Do you have to disclose symptoms if you don't have a diagnosis?
Open a life insurance or income protection application and you'll hit a question that trips more people up than almost anything else in the form: not the diagnosis you've had, but the symptoms you've had.
It sounds like a technicality. It isn't. In a recent Skye Deep Dive, underwriting specialist Aimee Cowling sat down with Phil Thompson to unpack why "I don't have a diagnosis" is often the wrong test entirely, and why getting this wrong on the way in is one of the most common reasons a claim gets knocked back years later.
Does "no diagnosis" mean there's nothing to disclose?
Not necessarily. Underwriting is the process an insurer uses to work out how risky you are to cover, and what that cover should cost. According to Aimee, underwriters aren't primarily checking whether you've been formally diagnosed with something, they're looking for early indicators of what might turn into a bigger problem over the decades a policy can run.
The comparison she draws is to home lending. A bank doesn't just check whether you can afford the mortgage today, it assesses whether you'll still be able to if interest rates rise. Insurers do the same thing with health: a diagnosis is a label at a single point in time, but symptoms, frequency, and how long something has been going on tell an underwriter far more about what's likely down the track.
Mental health is the clearest example. A client who says "I just saw a counsellor once or twice, it's no big deal" is answering the diagnosis question. The underwriter is asking a different one: could this become something more serious, something that leads to time off work later. Symptoms and frequency matter more than whether a psychologist ever gave it a name.
What's actually required when you disclose?
The legal obligation changed a few years ago, and plenty of people are still applying under the old assumption. It used to be a duty to disclose, which put the burden on the applicant to guess what might be relevant and volunteer it, whether asked or not.
New policies now sit under a duty to take reasonable care not to make a misrepresentation. In practice, that shifts responsibility onto the insurer to ask clear questions, and onto the applicant to answer those specific questions honestly, accurately and completely.
That sounds simpler, but it creates a different kind of mistake. Cowling points to a common pattern: a client increases cover through their super fund, gets a musculoskeletal question, and answers it about their knee without mentioning ongoing back issues too. They weren't hiding anything, they just answered the part of the question that came to mind first. The result can be a back exclusion added later, and a difficult conversation with the super fund about whether the original disclosure was ever complete.
What can actually happen if you don't disclose properly?
Insurers have a few tools available depending on what an applicant's health history shows:
Exclusion- a specific body part or condition is carved out of cover (a common outcome for ongoing back pain, or a mental health history with no formal diagnosis)
Loading - a higher premium to reflect extra risk (common for high BMI or existing heart concerns)
Postponement- cover is put on hold until an outstanding test, scan or specialist referral is resolved
Decline- the insurer won't offer that type of cover at all, though sometimes only part of an application is declined (income protection, say, while life and trauma cover still goes ahead)
ADHD is a good example of where the line sits. More people are doing an online quiz, being told they've probably got ADHD, and treating that as enough. Insurers don't. Aimee notes they're often unwilling to offer any cover at all until an applicant has seen an actual professional and been properly assessed, rather than applying an exclusion and moving on.
Where it becomes serious is at claim time. If an insurer later discovers something wasn't properly disclosed, and it would have changed the original underwriting decision, they can decline the claim, adjust the terms retrospectively, or in the worst case avoid the policy entirely, treating it as if it never existed.
What if a doctor says not to worry about it?
This is a genuinely awkward spot for clients to be in, and one Aimee and Phil discuss directly. A GP is making a call based on someone's health today. An insurer is pricing a promise to pay a claim that might not eventuate for another 30 or 40 years, and can't easily adjust that promise later if things change. That difference in time horizon is why a doctor and an insurer can land on different answers to the same question, and it's why it's worth checking with an adviser rather than assuming a doctor's reassurance settles the underwriting question too.
When's the best time to sort this out?
There's no way to game the timing of underwriting. The outcome is driven by health at the time of application. But the general pattern holds: the earlier someone applies, before health issues appear, the more straightforward it tends to be.
If something is going on, whether that's ongoing symptoms, a pending test, or an old specialist referral that was never followed up, it's worth getting that resolved (or confirmed as no longer necessary) before applying. And if there's nothing wrong and no symptoms, chasing full blood panels just to have a "clean" file isn't necessary, and can create new questions that didn't need to exist.
Frequently Asked Questions
Do you need to disclose something if you were never formally diagnosed?
Generally yes, if the insurer's questions cover symptoms, treatment or investigations, not just formal diagnoses. Answer what's actually asked.
What's the difference between the old "duty to disclose" and the current rule?
The old duty put the onus on applicants to volunteer anything relevant. The current duty to take reasonable care requires answering the insurer's specific questions honestly and completely.
Can an insurer decline a claim years later over something that wasn't mentioned?
Yes, if what wasn't disclosed would have changed the original underwriting decision, insurers can decline the claim or avoid the policy entirely.
Does an online self-assessment (like an ADHD quiz) count as a diagnosis?
No. Insurers generally won't accept it, and where there's a suspected condition or ongoing symptoms, they may decline to offer any cover at all until a proper professional assessment has been done.
Is it better to apply for life insurance before or after resolving a health issue?
Earlier is generally better, since the outcome is based on health at the time of application. If something is genuinely outstanding, resolving or confirming it first can avoid a postponement.
This post is general information only and doesn't take personal circumstances into account. Underwriting outcomes vary by insurer and individual health history, so it's worth talking to an adviser before applying.
Not sure whether something in your own health history needs disclosing, or how it might affect an application? Book a chat with a Skye adviser and get it mapped out before you apply, not after.
Aimee Cowling and Phil Thompson cover this in full in the Deep Dive episode, including more client examples. Watch it here.
