially if you have a pre-existing medical condition.
If you don't want to use an adviser, consider a direct insurer who offers a detailed medical questionnaire upfront. Although it takes longer to get cover, there is less uncertainty at claim time.
Is it possible to apply for income protection with no medical?
You will be required to complete a health check-up with most providers when you apply for income protection. This is to enable your insurance provider to obtain a more accurate depiction of your health and the level of risk that it is exposed to should it provide you with cover. This is standard procedure and isn't something to be feared.
An example of how a doctor works with an income protection insurer
Let's say I see an applicant with high blood pressure. If the patient's blood pressure isn't well controlled after multiple measurements and they've advised me about the medicine they are prescribed for this medical condition, I would recommend a review of their blood pressure management including their medication. It may be as simple as a patient going to see their GP to have their blood pressure reviewed. If the patient's blood pressure readings are within the normal range, or they normalise after a revision to the dose of their medication, the insurance company may proceed with the policy... but if a person has a past history of a diagnosis, such as cancer, that's an example of where the insurer may request more specific detail.
— Dr Deepak Gaur, the Founder of Pop Up GP, speaking to Finder about insurance medical assessments based on his experience.Read more here.
If you are looking to secure an income protection policy with no medical, you may want to consider the following alternatives:
Income protection from direct providers
Direct life insurance providers in Australia, such as Noble Oak and Zurich, offer income protection policies with competitive premiums with minimal medical underwriting. Even though you still have to go through a medical exam and complete a health questionnaire, there are generally fewer restrictions on the eligibility criteria with direct income protection application.
Why you can trust Finder's income protection insurance experts
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Frequently asked questions
Yes, you can. However, the medical conditions covered will vary from insurer to insurer and it'll also depend on your individual circumstances.
If you can get insurance, it could cost you more or an exclusion may be applied. An exclusion means you can still hold cover, but you won't be able to make a claim for that condition. Or, you may have to serve what's known as a 'qualifying period' before it becomes a claimable event.
Again, it varies. Some declared conditions you may be able to find cover for include high blood pressure, diabetes and anxiety. Be sure to read your PDS to have a clearer picture of what you are and aren't covered for.
Not necessarily. Finder's research team looked at 6 income protection policies and found that none mentioned "COVID" or "Long COVID" as either an incusion or a policy exclusion.
However, this condition may be a claimable event with some insurers.
It's best to reach out directly to an insurer if you have any specific questions on your coverage.
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To make sure you get accurate and helpful information, this guide has been edited by David Gregory as part of our fact-checking process.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
Gary Ross's expertise
Gary Ross has written 725 Finder guides across topics including:
James Martin was the insurance editor at Finder. He has written on a range of insurance and finance topics for over 7 years. James often shares his insurance expertise as a media spokesperson and has appeared on Prime 7 News, WIN News, Insurance News, 7NEWS and The Guardian. He holds a Tier 1 General Insurance (General Advice) certification and a Tier 1 Generic Knowledge certification, both of which meet the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
James's expertise
James has written 255 Finder guides across topics including:
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