Diagnosis timing is not the only test for income cover

The man had taken out income protection cover before receiving a cancer diagnosis. His argument was that elevated prostate-specific antigen readings did not automatically mean he had cancer, and that he only became aware of the disease after further testing. AFCA accepted that the diagnosis had not yet been made when earlier investigations occurred, but found the policy wording did not require a confirmed diagnosis for the exclusion to apply.

That distinction matters because many people think of pre-existing conditions as illnesses already named in a medical file. In practice, insurers and dispute bodies may also look at symptoms, abnormal test results, referrals, recommended procedures, pending investigations and medical advice received before cover began. The question is often not simply whether a person knew the exact diagnosis, but whether there was enough information to recognise an underlying medical issue.

The dispute also highlights the role of policy wording. Some exclusions are drafted broadly, while others are more specific. A policy may refer to illness, injury, symptoms, investigations or advice before the start date. For applicants, that makes the application process more than a formality. Accurate answers about recent tests, referrals and follow-up appointments can be just as important as disclosing an already diagnosed condition.

For workers comparing income protection insurance, the practical lesson is to pay close attention to timing. Taking out cover while waiting on test results or specialist advice can create uncertainty if a later claim relates to the same health issue. This is especially relevant for self-employed people and contractors who may be seeking cover because they have limited sick leave or a more variable income pattern.

The case should not be read as meaning every test or medical check-up will automatically prevent a claim. Outcomes depend on the policy, the medical history, what was known or reasonably knowable at the time, and how the exclusion is written. However, it is a timely reminder that income protection insurance applications are assessed through a detailed combination of medical, occupational and financial information. Keeping records of medical advice, reading exclusions carefully and clarifying unresolved health investigations before changing or starting cover can reduce unpleasant surprises later.