Story at-a-glance
- A policy exclusion is a clause that removes coverage for certain medical conditions.
- It’s usually added during underwriting when you have a pre-existing issue or higher risk.
- Exclusions allow you to get coverage for everything else—even if one condition is excluded.
- Some exclusions may be reviewed or removed later if your health stabilizes.
What Is a Policy Exclusion?
A policy exclusion is a formal clause in your disability insurance policy that says:
“We’ll cover you—except for this specific condition or area of the body.”
It’s usually tied to a health issue you had before applying, like:
- Back pain
- Knee injuries
- Anxiety or depression
- Migraines
- Surgery or physical therapy
If that condition comes back and causes a disability, your policy won’t pay benefits for that specific issue. But it still protects you for everything else.
Why Would My Policy Have One?
Disability insurance companies want to give you as much coverage as possible—but they also need to manage risk.
If a past condition significantly increases your chances of filing a claim, they may exclude it rather than deny your entire application.
This allows you to get a policy now, even if you’ve had medical history in the past.
You can still:
- Protect your income
- Cover illness or injury that’s unrelated
- Lock in rates while you’re younger
What Kinds of Things Get Excluded?
Common exclusions include:
- Body parts (e.g., left knee, lower back, right shoulder)
- Specific diagnoses (e.g., Crohn’s disease, bipolar disorder)
- Types of conditions (e.g., mental/nervous, spine-related)
These are based on your medical records and application. The underwriters decide what to exclude based on your history.
Can I Get It Removed Later?
Sometimes. Medical exclusion riders are often permanent—but not always.
You may request a review after a few years if:
- The condition hasn’t returned
- You haven’t received treatment or medication
- Your doctor agrees it’s resolved
If the company agrees, they may remove the exclusion so you’re fully covered going forward.
A Real-Life Example
Let’s say you had back pain in residency and saw a chiropractor. When you apply for disability insurance, the company may approve your policy—but add an exclusion for “lumbar spine conditions.”
Later, if you break your leg skiing or develop cancer, your policy still pays in full. The exclusion only applies to back-related claims.
Final Thought
A policy exclusion isn’t a deal-breaker—it’s a way to get strong income protection while working around a known risk. In most cases, it’s far better to have a policy with an exclusion than none at all.
Want to see how your health history might affect your coverage? Click the button below to request a free quote.
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