Expert Guide to Exclusions

When you are going through a life insurance quote request and life insurance comparison, it is important to know generally all deaths (except suicide in the first 13 months) are covered when it comes to insurance products offered by life insurance brokers.

Select Direct Insurance Products may exclude suicide and pre-existing medical conditions for several years from the time of the policy application. In select cases, a life insurance company may put in place an exclusion on your policy.

This life insurance guide will help to answer some of the questions around exclusions, including:

  1. Definition
  2. What are my options?
  3. What if I have an existing exclusion on my policy?
  4. What if I have a pre-existing medical condition?
  5. What do I do if I have had a claim denied due to an exclusion?
  6. Policy reviews
  7. General Exclusions & Case Studies 


An exclusion is something that is unable to be covered under your life, trauma, TPD or income protection policy. If you have one in place, you will never be able to make a claim if your claim is a result of that particular exclusion. However this may be reviewable and it may be able to be removed from your policy after 12 months.

What are my options?

If you have recently applied for a life insurance quote and you have had an exclusion put in place, there are a number of steps you can take:

  1. Ask our specialists to contact other companies we work with to obtain their view on your exclusion.
  2. Find out from our specialists when your policy is reviewable. This may be in 12 or 24 months or at a specific time for example when you return back from a holiday or when you have fully recovered from an injury or sickness.

What if I have an existing exclusion on my policy?

It is important to know this can potentially be in place for the life of the policy. Generally, exclusions are reviewable every 12 months, which allows our specialists to approach insurance partners to find out if your exclusion is reviewable and if it can either be removed from your policy.

What if I have a pre-existing medical condition?

If you are concerned about how this may impact on your application there are a number of steps you need to follow. Once you have undertaken these steps you should ask our specialists about when your pre-existing medical condition may be reviewable and if there is a positive change in your condition, if the exclusion can be removed from your policy.

What do I do if I have had a claim denied due to an exclusion?

If you have recently lodged a claim request which has been denied due to an existing exclusion, it is important to make sure you followed the correct claims procedure outlined on our lodging a claim page. It is also important to speak to our specialists about the declined claim, why it occurred and make sure that it is consistent with the exclusion that is in place.

Policy Reviews

Your exclusions may be reviewable depending on the type of exclusion you have in place. If you would have your exclusion reviewed, please contact us and we can approach your life insurance company to find out if the exclusion is reviewable.

General Exclusions and Case Studies

War & Terrorism:

Case Study:Jill and Alan have recently married and have booked their honeymoon for Bali. Due to their marriage, they decide to take out life and trauma insurance policies to protect them in case of death, terminal illness or a trauma event. As they have already planned and booked their holiday, their insurers place a war & terrorism exclusion on their policy as they are travelling to Bali at a time when the DFAT has a “reconsider your travel warning” in place, due to recent acts of terrorism.

This means that if Jill and Alan were to pass away or become terminally ill due to a war and terrorism activities while in Bali, they would not be covered under their policy. The war & terrorism exclusion generally excludes coverage in countries which have a certain Department of Foreign Affairs and Trade (DFAT) warning. Generally, life insurance companies will exclude claims due to the following:

  • War or hostilities (whether war is declared or not)
  • Civil War, Rebellion, Revolution, Invasion, Insurrection by any military or usurped power, mutiny, civil unrest or riot
  • Participation in any armed forces or peace keeping activities; or
  • Any act of any person or persons acting on their own or on behalf of or in connection with any group or organisation to influence by force, any persons or group, corporation or government by terrorism, kidnapping or attempted kidnapping, attack, assault or any other violent means or acts 

The Spine:

Life Insurance companies may apply exclusion or an extended waiting period for certain back conditions.

Life Insurers will be alerted to a history of ‘back disorder’ by the mention of any condition of or treatment to any part of the back or neck. The insurer will generally ensure that they have sufficient medical information via your Personal Medical Attendance Record (PMAR) and Questionnaire to have an understanding of the past and present state of the condition. Where it is practical and reasonable to do so based on the medical and occupational information the insurance company may be able to limit the exclusion to one of three areas of the spine:

  • Neck or middle back; or
  • Lower = Lumbar Sacral; or
  • Full Back Exclusion 

Case Study:Bill decides to take out a TPD insurance policy as he has recently bought a house and wants to make sure he is able to meet the repayments as well as paying other debts if he becomes totally and permanently disabled and unable to work. While going through the application, in complying with his duty of disclosure.

Bill informs his broker (and his insurance company) that he suffers from a back condition which is the result of a rugby injury, which causes him immense pain. As a result of this disclosure, his insurance company decide that they will exclude all back conditions from his trauma policy. Four years after taking out his policy, on a regular check up with a medical practitioner, he is informed that his back condition has improved and has almost healed. Upon hearing this news, Bill contacts his broker and finds out that his exclusion can be reviewed in two months time on his policy anniversary. In his review, Bill’s insurer requests a Personal Medical Attendance Report from his doctor as well as additional medical information from his doctor, including:

  • The type of condition Bill has
  • Date of diagnosis
  • Cause
  • Recurrence
  • Severity
  • Treatment
  • Co-existing conditions
  • Date of last treatment or symptoms
  • Any time off work

As his doctor agrees that he is symptom and treatment free, his insurer agrees to remove his back exclusion from his policy, allowing Bill to claim for any trauma conditions which are caused by his back.

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Cieran Murphy

I have received nothing but attentive, detailed, consistent advice from Life Insurance Direct. My case officer was patient, professional and successful in securing my claim when I needed it. I would recommend the service and will use them again should I need to in the future.

If you would like more information on exclusions and how to deal with them when applying for life insurance, contact us on 1300 135 205.

Published: June 24, 2013

Ask an Expert?


  • Dean |

    Hey Team,

    What are all the exclusions with a TPD Insurance Policy and when will you see your claims rejected as such?


      Brett Lenertz |

      Thanks for contacting us Dean, with regards to your question around exclusions with TPD Insurance and its impact on claims we will look at TPD Insurance within two areas.

      First of all to be eligible for claim you have to meet the Insurer’s definition within the PDS. TPD Insurance is generally available across various options being Own Occupation, Any Occupation, Home Duties & Modified (Activities of Daily Living) and therefore these categories are defined differently within the PDS and will vary amongst Insurers. Remember, generally speaking to be eligible for a claim on TPD Insurance you have to be disabled continuously for a minimum of three to six months, solely because of the injury or illness. You will have to check with your Insurer in regards to their definition.

      Secondly, it is possible that a TPD policy can have an exclusion based on what a person disclosed during the application to take out a policy. Therefore, the Insurer will issue a TPD Policy but exclude areas in which the policy holder can make a claim for in the future. This would be made apparent on the policy schedule and made aware to the life insured before they choose to accept the cover with the exclusion applied. Sometimes exclusions can be reviewable in the future so it can be worth making contact with the Insurer to discuss the situation later on while they hold the TPD Policy.

      Keep in mind, claims may also be rejected if for example the life insured did not fully disclose their medical history during the Duty of Disclosure and the Life Insurance Company sees discrepancies between their medical file and disclosed health information during the application process.

  • Sr M Langeveld |

    Good day

    I am a 47 year old female. Occupation Registered Nurse. I have updated my life insurance policy with Sanlam lately. I am a insured member with them for 10 years now, never had any exclusions. Now I declared on the telephonic interview that I was treated for neck spasms. So they requested all tests done on my neck. X-ray and MRI. MRI summary shows degenerative changes with involvement on levels C3 to C7 with close nerve root approximation. I do not have any other symptoms but neck spasms when I am working on the computer a lot. Now Sanlam except to update my life insurance with a exclusion of the whole spine. They don’t even have x-rays or anything of the rest of the spine. I am still working and very active. No neurological outfalls in any way currently. What is the criteria used to decide on a exclusion? Can they exclude the whole spine without having any investigations done?

      Mark Anderson |


      Thank you for the detail you have added to your exclusion enquiry.

      All though I don’t know the specific policy you have with Sanlam, I can give you a general idea of how back and neck conditions are typically treated by life insurers.

      If the underlying back/neck condition is deemed structural then typically the insurer will place an exclusion on the policy. These exclusions are usually just on the affected area. For example, the back/spine is typically divided into 3 sections Cervical (neck or upper), Thoracic (middle) and Lumbar Sacral (lower). In your circumstances outlined above, the exclusion could be expected on the cervical area of the spine. A full spine exclusion could be seen as a little excessive.

      However, the individual insurer is actually able to make their own decision on the extent of any exclusion. Obviously, you do not have to accept the decision of the insurer, but this may mean you will need to find a different insurance provider for your policy.

  • Bert |

    Hi there. I was wondering how insurers would or should treat a condition like Crohn’s disease? I’ve been given an exclusion for Crohn’s disease when I applied for income protection.

    While Crohn’s can never be cured, I have been in remission and symptom-free for several years. I still take medication to manage my condition, but it doesn’t impact on my life at all. Shouldn’t that count for something?

      Anneke |

      Hi Bert.
      It’s important to remember that each insurer has different underwriting guidelines. While one company might issue an exclusion for Crohn’s disease, another might provide cover at standard rates or request that you pay a little more for the cover.

      Their decision will be based on your unique medical history, so it might be beneficial for you to speak with a specialist who has access to a large panel of insurers. You can also ask them to do a pre-assessment for you to see whether they can get Chron’s covered in your policy.

      Give us a call on 1300 135 205 and a specialist will assist you.