The reality check on pre-existing conditions
If you’ve ever worried that your history of back pain, a mental health check-in, or even a family link to cancer will lock you out of life insurance, you’re not alone. Pre-existing conditions can sound like a brick wall. But in reality, insurers handle them in different ways — and understanding how it works can save you from making the wrong assumptions.
“People get worried that if they’ve got a health history of some description, they’re not going to get cover.”
The truth is, most people can still get cover. The question is how the insurer underwrites your situation — whether that means adjusting premiums, adding exclusions, or in rare cases, declining cover altogether.
What counts as a pre-existing condition?
In insurance, a pre-existing condition is any health issue you had before applying for cover — even if you’ve never been formally diagnosed. That could mean:
Seeing a psychologist for stress or anxiety
Regular back or shoulder pain from work
Asthma you’ve had since childhood
High blood pressure, cholesterol, or BMI
Family history of cancers or genetic conditions
It’s broader than most people think, which is why disclosure is so important. If you don’t tell the insurer, you risk a denied claim later.
Why underwriting matters
Underwriting is how insurers work out the level of risk you bring to the table. They’ll ask about your health history, lifestyle, family medical background, and even hobbies. Based on that, they might:
Accept your cover as is
Apply a loading (higher premium)
Apply an exclusion (that condition isn’t covered)
Decline cover (less common, usually for very high-risk cases)
“If you’ve got back pain, you might get an exclusion… if you’ve got a higher BMI, you might get a loading.”
It’s not about punishment — it’s about tailoring cover to actual risk.
Do you get to choose between a loading and an exclusion?
Not always. Some insurers might give you the option to take an exclusion instead of paying a higher premium, or vice versa. But often, the underwriter makes the call based on their policy rules.
“Some insurers are really tough on mental health, some are really tough on back conditions, some are a bit more flexible.”
That’s where having multiple insurers to compare makes a huge difference.
The stats behind exclusions and claims
A big worry is whether exclusions make insurance “not worth it.” But the data shows otherwise.
72% of death claims for men aged 34 are from accidents (APRA, 2024). And accidents are rarely excluded.
Cancer remains the leading cause of trauma and life claims, making up 63% of trauma and 33% of life claims (APRA, 2024).
Mental health is driving growth in TPD and income protection claims, with 25% of TPD claims linked to mental health conditions (Financial Services Council, 2024).
So even if a condition like anxiety or back pain ends up excluded, the majority of claims are for events that are still covered.
“If someone’s got a back exclusion and they’re like, ‘Oh, I won’t bother,’ the chances are if you’re in your thirties, the biggest risk is actually an accident or cancer, and those are still covered.”
Common pre-existing conditions insurers flag
Here are some examples of conditions that often come up in underwriting:
Mental health: Often leads to exclusions, especially for income protection. Some insurers may cover with conditions.
Back pain or musculoskeletal issues: Can result in exclusions for spinal conditions.
Asthma: Usually accepted, but may come with exclusions if severe.
Family history of breast cancer: May trigger extra questions, but cover is often still available.
High BMI, cholesterol, or blood pressure: Can mean a loading (higher premiums).
Degenerative eye conditions: More likely to attract exclusions.
Each insurer treats these differently, which is why advice and pre-assessments matter.
Why full disclosure matters
Trying to “hide” a condition is the fastest way to get a claim denied. Insurers cross-check medical records, GP reports, and even Medicare histories. If something doesn’t match up, your claim can be rejected for non-disclosure.
“If you don’t disclose something, that’s when you’ve got problems later. Better to tell them upfront.”
Being upfront doesn’t always mean worse outcomes. In fact, advisers can often direct you to an insurer that’s more flexible with your situation.
Should you still get cover if there’s an exclusion?
This is the big question. If you’ve got an exclusion on something that matters to you, is the policy still worth it?
“We had someone with a back exclusion, and they were like, ‘What’s the point?’ But their risk profile showed accidents and cancer were the main threats — which were covered. So the cover still gave them real protection.”
In other words, even imperfect cover can still protect you from life’s biggest risks.
How younger Aussies can navigate underwriting
For people in their 20s and 30s, this comes down to a few practical steps:
Get pre-assessed — Advisers can ask insurers for an informal opinion before you formally apply.
Compare insurers — Different companies treat conditions differently.
Prioritise major risks — Even if one condition is excluded, you’re usually still protected for the leading causes of claims.
Don’t rely on super alone — Default cover inside super rarely asks health questions, but it’s lower-value and limited in benefits.
The takeaway
Pre-existing conditions don’t shut you out of life insurance. They shape your underwriting outcome — whether that’s a higher premium, an exclusion, or adjusted terms.
The key is understanding the balance between what’s excluded and what’s still covered. For most young Australians, the biggest claim risks — like cancer, accidents, and mental health — are still insurable with the right policy.
“It’s about getting the best outcome, not just the cheapest cover. Every insurer is different.”
Insurance isn’t about perfection. It’s about making sure that when the unexpected happens, you’ve still got a safety net.
Resources
Australian Prudential Regulation Authority (APRA, 2024). Life Insurance Claims and Disputes Statistics.
Financial Services Council (2024). Life Insurance Industry Data.
TAL (2025). Mental health claims insights.
Australian Institute of Health and Welfare (AIHW, 2024). Australia’s Health 2024: Long-term health conditions in young Australians.