Can you get income protection with a pre-existing condition?

Insurance companies provide financial protection against risk. Their underwriting process involves assessing the likelihood of that risk becoming reality. It is why your motor insurance costs more if you park on the street instead of in a garage, and why pet insurance is cheaper for puppies and kittens than for ten-year-old dogs and cats.

The same principle applies to protection insurance. Income protection replaces part of your earnings if illness or injury stops you working. The starting point for income protection is that the applicant is in work and currently fit and well. There is always a chance that someone who is perfectly healthy on the day they apply becomes unwell shortly afterwards, and that is precisely the risk the insurer is paid to carry.

A pre-existing condition changes the picture, because the insurer would be covering something that has already happened rather than something that might. So does income protection cover pre-existing conditions, and if so, how?

What counts as a pre-existing condition?

The Financial Ombudsman Service defines a pre-existing medical condition simply as "an illness or injury you had before your policy began or was renewed", giving diabetes, asthma, high cholesterol and long-term back conditions as examples.

The Ombudsman also draws a distinction that matters a great deal:

• Individually underwritten policies. The insurer asks health questions, then tells you what is and is not covered. Most individual income protection sold in the UK works this way.
• Non-underwritten policies. No medical screening takes place, and the policy applies a blanket exclusion for anything caused by or related to a pre-existing condition.

If nobody asked you any health questions when you bought a policy, that is a strong signal you are in the second category, and it is worth checking exactly what you have bought.

What the law actually requires you to disclose

This is the part most articles get wrong, and it matters because it changes what you need to do.

The duty is to answer questions carefully, not to volunteer everything

Under the Consumer Insurance (Disclosure and Representations) Act 2012, consumers no longer have a general duty to volunteer anything an insurer might conceivably find relevant. The duty is narrower and clearer: you must take reasonable care not to make a misrepresentation.

In practice that means answering the questions the insurer actually asks, fully, honestly and accurately. If an application asks whether you have received treatment or advice for a back problem in the last five years, answer that question properly. You are not expected to guess at what else might matter.

The Financial Ombudsman assesses this against "the standard of care of a reasonable customer", taking into account how clear the questions were and what information you were given.

What happens if you get it wrong

The consequences depend on why the answer was wrong, and the difference is stark.

• Careless misrepresentation. The insurer can do what it would have done had it known the truth. That might mean charging the extra premium and paying a reduced proportion of the claim, applying the terms it would have applied, or cancelling the policy and refunding premiums.
• Deliberate or reckless misrepresentation. The insurer can void the policy, keep the premiums and refuse the claim outright.

The practical lesson is the same one every insurer's own guidance repeats: it is better to tell them too much than too little. Vague answers cause delays and further questions. Inaccurate ones can cost your family a claim at the worst possible moment.

Personal exclusions and general exclusions are different things

It is worth separating two ideas that often get muddled.

• A personal exclusion (sometimes called a medical exclusion) is added to your policy specifically because of your own history. It prevents a claim where the excluded condition is wholly or partly the cause of you being unable to work.
• A general exclusion applies to everyone who holds that policy, regardless of health. These usually cover things like hazardous occupations, dangerous pursuits, war and self-inflicted injury.

The outcomes an underwriter can reach

Disclosing a condition does not mean automatic rejection, and it does not usually mean an exclusion either. UK protection underwriters typically choose between the following.

Standard terms

The condition is disclosed and the policy is issued at ordinary rates with nothing added. This happens far more often than most people expect, particularly for well-controlled conditions.

A premium loading

The insurer accepts the risk but charges more for it. Loadings are expressed as a percentage of the standard premium, so a rating of +50% means you pay 150% of the standard price rather than receiving 50% less cover.

A personal exclusion

The insurer offers cover at standard rates but will not pay a claim arising from the stated condition. For income protection this is common for musculoskeletal and mental health histories.

A postponement

The application is deferred for a set period, typically because a condition is too recent, a diagnosis is too new, or you are waiting for test results. Applying again once the period has passed is normal and expected.

Unable to offer terms

For some conditions the risk is outside what the insurer will take on. This varies enormously between insurers, which is the single most important thing to understand if you have been declined once.

Exclusions are not always permanent

Many UK insurers will add a review date to an exclusion, often one to three years after the policy starts. If the condition has not recurred in that window, you can ask for the exclusion to be reconsidered. Some exclusions have an explicit trigger for removal: an exclusion applied after an abnormal cervical smear, for example, is commonly lifted once a subsequent normal smear result comes through.

If an exclusion is applied, ask two questions before you accept: is there a review date, and what specifically would need to happen for it to be removed?

A note on moratorium underwriting. Some articles describe a "moratorium" as a standard income protection outcome, where an exclusion falls away after a symptom-free period of several years. Moratorium underwriting is genuinely common in private medical insurance, but individual income protection in the UK is normally fully medically underwritten instead. Reviewable exclusions, described above, are the mechanism you are much more likely to encounter.

Common conditions and how insurers tend to treat them

There is no single industry list of excluded conditions. Every insurer publishes its own underwriting guidance, and the differences between them are large enough that being declined by one insurer tells you very little about what a second would say.

The summaries below describe general patterns across the UK market rather than any one insurer's rules. Each is a candidate for a fuller standalone guide.

Back pain and musculoskeletal conditions

Back pain is one of the leading causes of disability, which makes it one of the most significant disclosures for income protection specifically. A single episode a long time ago in a desk-based role may attract nothing at all. Recurrent episodes, recent symptoms, or more than a week or two off work in the last couple of years commonly lead to a spine or musculoskeletal exclusion. Manual occupations are assessed more cautiously than sedentary ones.

Insurers typically want to know: time off work, time since last symptoms, how many episodes and over what period, whether your job is manual or sedentary, and whether an underlying cause was ever identified.

Anxiety, depression and stress

Mental health conditions are among the most frequent disclosures and a leading cause of income protection claims, so they are assessed carefully. A single short-lived episode, particularly one connected to a specific life event such as bereavement, may well attract standard terms or a temporary exclusion. Recurrent episodes, psychiatric referral, inpatient treatment, significant time off work, or a history of self-harm or suicide attempts push towards exclusion, postponement or decline.

Longer deferred periods can help here. Some insurers can offer better mental health terms on a 13-week or longer deferred period than on a short one.

Insurers typically want to know: the diagnosis, when symptoms started and last occurred, treatment received including counselling or CBT, time off work, and how frequent and severe symptoms are.

Asthma

Contrary to a widespread assumption, asthma is usually not excluded. Mild, well-controlled asthma managed with inhalers is commonly accepted at standard rates. Terms worsen with frequency of symptoms, use of steroid tablets, and hospital admissions. Smoking makes a material difference, and a smoker with asthma should expect a loading at minimum.

Insurers typically want to know: how often you need a reliever inhaler, what else you are prescribed, any hospital admissions in the last five years, and time off work.

Diabetes

Diabetes is the condition where insurers diverge most sharply. Some UK insurers will not offer income protection to anyone with diabetes at all. Others will consider type 2 while declining type 1. Others again will offer cover with a diabetes exclusion, provided control is good and there are no complications.

Where terms are available, they usually hinge on your most recent HbA1c reading, how long ago you were diagnosed, whether you attend regular reviews, and whether there are complications affecting eyes, kidneys, nerves or circulation. Gestational diabetes that has fully resolved is generally treated much more favourably.

If you have diabetes and want income protection, using an adviser who can place the case with the right insurer is not a luxury. It is close to essential.

Insurers typically want to know: type, date of diagnosis, most recent HbA1c, date of last diabetic review, and any complications.

High blood pressure

Another condition that is commonly assumed to be a problem and usually is not. Where blood pressure is well controlled, you comply with treatment, you attend follow-ups and there are no complications or other risk factors, standard terms are the normal outcome across the UK market.

Ratings appear when readings are high and uncontrolled, or when high blood pressure sits alongside other risk factors such as smoking, raised cholesterol, a high BMI or diabetes. Risk factors combine, so the total loading can be more than the sum of the parts.

Insurers typically want to know: your most recent readings, your treatment, and whether there are complications or other cardiovascular risk factors.

Raised cholesterol

Treated as very similar to blood pressure. Controlled cholesterol, usually with a statin, is normally accepted at standard rates. Uncontrolled levels are rated according to the most recent reading.

Familial hypercholesterolaemia, the inherited form, is assessed differently and much more cautiously.

Insurers typically want to know: date of diagnosis, date and result of your last cholesterol test, treatment, and other risk factors.

Epilepsy

Epilepsy is one condition where an exclusion genuinely is the common outcome for income protection. Terms depend heavily on seizure type, how long since your last seizure, and your occupation. Where driving is an essential part of your job, an exclusion is very likely to be applied regardless of how well controlled the condition is.

Time matters a great deal here. Terms improve significantly as the interval since the last seizure lengthens.

Insurers typically want to know: seizure type, frequency, date of last seizure, medication, and whether driving is essential to your work.

Crohn's disease, ulcerative colitis and rheumatoid arthritis

These inflammatory and autoimmune conditions are among the harder disclosures for income protection.

Rheumatoid arthritis is declined for income protection by a number of UK insurers. Crohn's and ulcerative colitis are more often considered, though a recent major flare-up will usually mean an exclusion or a postponement, and severe cases may not be offered terms.

Treatment matters as much as diagnosis. Several insurers decline applications where biologic drugs are being taken. Osteoarthritis is treated far more leniently than rheumatoid arthritis, and typically results in the affected joints being excluded rather than a decline.

Insurers typically want to know: which joints or areas are affected, all medication, time off work, severity and frequency of flare-ups, and any restrictions on daily activities.

A history of cancer

Cancer is rarely a permanent barrier, but timing is everything. Insurers will not usually offer terms until initial treatment has finished successfully, and many apply a further postponement period on top of that, which can run to several years for some cancers.

Once terms become available, the rating depends on the type and site of the cancer, the staging or grading, how long ago treatment finished and whether there has been any spread. Because loadings improve as time passes, someone declined or heavily rated shortly after treatment may get materially better terms by reapplying a few years later.

Insurers typically want to know: type and site, staging or grading (the TNM classification if you have it), when treatment finished, and whether there was any spread.

Heart conditions

A history of heart attack or angina is one of the more common reasons income protection is declined outright rather than excluded, at several UK insurers. Where cover is considered, the assessment turns on your age at the time of the event, how long ago it was, how many vessels were involved, and whether there are other risk factors such as diabetes or smoking.

Life cover is often still available where income protection is not, which is worth knowing if protecting your family is the underlying goal.

Insurers typically want to know: dates, any ongoing chest pain, treatment including stenting or bypass surgery, and whether there has been more than one event.

Multiple sclerosis and other neurological conditions

Multiple sclerosis, motor neurone disease, Parkinson's disease, Huntington's disease and dementia are declined for income protection across most of the UK market. Life cover may still be available depending on type and severity, and for MS in particular terms vary with the form of the condition, time since last relapse and the extent of any disability.

A family history of these conditions is an entirely different matter from having one, and often results in nothing more than an exclusion or a modest rating, depending on how many relatives were affected and at what age.

Underactive thyroid

Usually straightforward. A recent diagnosis may be postponed for a few months. Once you are asymptomatic, thyroid function tests are normal and there has been no recent time off work, standard terms are the usual outcome. Ongoing symptoms or abnormal test results lead to an exclusion or a postponement.

Weight and BMI

BMI is assessed on its own and alongside everything else. Broadly, a BMI in the healthy to moderately overweight range attracts no loading. Loadings begin somewhere in the low thirties, increase steadily, and most insurers stop offering cover somewhere between BMI 40 and the mid forties. Very low BMI is also assessed, and can result in a referral or a decline.

Age changes the picture: a given BMI often attracts a smaller loading at 50 than at 25, because the underwriting concern is the number of years of exposure ahead.

Smoking, alcohol and recreational drugs

The original version of this guide called this a grey area. It is not, really. These are well-defined rating factors.

• Smoking determines whether you pay smoker or non-smoker rates. Definitions vary but generally cover cigarettes, cigars, pipe tobacco, chewing tobacco and nicotine replacement products including vapes, usually within the last twelve months. Heavy consumption can add a loading on top of smoker rates, and insurers use cotinine testing to verify declared non-smokers. Where a condition is aggravated by smoking, such as asthma or heart disease, the combination is treated much more seriously than either factor alone.
• Alcohol at moderate social levels does not affect premiums. Drinking above the recommended limits may lead to a loading or a request for a liver function test. A history of dependence generally requires a substantial period of complete abstinence, and periods of several years are common.
• Recreational drugs normally trigger a postponement running from the date of last use, with the length depending on the substance. Cannabis is treated more leniently than other drugs. A combination of drug and alcohol misuse is likely to mean no cover.

What the underwriting process involves

The application

Applying is much the same as a standard application. You will be asked about your age, occupation, height and weight, current and past medical history, family history, hobbies, and smoking, alcohol and drug use. Roughly half to eight in ten applicants receive an immediate decision, depending on the insurer, because modern applications use dynamic questioning that only asks what is relevant to your answers.

When further medical evidence is needed

If the application cannot be assessed on its own, insurers draw on:

• A GP report, compiled from your medical records with your consent under the Access to Medical Reports Act
• A nurse screening or mini-screening, a short home visit recording height, weight, blood pressure and a urine sample
• A nurse tele-interview, a phone call to clarify a disclosure, often around ten minutes
• A full medical examination, carried out by an independent examiner
• Specific tests, such as blood tests, a cotinine test or an exercise ECG

Insurers also apply automatic medical limits, meaning evidence is requested purely because of your age and the benefit amount, regardless of your health. Younger applicants and smaller benefit amounts frequently need nothing at all.

How to get the best outcome

If the terms you are offered are not what you hoped for, you have more options than simply accepting or walking away.

Adjust the deferred period

The deferred period, sometimes called the waiting period, is the time between becoming unable to work and your first benefit payment. Common options are 4, 13, 26 and 52 weeks. Extending it reduces your premium, and for some conditions, notably mental health, a longer deferred period can also unlock better terms.

Set it against your actual position. Statutory Sick Pay is currently £123.25 a week for up to 28 weeks, and many employers pay nothing beyond that, so check your contractual sick pay before choosing.

Adjust the benefit period

The benefit period caps how long a single claim can be paid. Short-term policies typically pay for one, two or five years; full-term policies pay until you can return to work or reach the end of the policy, whichever comes first. Choosing a shorter benefit period reduces the premium.

Agree to fuller medical evidence

Where the application alone is not enough, an underwriter has to price cautiously. Agreeing to a GP report, a nurse screening or a medical examination gives them the detail to price accurately, and for a well-controlled condition that often produces better terms than the initial indication.

Reduce the benefit amount

Income protection pays a proportion of your earnings rather than all of them, typically between 50% and 65% of gross income, or as Citizens Advice puts it, "about a half to two-thirds of your earnings before tax". The benefit is normally paid tax free. Taking a lower benefit reduces the premium and may also keep you below the automatic medical evidence limits.

Use a specialist adviser

Because insurers assess the same condition so differently, a protection adviser who knows which insurer takes which view is genuinely valuable for a non-standard case. Ask how they are paid, whether by commission or a fee, and how much of the market they cover.

Group income protection

If you are employed and your employer does not run a group income protection scheme, it is worth suggesting. Group schemes typically underwrite the workforce as a whole rather than each individual, which means many employees are covered without individual medical questions up to a set benefit level. Cover can be more basic than a personal policy, but for someone with a difficult medical history it may be the most accessible route to any cover at all.

Worried that your health might disqualify you?

Having a pre-existing condition does not automatically mean you cannot get cover.

If you cannot get income protection

If you have genuinely exhausted the market, other kinds of cover do different jobs but may still be worth holding.

Critical illness cover

Critical illness cover pays a tax-free lump sum on diagnosis of a condition named in the policy. Under the Association of British Insurers' minimum standards, all policies must cover cancer, heart attack and stroke, and most insurers add a longer list that commonly includes multiple sclerosis, Parkinson's disease, kidney failure, major organ transplant and loss of limbs.

One important correction to a claim that circulates widely: critical illness cover does not cover mental illness. Psychiatric conditions are not critical illness conditions under ABI minimum standards, and depression, anxiety and stress will not trigger a critical illness claim. If mental health is your concern, income protection, not critical illness cover, is the product that responds to it.

Note also that critical illness is underwritten too, so a pre-existing condition will usually be excluded here as well.

Accident-only cover

If illness cover is unavailable because of your medical history, accident-only cover pays out where you are unable to work because of an accidental injury. Because it does not cover illness at all, it involves little or no medical underwriting.

Be clear-eyed about the trade-off. The large majority of income protection claims arise from illness rather than accident, so accident-only cover is a considerably narrower product. Exclusions for dangerous occupations and pursuits still apply.

Life insurance

Life insurance does nothing for you while you are alive, but it protects the people who depend on your income if you die. It is also frequently available when income protection is not: several conditions that lead to an automatic income protection decline, including heart attack history, stroke and multiple sclerosis, can still be offered life cover at a rating.

Sources

• Consumer Insurance (Disclosure and Representations) Act 2012, legislation.gov.uk
• Financial Ombudsman Service, "Pre-existing medical conditions"
• Financial Ombudsman Service, "Misrepresentation and non-disclosure"
• MoneyHelper, "What is income protection insurance?"
• Citizens Advice, "Income protection insurance"
• Association of British Insurers, "Critical Illness Cover: what you need to know"
• GOV.UK, "Statutory Sick Pay: what you'll get"
• Underwriting guidance published by UK protection insurers, including Aviva, Royal London, The Exeter and Cirencester Friendly

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This guide is for general information and is not financial or medical advice. Underwriting outcomes vary between insurers and are assessed individually, so nothing here is a guarantee of the terms you would be offered. Product features, availability and definitions vary by insurer and policy. Always read the policy documents and consider speaking to a regulated protection adviser before you buy.