Having a pre-existing medical condition doesn't usually mean you can't get life insurance — but it does mean the application process looks different, and the outcome can vary a lot between insurers. Understanding how underwriting works can help you avoid unnecessary rejections and pay a fairer price.
How insurers assess health
When you apply for life insurance, you'll be asked detailed questions about your medical history, lifestyle, family history and sometimes your job or hobbies. For many conditions, the insurer's underwriter will also request a report from your GP or ask you to complete a condition-specific questionnaire covering things like when you were diagnosed, how it's being managed, and any complications.
The underwriter uses this to assess how your condition affects mortality risk compared with someone in average health, then decides whether to offer standard terms, adjusted terms, or decline the application.
The possible outcomes
- Standard terms — the condition is judged not to add meaningful risk, or is well-controlled with no complications.
- A premium loading — you're offered cover but at a higher monthly premium to reflect the increased risk.
- An exclusion — cover is offered but a specific cause of death related to the condition is excluded from the policy, while everything else is covered as normal.
- Postponement — the insurer asks you to reapply after a set period, often used for recent diagnoses or ongoing investigations.
- Decline — the insurer won't offer cover at all, usually reserved for the most serious or highest-risk situations.
Why insurers disagree with each other
Underwriting criteria are set individually by each insurer, based on their own claims data and risk appetite. This means one insurer might decline an application while another offers standard terms for the exact same condition. It's one of the main reasons working with a broker who specialises in medical underwriting, or asking for pre-application "underwriting in principle" checks, can make a real difference to the outcome.
What if you're offered a loading, exclusion or decline?
| Outcome | Options worth exploring |
|---|---|
| Loading | Compare across multiple insurers; ask if the loading reduces over time as the condition stabilises |
| Exclusion | Check exactly what's excluded — often it's narrower than expected; consider whether it's still worth having |
| Decline | Ask a specialist broker about impaired-life or guaranteed-acceptance policies, though these typically cost more or cap the payout |
Common misconceptions
- That any mention of a health condition automatically means a decline — most applications with a manageable condition still result in an offer of cover, sometimes with a loading.
- That you should hide a condition to get a cheaper quote — non-disclosure can lead to a claim being refused entirely, leaving your family with nothing at the point they need the payout most.
- That a decline from one insurer means you're uninsurable everywhere — it often just means that insurer's criteria don't fit your case.
What to do next
Be honest and thorough on any application — disclosure is the one part of this process you have full control over. If you have a known condition, consider approaching a broker experienced in medical underwriting before applying directly, since they can often identify which insurers are more favourable for your specific circumstances without multiple applications appearing on your record.