Insurance after a serious diagnosis

There is a specific and important asymmetry in insurance that matters enormously at this moment. Cover you already own was underwritten on your health at the time you applied. A diagnosis afterwards does not allow the insurer to increase your premium individually, add an exclusion, or cancel the policy. What you hold, you hold. That is the whole value of having bought it beforehand, and it is why the first step is always to find the policies rather than to make any decision about them.

The second point is that a claim may already be available. Trauma cover, sometimes called critical illness cover, generally pays a lump sum on the diagnosis of a listed condition meeting the policy’s definition — it does not require you to be unable to work, and it does not require a poor outcome. Many people hold trauma cover attached to a life policy without remembering it is there. Income protection may also be claimable once a waiting period has passed, and some life policies include a terminal illness benefit that advances part or all of the sum insured in defined circumstances.

The third point is about new cover. Realistically, an insurer will not offer new cover for a condition you have already been diagnosed with. That does not always mean nothing is available — outcomes depend on the condition, the time elapsed, and the insurer, and some applications result in cover with an exclusion for the diagnosed condition rather than a decline. It is worth having someone check rather than assuming either way.

1. 1Gather every policy document you can find, including cover through an employer, a mortgage, or a KiwiSaver provider.
2. 2Do not cancel anything, and make sure premiums keep being paid. A lapse now is irreversible.
3. 3Ask an adviser or the insurer directly whether any benefit is claimable already — trauma, terminal illness, income protection or waiver of premium.
4. 4Check whether a waiver of premium benefit applies, which would keep the policy in force without payments.
5. 5Get the claim requirements in writing early, since medical evidence takes time to assemble.
6. 6Deal with the paperwork side — will, beneficiary nominations, enduring powers of attorney — separately and with a lawyer.

Making a claim

Claims are assessed against the policy’s definition of the condition, not against how serious it feels or what your specialist has said in conversation. That means the wording matters, the medical evidence has to address the specific criteria, and a claim that is declined on a definition can sometimes succeed later if the condition progresses or if further evidence is provided.

You do not have to manage this alone. An adviser can obtain the wording, work out which benefit applies, tell you what evidence the insurer needs and deal with the insurer on your behalf. If a claim is declined and you disagree, the insurer has an internal complaints process and belongs to a free, independent dispute resolution scheme you can escalate to at no cost.

These are the details that decide whether the cover does what you expected. Read them before you compare on price.

• Whether trauma cover you hold pays on diagnosis or requires a further threshold to be met.
• Whether a life policy includes a terminal illness benefit, and the life expectancy it specifies.
• Whether a waiver of premium benefit exists and what it requires to be activated.
• Whether an income protection waiting period has started running from the date you stopped work.
• Whether any employer scheme provides cover that ends when your employment does.
• Whether a trauma buy-back option would let life cover be reinstated after a trauma claim reduces it.

Every New Zealand insurer writes cover after a diagnosis to its own wording, and the words are where the money is. Two policies that look identical on price can pay very differently when it matters. Closing that gap is the entire job of an adviser.

• Reading the wordings and identifying every benefit that may be claimable, including ones you did not know you had.
• Assembling medical evidence that addresses the policy definition rather than describing the condition generally.
• Dealing with the insurer so you are not managing a claims process during treatment.
• Advising honestly on whether any new cover is worth applying for, and telling you when it is not.

There are three ways to buy life cover in New Zealand, and they are not equivalent. You can buy direct from one insurer, which means you see one product range and one underwriting appetite. You can buy through your bank, which usually means a single insurer’s product sold under the bank’s brand, often with narrower definitions. Or you can go through an adviser, who quotes several insurers at once and is required to put your interests first.

The premium you pay is the same either way. Insurers build adviser commission into their pricing whether or not an adviser is involved, so going direct does not get you a discount — it just removes the person whose job is to argue your corner at application and at claim time.

• An adviser can see which insurer is currently taking your health history on standard terms, and which one will load or exclude it.
• An adviser can structure cover across two insurers if that produces a better outcome than putting everything with one.
• An adviser handles the underwriting back-and-forth, and is the person who chases the claim when a family is least able to.
• An adviser has to document why the recommendation suits you, which is a written record you can hold them to.

We are a referral service, not an insurer. We do not quote premiums and we do not sell policies. What we do is put you in front of one licensed New Zealand adviser who can compare the market properly.

1. 1

   You tell us what you are looking at

   The form takes about a minute. Nobody asks for your medical history on a web form — that conversation happens with the adviser, properly, and only once you have decided to proceed.

2. 2

   An adviser calls you

   A licensed New Zealand adviser talks through your situation: who depends on you, what you owe, what you already have in place, and what you are actually worried about.

3. 3

   They compare the market

   The adviser quotes across the major insurers, checks which of them will take your health history on the best terms, and puts the options side by side in writing.

4. 4

   You decide, in your own time

   There is no obligation and no cost to you. If the answer is that you already have enough cover, a good adviser will tell you that.