Knee and joint injuries in underwriting

Joint injuries are extremely common on New Zealand applications, particularly among people who have played sport. The underwriting response follows the same logic as a back injury: the event is close to irrelevant for life cover, and directly relevant to the risk of being unable to work.

What separates a narrow outcome from a broad one is the recorded recovery. A single reconstruction some years ago with a documented return to full function and no further treatment usually attracts a narrow exclusion, or occasionally none. Repeated procedures on the same joint, ongoing symptoms, or a pattern across several joints is what produces broader wording.

The questions are specific to the joint and to what happened afterwards.

• Which joint was affected, and how the injury occurred.
• What treatment was given, including any surgery, and when.
• Whether there has been more than one procedure on the same joint.
• Whether full function returned, and whether any symptoms continue.
• Whether any time off work was taken.
• Whether other joints have also been affected.
• Your occupation and whether it is physically demanding.

Evidence commonly requested

• A GP report covering consultations and referrals.
• An orthopaedic or surgical report where a procedure was done.
• Occasionally an ACC claim history.

What underwriters look at over time is a documented return to full function, no further treatment, no recurrence, and stability across the rest of the musculoskeletal record. Where an exclusion has been written broadly and several clear years have followed, a request for narrower wording is reasonable. As always, insurers move on exclusions less readily than on loadings.

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

• Whether the exclusion names the specific joint or covers all joints and musculoskeletal conditions.
• That repeated procedures on one joint widen the likely wording.
• That an injury to one knee does not automatically justify excluding both — ask.
• That manual occupations attract more restrictive terms on income protection.
• That ACC claim history is a record the insurer can ask about.

Every New Zealand insurer writes applications with a joint injury history 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.

• Insurers differ markedly on whether they exclude one joint or a category, and the difference is substantial.
• An adviser can obtain indicative wordings from several insurers before an application is made.
• Supplying the surgical report and evidence of full recovery usually narrows the exclusion offered.
• After a long clear period, an adviser can request that the wording be narrowed or removed.

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.