By Tony Smilevski · Updated 11 October 2026
Key points
- Insurers define a pre-existing condition differently: AIA's PDS ties it to a condition that first occurred before the cover started, was reinstated or was increased, and that you were aware of or a reasonable person could have been expected to be aware of (it also counts a condition whose symptoms would have pointed a reasonable person to it, even if you weren't in fact aware),[1] while Acenda's Protectionfirst PDS ties it to a sickness, disease or physical condition for which symptoms existed, that would cause a reasonable person to seek diagnosis, care or treatment from a medical practitioner, before the start date, reinstatement date or upgrade-guarantee date.[2]
- Zurich's TMD says death cover is subject to its assessment of health, occupation and pastimes, so consumers with pre-existing health conditions may not be eligible for cover, and the outcome of the assessment may affect premiums, the sum insured and the terms, or cover may be declined.[3]
- MetLife's PDS says that after its underwriting assessment it will either accept an application on standard terms or offer amended terms with loadings, exclusions or special terms, and in some circumstances it will decline cover altogether.[4]
- AIA's PDS says the policy will not cover any Pre-existing Condition, except in three listed cases (for example, you disclosed it before cover started and AIA did not limit or exclude cover for it), and the exclusion does not apply to its Complimentary Family Final Expenses benefit.[5]
- NEOS's and Futura's PDSs each say you may apply to have a loading removed if your circumstances change and the reason for the loading no longer applies.[6][7]
The guide does not predict an outcome for any condition.
In the PDSs quoted below, a pre-existing condition is a health condition from before your cover started, and the wording adds tests such as symptoms or what you knew. Insurers assess your health and decide the outcome, so we can't tell you what they will decide for you or for any condition. This guide draws on insurer product disclosure statements (PDSs) and target market determinations (TMDs, which say who a product is designed for).
What is a pre-existing condition?
- AIA's PDS defines it as "a health condition: • that first occurred before the commencement, reinstatement or increase of the relevant cover; and • which you had at the relevant time been aware of, or which a reasonable person in your position could have been expected to have been aware of." It adds that if, before the cover started or was reinstated or increased, you had "suffered symptoms which, to a reasonable person, would have indicated the presence of that health condition or the need to seek medical treatment or investigation that would have revealed the presence of that health condition", it is a Pre-existing Condition "notwithstanding that you were not in fact aware that you had the health condition."[1]
- Acenda's Protectionfirst PDS defines it as "a sickness, disease or physical condition for which symptoms existed, that would cause a reasonable person to seek diagnosis, care or treatment from a Medical Practitioner, before the start date, date of reinstatement or the date an improvement is offered under the upgrade guarantee."[2]
Can I get life insurance with a pre-existing condition?
We can't say, and this page doesn't predict an outcome for any condition. Zurich's TMD for death cover, which is subject to its assessment of health, occupation and pastimes, says "consumers with pre-existing health conditions may not be eligible for cover" and "the outcome of the assessment may impact the premiums, the sum insured and the terms of the insurance policy, or cover may be declined".[3] Outcomes range from standard terms to different terms or a decline; see "What can an insurer decide after assessing my health?" below.
How does underwriting work?
TAL's PDS says underwriting is "how we decide whether we can cover you, and if so on what terms and for what premium". Its questions are about "your health and medical history, occupation, income, lifestyle, pastimes, and current and past insurance".[8] MetLife's PDS adds "family medical history" to what its assessment takes into account.[4] PPS Mutual's life insurance TMD says underwriting may need "a medical report from the life to be insured's treating doctor(s) and/or medical screening tests".[9]
What is my duty when I answer health questions?
You have a legal duty to take reasonable care not to make a misrepresentation. AIA's PDS says: "Before you enter into a life insurance contract, you have a legal duty to take reasonable care not to make a misrepresentation to the insurer before the contract of insurance is entered into." A misrepresentation is "a false answer, an answer that is only partially true, or an answer which does not fairly reflect the truth."[10]
What the insurer can do if the duty isn't met differs by PDS:
- AIA: "Your cover could be avoided (treated as if it never existed), or its terms may be varied. This may also result in a claim being declined or a benefit being reduced."[10] But "Before we exercise any of these remedies, we will explain our reasons and what you can do if you disagree",[10] and "If, after the cover starts, you think you may not have met your duty, please contact us immediately and we'll let you know whether it has any impact on the cover."[5]
- ClearView: it may be able to avoid the cover, "however we will return your premiums", reduce the cover using a set formula, or vary the terms, "For example, we may apply an exclusion to your cover". What it can do depends on factors including whether the misrepresentation was fraudulent or innocent and "in some cases how long it has been since the cover started".[11]
- PPS Mutual: "we may avoid your cover within three years of entering into it", and a reduction of cover "in respect of the death of an insured person can only occur within three years of the cover commencement date". But "if the misrepresentation is fraudulent, we may refuse to pay your claim at any time and we may treat your cover as having never existed".[12]
How the insurers compare
What each insurer's PDS says it can do if the duty to take reasonable care not to make a misrepresentation isn't met:
- Insurer: AIA — What it can do: Treat cover as if it never existed, or vary its terms; decline a claim or reduce a benefit.[10]; Depends on: Before using these remedies it explains its reasons and what you can do if you disagree.[10]
- Insurer: ClearView — What it can do: Avoid the cover but return premiums, reduce it by a set formula, or vary the terms (for example, add an exclusion).[11]; Depends on: Whether the misrepresentation was fraudulent or innocent and, in some cases, how long since cover started.[11]
- Insurer: PPS Mutual — What it can do: Avoid cover within three years; reduce it by formula (for a death, only within three years); vary it, except Life Cover.[12]; Depends on: If fraudulent, it may refuse a claim at any time and treat cover as never existing.[12]
What can an insurer decide after assessing my health?
MetLife's PDS says it "will either accept the application for cover under the standard terms of the Policy or offer amended terms where additional loadings and/or exclusions and/or special terms will apply", and "In some circumstances, we will decline cover altogether." It adds: "We will notify you of any offer of amended terms for you to consider if you would like to proceed."[4] PPS Mutual's TMD lists "an increase in the price of the product, limitations to the sum insured, special terms and conditions applied to cover, or declining cover".[9] Examples:
- A loading. Acenda's PDS defines loadings as "a higher premium that we charge for your insurance based on your individual circumstances, including hazardous occupations or pastimes and pre-existing medical conditions", and says "We will tell you before we apply any loadings."[13] See our life insurance premiums guide.
- An exclusion. Acenda's PDS says "We will tell you before we apply any specific exclusions."[13]
Do some covers exclude pre-existing conditions?
Some do. AIA's PDS says the Policy "will not provide cover in respect of any Pre-existing Condition", except if:[5]
- you disclosed the condition before the cover started, or before it was reinstated or increased, and AIA did not limit or exclude cover for it; or
- you did not disclose it, but AIA would not have declined, limited or excluded the cover, or applied a loading, because of it; or
- when the original cover started, or at the most recent reinstatement or increase, you were not aware of it and a reasonable person in the circumstances could not be expected to have been.
The exclusion does not apply to AIA's Complimentary Family Final Expenses benefit.[5] Acenda's Protectionfirst PDS says: "For any Pre-Existing Condition to be covered under the policy you must have told us about it in your application."[2]
What do PDSs say about mental health, cancer, diabetes and smoking?
The documents we drew on say little that is specific to a condition, and we can't predict how any condition is treated.
- Mental health. For its TPD Support Option (an optional TPD feature), TAL's PDS says: "If we apply a mental health exclusion as a result of our Underwriting assessment, the TPD Support Option will not be available."[14]
- Cancer and diabetes. The documents don't set out how either is assessed. See our trauma insurance guide.
- Smoking and vaping. AIA's PDS defines a non-smoker as "not having smoked tobacco or any other substance for a continuous period of 12 months prior to that point in time".[15] Zurich's PDS says the cost of cover is generally lower if the life insured is a non-smoker who "has not smoked tobacco, e-cigarettes (vaping) or any other substance and has not used a nicotine product in the past 12 months".[16]
Can a loading be reviewed later?
Some PDSs say you can ask. NEOS's and Futura's PDSs each say: "You may apply to have this loading removed if your circumstances change and the reason we applied the loading no longer applies."[6][7]
Why does disclosure matter when I make a claim?
Because the insurer can check your application answers when a claim is made. AIA's PDS says: "there may be circumstances where we later investigate whether the information given to us was true. For example, we may do this when a claim is made."[10] MetLife's PDS says it "may later investigate the answers given in your application, including at the time of a claim".[17] Our life insurance claims guide explains the claim process.
Questions to ask before you choose
- How does the PDS define a pre-existing condition?
- Does the policy exclude pre-existing conditions, and what are the exceptions?
- If a loading, exclusion or lower sum insured is offered, can I see it in writing before cover starts?
- Can a loading be reviewed later, and what would the insurer need?
- What happens if I find an answer was wrong after cover starts?
This guide covers life insurance, not health insurance. Health insurance isn't Tony's area of expertise, but our team can help: we can put you in touch with a trusted partner who specialises in it.
Read the insurer's PDS and TMD before deciding. You can find them in our PDS and TMD library. We deal with 11 Australian life insurers. For general information about anything in this guide, book a time with Tony or call 0433 22 77 11.
Sources
- [1] AIA Priority Protection and Priority Protection for Platform Investors PDS (Aug 2026), PDF page 199.
- [2] Acenda Protectionfirst PDS Combo kit (Sep 2025), PDF page 117.
- [3] Zurich TMD (Nov 2025), PDF page 4.
- [4] MetLife Protect and Combined PDS / Policy Terms (Nov 2025), PDF page 127.
- [5] AIA Priority Protection and Priority Protection for Platform Investors PDS (Aug 2026), PDF page 7.
- [6] NEOS Protection PDS (Dec 2024), PDF page 54.
- [7] Futura Protection PDS (Oct 2025), PDF page 72.
- [8] TAL Accelerated Protection Combined PDS and Policy Document (Dec 2025), PDF page 41.
- [9] PPS TMD Life-Insurance (Sep 2026), PDF page 4.
- [10] AIA Priority Protection and Priority Protection for Platform Investors PDS (Aug 2026), PDF page 6.
- [11] ClearView ClearChoice Combined PDS (Aug 2026), PDF page 29.
- [12] PPS Mutual Professionals Choice PDS (Dec 2024), PDF page 82.
- [13] Acenda Insurance and Acenda Insurance (Super) PDS (Apr 2026), PDF page 125.
- [14] TAL Accelerated Protection Combined PDS and Policy Document (Dec 2025), PDF page 20.
- [15] AIA Priority Protection and Priority Protection for Platform Investors PDS (Aug 2026), PDF page 193.
- [16] Zurich Wealth Protection PDS and policy conditions (Nov 2025), PDF page 197.
- [17] MetLife Protect and Combined PDS / Policy Terms (Nov 2025), PDF page 10.
Just so you know, Tony Insurance operates under Sustainable Life Solutions (AFSL 536966) and can only give general advice about life insurance. That means we'll tell you what you need to know for you to make a good decision, but we can't give you specific advice or recommendations. It also means that everything on our website is only general information and isn't specific to you.
Toni Smilevski, Authorised Representative 343156 of Sustainable Life Solutions Pty Ltd (AFSL 536966)