Can You Get Disability Insurance With a Pre-Existing Condition in Canada?

You may be able to get disability insurance with a pre-existing condition in Canada. Having an existing medical condition does not automatically disqualify you from coverage with leading Canadian insurers. However, your medical history can affect whether an insurer approves your application, what coverage it offers, which conditions are excluded, and the premium you pay.

Can you get disability insurance in Canada with a pre-existing condition?

Yes, you can get disability insurance in Canada with a pre-existing condition. However, the insurer may approve the policy as applied for, modify the coverage, exclude a condition, charge an extra premium, or decline the application depending on its underwriting assessment. The outcome depends on the insurer’s assessment of your medical history, current health, treatment, occupation, income, requested coverage, and the likelihood that the condition could affect your ability to work. Different insurers may assess the same medical history differently.

It is also worth noting that a pre-existing condition can affect a future disability claim, especially in group disability claims. Some LTD plans may not cover a disability linked to a pre-existing condition if the disability starts within a period after your coverage begins. Coverage may only apply once you have been insured under the plan for a specified duration.

Here’s a glance at how pre-existing conditions may affect your disability insurance policy in Canada:

What is a pre-existing condition in disability insurance? 

In disability insurance, a pre-existing condition generally refers to an illness, injury, or medical condition that existed before your disability insurance coverage came into force. Depending on the policy, this may include conditions for which you experienced symptoms, sought medical advice, received treatment, or took prescription medication during a specified period before coverage started.

An insurer may treat any of the following as evidence of a pre-existing condition:

• Previous illnesses or injuries
• Symptoms experienced before coverage
• Medical consultations
• Treatment received before coverage
• Prescription medication or a change in medication or dosage 
• Advice to seek treatment that was not followed 

However, this depends on the specific policy terms and may specify how far back the insurer reviews medical history and how long the restriction applies after coverage begins. These periods and conditions vary by policy. Some provisions focus on treatment or consultation, while others may include symptoms or prescribed medication.

Can an undiagnosed condition count as pre-existing? 

Yes, it may count. A condition does not necessarily need to be formally diagnosed to fall under a disability policy’s pre-existing-condition definition. Some insurers, like RBC, consider an undiagnosed condition within the parameters of a pre-existing condition. This may affect whether benefits are payable if the disability is linked directly or indirectly to that condition.

Here are some of the parameters which can be considered a pre-existing condition:

• You incurred health-related expenses on the advice of a physician or other health-care practitioner.
• You took prescribed medication for the condition or symptoms.
• You consulted a physician or other health-care practitioner about the condition or symptoms.
• You received health-related care, advice, or treatment from a physician or other health-care practitioner.
• A reasonably prudent person would have sought medical advice for the condition or symptoms, even if you did not actually see a doctor

Does taking medication count as treatment for a pre-existing condition?

Some policies may include taking prescription medication as treatment for a pre-existing condition. Based on the policy terms, insurers may evaluate whether you have:

• Started or stopped taking a prescribed medication
• Refilled an existing prescription
• Changed medication dosage
• Why the medication was prescribed and whether it relates to the condition involved in your claim

What is a pre-existing condition clause and elimination period?

A pre-existing condition clause is a period during which the insurer does not cover disabilities that result from a condition that existed before the policy became effective pre-existing. Similar to a look-back period in life insurance policies, it defines how far back in the applicant’s medical history the insurer will look to exclude coverage for certain conditions.

Meanwhile, an elimination period is simply the waiting period after disability begins before monthly benefits become payable. Claims related to that condition during the elimination period may be denied, or the insurer may restrict claims connected with that condition for a period after coverage begins. 

These two terms are crucial in understanding how your disability insurance policy treats your pre-existing condition and what it considers a qualifying condition.

How does a pre-existing condition affect disability insurance? 

A pre-existing condition can affect both your eligibility when you apply for coverage and whether a future claim is covered. During the application process, insurers may evaluate your medical history to determine the coverage they can offer. Additionally, they might request medical information when reviewing a disability claim to check whether the condition falls under any applicable exclusions or limitations.

Here’s how a pre-existing condition may affect your policy at each stage:

During the application: While you apply for coverage under an underwritten plan, insurers may review your medical information and decide:

• Whether to approve the application.
• Whether to exclude a pre-existing condition or related conditions.
• Whether to charge a higher premium
• Whether to modify the benefit amount, elimination period, or benefit period.
• Whether to request additional medical evidence.
• Whether to postpone or decline the application.

During a disability claim: During a disability insurance claim, the insurer may investigate whether:

• The condition or symptoms existed during the policy’s pre-existing clause
• The current disability is related to that condition.
• The disability began during the post-issue exclusion period.
• The claim meets the policy’s definition of disability.
• The required medical and functional evidence has been provided.