Applying for cover: medical questions, underwriting and GP reports

When you apply for life insurance, critical illness cover or income protection, the insurer does not simply take your word for what you have said on the form. It assesses the risk you represent, using your application, questions about your lifestyle, your medical history, a doctor's report where needed, and its own historical data and research¹. That assessment is called underwriting, and its outcome decides whether you are offered cover, what you pay, and what the policy excludes.

For most people the process is quick and invisible. A standard life insurance quote involves a set of about ten questions, and many applications are accepted on the answers alone². Where something in your history needs checking, the insurer may ask for a GP report or send a nurse to your home, always with your permission³. The results range from standard terms, meaning the price first quoted, to a higher premium, an exclusion for a specific condition, a postponement while treatment finishes, or in some cases a refusal.

This page explains each stage: the questions you are asked, why full and honest answers matter, when medical reports are requested, and the two underwriting approaches used for health-related cover, full medical and moratorium.

What underwriting is and why every application goes through it

Underwriting is the insurer's process for working out how likely you are to claim, and pricing the policy accordingly. Premiums are based on your age, the medical information you and your doctor provide, and your lifestyle⁷. More broadly, the price depends on your age, health, lifestyle, how much cover you need, the type of policy, your family health history, the term length, your job and any extras⁴. None of that can be guessed from a name and an address, so every application passes through some form of assessment.

The point of the exercise is fairness in both directions. People who represent a lower risk pay less, and people who represent a higher risk pay more or accept exclusions, so that the pool of premiums covers the claims actually made. Without underwriting, every policyholder would pay the same price regardless of health, or insurers would have to refuse anyone with a medical history.

Underwriting normally happens once, when you take out the policy. Income protection is medically underwritten when taken out, and the premiums are then either set and fixed or rise each year by a specified amount⁸. Some term policies work differently: with renewable term life insurance, medical underwriting is bypassed at renewal, but the renewed premium reflects your increased age at that point⁹. Once a policy is in place on standard terms, a later change in your health does not reopen the underwriting, which is why the answers you give at the application stage carry so much weight.

The questions you are asked about your health and lifestyle

A standard life insurance application asks a set of about ten questions. These typically cover your medical history in three time frames: "have you ever" questions about conditions at any point in your life, illnesses diagnosed within the past five years, and any medical treatment in the past 12 months². Alongside health, the questions cover lifestyle, which includes smoking, and insurers also ask about your job and how much cover you want⁴.

Applicants are normally asked about current health, previous health problems, and any major health problems in the family³. Family history matters because some conditions run in families and affect the risk the insurer is pricing. If you have a specific condition, the questions go deeper. Someone applying with diabetes must tell the insurer whether they have type 1 or type 2 diabetes or a rarer form, their HbA1c average blood glucose test results, any hospitalisations or significant developments, changes to their treatment or management, and any complications they have experienced¹⁰. They will also need to give full details of when they were first diagnosed, their wider medical history, and the specifics of their treatment and medication¹¹.

One question people often miss: you must tell each insurer that you have existing life insurance in place¹². Having more than one policy is perfectly legal and fairly common⁷, but the insurer still wants to know about it.

Insurers will also check your answers with your GP⁴, so the form is not the last word. Answering truthfully at this stage is what makes the rest of the process work.

Answer every question fully: what non-disclosure can do to a claim

The duty on you is to take reasonable care to answer honestly and fully. The consequences of not doing so are severe and apply across insurance, not just life cover. With critical illness insurance, you must tell the truth in your application about any pre-existing conditions; if the insurer finds out later that you were not entirely honest, it could void your entire policy¹³. If you lie about your smoking and get a cheaper premium as a result, you will have committed fraud, and if your family later needs to claim, the policy may be declared void and any payout refused¹⁴.

The same principle applies to health conditions of every kind, including mental health, and even to conditions you have recovered from: insurers need to be told about past or current health issues even if you have recovered¹⁵. In travel insurance, it is very likely a claim arising from an undisclosed medical condition will be rejected, leaving you to pay the cost of treatment yourself¹⁶. Surveys suggest the problem is widespread: research has found that millions of customers do not disclose medical conditions, jeopardising their cover¹⁷.

There are limits on how far an insurer can go, and protections if you made an honest mistake. The Financial Ombudsman Service takes a proportionate approach: if the insurer would have covered the condition for an additional premium, it generally considers it fair for the insurer to pay the claim, minus that additional premium¹⁸. The Consumer Insurance (Disclosure and Representations) Act 2012 protects consumers who took reasonable care not to misrepresent, but that protection does not extend to mid-term information disclosures, where an insurer may reject a claim even if the policyholder took reasonable care¹⁹. Elsewhere in general insurance, failure to answer fully may mean the insurer cancels the policy and rejects any claims²⁰.

Many applications are decided straight away

Despite the depth of the questions, most applications never reach a doctor. The about ten questions on a standard application are enough for the insurer to accept many people at the quoted price². Where your answers show nothing that needs clarifying, the policy is issued on standard terms without a GP report or medical examination, and cover can start immediately.

The process is designed to be proportionate. Only where an answer raises a question, a condition needs detail, or the sum insured is large does the insurer move to the next stage of asking your GP for a report or arranging a medical screening²¹. Even then, the insurer will often send a specialist nurse to your home rather than asking you to travel¹⁴.

Most applications are decided on the form alone; only some go on to reports or screening.

The speed of underwriting is separate from the speed of claims. When a claim is eventually made, processing times vary by product: reported average processing times include 20 days for guaranteed over 50s plans²³. The underwriting decision, by contrast, is usually made within days of the application.

What triggers a GP report or medical screening

An insurer moves beyond the application form when it needs more detail to price a risk accurately. Insurance companies may request medical information from your GP or hospital doctor to better understand a condition and accurately price the additional risk³. In unusual circumstances, you may require further medical examinations before a premium can be quoted²¹. A General Practitioners Report, or GPR, is the usual route: with your fully informed consent, the insurer sends your GP or hospital doctor a report form covering your current health, your sickness record, your past health and any predictive genetic test results, and the doctor is required to complete it³.

Common triggers include a condition mentioned on the form that the insurer wants detail on, a large sum insured, or answers that suggest something in your history needs clarifying. Where a medical examination is needed, insurers will often send a specialist nurse to your home for this¹⁴. The insurer may also consult its own Chief Medical Officer or other qualified experts³.

The regulator sets rules about when firms must signpost extra help in travel insurance, and the triggers listed there give a sense of when a medical condition changes what is on offer: where a firm declines or does not offer a quotation due to a medical condition, cancels a policy due to a medical condition, offers a policy with a medical condition exclusion which cannot be removed, offers a policy with a medical condition premium of £100 or more, or offers a policy where the medical condition premium is not known²⁴. The same logic drives protection underwriting: the more a condition changes the risk, the more likely a report or screening becomes.

You give consent before the insurer contacts your GP

The insurer cannot quietly read your medical records. If a GP or hospital doctor report is requested, you will be asked for your fully informed consent, and there may be a question about whether you would like to see a copy of the report before it is sent³. The insurance company will always ask for your permission to contact your GP or hospital doctor³.

You also have rights around the report itself. You are entitled to talk with your GP or hospital doctor before medical reports are sent to the insurance company, and you are entitled to know what information your GP or hospital doctor has provided³. Insurers will also check your answers with your GP as a matter of course⁴, so the report is a verification of what you declared, not a fishing trip through your records.

Consent is not a formality to rush. Seeing the report before it is sent gives you the chance to correct anything that is out of date or wrong, which matters because the report feeds directly into the terms you are offered.

Full medical underwriting: declaring your history up front

Full medical underwriting means you tell the insurer about your medical history when you apply: your health, your lifestyle, and the health of close relations such as parents and siblings²⁵. The insurer assesses all of it before it sets your terms, and you make an honest declaration about these issues, with your GP asked to confirm your medical conditions²¹.

Full medical underwriting is usually needed for income protection insurance, critical illness cover and some private medical insurance²⁵. Individual private health insurance policies commonly use either full medical underwriting or moratorium underwriting⁵, so applicants for those policies often face a genuine choice between the two.

The advantage of declaring everything up front is certainty. You know before the policy starts what is covered and what is excluded, and the terms do not depend on how your health behaves in the next two years. The trade-off is the work involved: a longer application, and a greater chance of a GP report or medical examination before terms are offered. One variant works the other way round: policies obtained through an employer may use "medical history disregarded" underwriting, which generally includes pre-existing conditions, so you can claim on medical conditions you already had before taking out the policy²⁵.

Moratorium underwriting: no questions now, a waiting period later

Moratorium underwriting takes the opposite approach. There are no medical questions when you apply. Instead, any recent conditions, usually those you have had within the last five years, are considered pre-existing and automatically excluded when the policy starts⁵. The exclusion then lasts for a moratorium period, typically two years, during which you must have had no treatment, medication or follow-up for the condition⁵. If a claim is made after that time, the medical condition will be covered, but there need to have been no symptoms or treatment during the moratorium period²⁵.

Some policies exclude a condition initially but start to cover it after a waiting period or moratorium, often of two years, provided there has been no symptoms or treatment²⁶. The mechanics are the same in each case: the clock starts with the policy, and the condition is only picked up if it stays completely quiet.

The exclusion lifts only if the condition stays completely quiet, with no symptoms, treatment, medication or follow-up, for the whole moratorium period.

The attraction is speed and simplicity at application: no long form, no GP report, and cover in force quickly. The risk is uncertainty at claim time. Whether a condition counts as pre-existing, and whether the moratorium has been satisfied, is assessed when you claim, which is the worst moment to discover an exclusion still applies.

Full medical or moratorium: how each treats pre-existing conditions

The two approaches differ most sharply on conditions you already have. Under full medical underwriting, you declare everything up front and the insurer decides immediately: it may cover the condition, exclude it, or price it in. Under moratorium underwriting, all pre-existing conditions from the last five years are excluded for a set period, usually two years, but may then be included after that²⁸. In effect, full medical gives you a decision now that may be less generous, while moratorium gives you a chance at fuller cover later that depends on your health staying stable.

Other products show the same spectrum. Most payment protection insurance policies exclude or limit cover for pre-existing medical conditions entirely, though some cover them later if the consumer stays symptom-free for a defined period²⁹. In private health insurance, treatment for some illnesses, including pre-existing conditions, will likely not be covered by an individual policy³⁰, and when switching provider, some insurers might not cover illnesses or injuries you have experienced recently or any conditions you currently have, even if these are covered by your existing insurer³⁰. Some insurers make exceptions to referral rules for certain conditions, such as muscle or joint conditions, mental health conditions where covered, and cancer symptoms³¹.

Which suits you depends on your circumstances rather than on any general rule. If your recent history is complicated, full medical underwriting gives certainty about what is and is not covered, at the cost of more questions and possibly a report. If your conditions are stable and well in the past, moratorium underwriting may eventually cover them without you having to argue your case at application, but only if they stay quiet for the waiting period.

Acceptance terms: higher premiums and exclusions

Once underwriting is complete, the insurer writes to you with its terms. The best outcome is standard terms: the price first quoted, with no exclusions. Beyond that, the main outcomes are a higher premium, an exclusion for a named condition, postponement until treatment or test results are complete, or refusal of cover.

Higher premiums reflect risk. Any significant pre-existing medical or other health conditions that increase the risk of you dying early will also increase premiums²¹. Insurers may consider someone with a pre-existing condition high risk, which could mean the premium is more expensive, and they may require a medical exam before covering you¹¹. People who have recovered from cancer may be asked to provide detailed medical information and attend a medical examination, and may face higher premiums and restrictions on the maximum sum insured¹⁰. Critical illness cover with pre-existing conditions is likely to be more expensive and may have more extensive exclusions than cover for people without a history of medical issues¹³.

Exclusions vary by policy, and the small print matters. Life insurance policies do not have standard wordings; some have exclusions, or make claiming harder if you develop a terminal illness²¹. Insurers' policy summaries must spell out exclusions and limitations, which can include deferred payment periods, exclusion of certain conditions, diseases or pre-existing medical conditions, moratorium periods, limits on the amounts of cover, limits on the period for which benefits will be paid, restrictions on eligibility to claim such as age, residence or employment status, and excesses³².

Two protections are worth knowing. First, once a policy is in place, the premiums cannot be increased after a later diagnosis such as cancer¹⁴. Second, if the insurer fails, term life insurance and critical illness insurance are covered by the FSCS, with 100% of the claim paid where the firm failed on or after 3 July 2015, and 90% if before³³. On tax, life insurance and most other long term insurance is exempt from Insurance Premium Tax⁶. There is also a standing agreement on genetics: the classes of insurance for which genetic test results may be relevant are life, critical illness and income protection³⁴, covered in more detail on genetic testing and insurance.

If standard terms are not available anywhere, guaranteed acceptance policies exist: specialist, non-medically screened policies that offer guaranteed cover for anyone, but these are often more expensive, with limited term length or total sum insured¹⁴. Over 50s life insurance works this way, being non-medically underwritten, with premiums based only on age, smoking status and level of cover². The trade-off is explained in over 50s life insurance, and the wider options in getting cover with a pre-existing condition.

If you believe an insurer's decision was wrong, or a claim has been rejected over something you declared, you can complain to the insurer and then to the Financial Ombudsman Service, which is free. The ombudsman's approach to non-disclosure, paying a claim minus the additional premium that would have been charged¹⁸, shows that outcomes are not all or nothing. More on the duty to answer honestly is in non-disclosure and claims, and on the wider application process in buying protection insurance.