Pre-existing Medical Conditions

PPI Insurance Policies and Pre-Existing Medical Conditions?

One of the main reasons that companies refused PPI payouts was because of pre-existing conditions, and they often applied very liberal use of the term. In many cases – particularly with back problems – they linked illnesses and injuries to pre-existing conditions, regardless of whether or not this is true.

If you have a PPI policy and pre-existing medical conditions, you will probably not be covered for them. The same applies for any past medical issues. Most PPI policies also will not cover for stress and back problems.

These exclusions should have been made clear to you at the time of taking out the policy. If they weren’t you may be able to claim the PPI premiums back.

The terms and conditions of your PPI policy will state what the insurer classes a pre-existing condition to be, so you need to check this carefully. Insurers are generally quite strict in how they apply their definitions.

When making a claim for PPI, it is possible the insurer will ask to see your medical records, the reason is to rule out a pre-existing medical condition. This could provide the insurer a reason to reject a claim.

Regarding back pain for example, if you’ve had issues with your lower back before but are now experiencing problems with your upper back, your insurer may rule this as a pre-existing condition.

Problems arise when being sold PPI policies as sales people are not medical professionals – they won’t go through your personal medical history. Regardless they must mention the exclusions contained within the policy. If the exclusions were not mentioned, you may be able to make a claim.

However, if it was made clear that a pre-existing condition was not covered, and you still took out the PPI policy, you will not be able to claim compensation.

If by chance your policy does cover pre-existing conditions and you have been free of symptoms for ‘x’ number of years, you still would not be able to claim compensation if this was explained to you.

What is a pre-existing condition?

Pre-existing conditions are any medical conditions that you have received advice about, had symptoms and had treatment for in the past. This will include any consultations, prescribed medication for, had surgery or any form of treatment by the NHS or through private healthcare.

If you’ve had any symptoms of a condition or had treatment for it in the last five years, insurers will consider this to be a pre-existing condition, regardless if the diagnosis was made much earlier. The time factor varies for different providers, some look at the last three years, others look as far back as seven years.

A general rule of thumb is to mention any medical condition that you’ve had serious or not.

Examples of Common Medical Conditions

The list of pre-existing conditions will change from insurer to insurer, so it is imperative that you check to see what information is being asked for. However, the most common conditions asked about are:

• Heart conditions, including heart attack, high blood pressure & angina
• Cancer
• Breathing conditions, including asthma or emphysema
• Joint and bone conditions, including arthritis
• Diabetes
• Gastrointestinal condition (problems with your stomach) – includes Irritable Bowel Syndrome (IBS) & Crohn’s disease
• Psychological issues, including depression or anxiety
• Strokes
• Back pain you needed surgery for

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