Does Life Insurance Require a Medical Exam in Australia?

No, applying for life insurance in Australia does not automatically mean you will need a medical examination.

Most applications begin with an underwriting assessment based on the information you provide. This usually includes questions about your health, medical history, occupation, lifestyle and the amount of cover you are applying for.

If the insurer has enough information to assess your application, it may be able to make a decision without asking you to complete any medical tests. However, certain health disclosures, your age or a higher sum insured can result in the insurer requesting additional medical evidence.

That evidence might involve a report from your doctor, blood tests or, in some cases, a medical examination. Being asked for further information does not necessarily mean your application will be declined. It generally means the underwriter needs more evidence before deciding whether cover can be offered and on what terms.

If you are considering cover, you can compare life insurance options and begin by reviewing the premiums and general product features available.

When you apply for individually underwritten life insurance, the insurer assesses the risk of covering you. This process is known as underwriting.

You may be asked about:

• Your age, height and weight
• Current and previous medical conditions
• Medications and treatments
• Recent symptoms, tests or referrals
• Your family medical history
• Smoking and alcohol consumption
• Your occupation and work duties
• Dangerous sports or recreational activities
• Overseas travel or residency
• Existing insurance and the amount of cover requested

An application can sometimes be assessed from your answers alone. This is what I generally describe as an “underwriting assessment of the application only”.

If something in the application requires clarification, the insurer may ask additional questions or request medical evidence before reaching a decision.

There is no single rule applying to every insurer or applicant. Medical requirements differ between insurers, products and underwriting guidelines.

However, there are several common reasons why further medical evidence may be requested.

1. You disclose a medical condition

A current or previous medical condition can lead to further questions. The insurer may want to understand:

• When the condition began
• How severe it has been
• What treatment you received
• Whether the condition is stable
• Whether you are still experiencing symptoms
• Whether follow-up tests or treatment are required

A well-documented and stable condition may sometimes be assessed using information already available from your doctor. In other cases, the insurer may request an examination or additional tests.

The existence of a medical condition does not automatically prevent you from obtaining life insurance. The nature, severity, treatment and current status of the condition will all influence the underwriting assessment.

2. You have unexplained or untreated symptoms

An insurer may need more information if you disclose symptoms that have not been investigated or a condition for which recommended treatment has not been completed.

For example, an application may be more difficult to assess if you are:

• Waiting for test results
• Awaiting a specialist appointment
• Experiencing ongoing symptoms without a diagnosis
• Due to undergo surgery
• Not following a recommended treatment plan

In some circumstances, the insurer may request medical evidence. In others, it may postpone making a final decision until the investigation or treatment is complete.

3. You apply for a higher sum insured

The amount of cover requested can affect the evidence required.

An insurer may be willing to assess a younger applicant seeking a moderate level of cover from the application alone. The same insurer may require medical tests when the sum insured is substantially higher, even where no significant health condition has been disclosed.

These limits vary between insurers and can change over time. They may also differ between life, TPD, trauma and income protection insurance.

4. Your age triggers additional requirements

Age is another common underwriting factor. As applicants get older, insurers may be more likely to request additional medical information, particularly when higher levels of cover are involved.

Age alone does not mean a medical examination will be required. It usually operates together with factors such as the amount and type of cover, medical history and the insurer’s underwriting limits.

5. Your answers need clarification

Sometimes further evidence is requested because the application does not provide enough detail.

An underwriter may want clarification about a previous test, recurring injury, prescription, mental health consultation or period away from work. The additional requirement could be a short questionnaire rather than a complete medical examination.

Providing clear and accurate information at the beginning can reduce unnecessary follow-up, although it cannot guarantee that further evidence will not be required.

 A “medical assessment” does not always mean attending a clinic for a comprehensive physical examination. The insurer may request one or more forms of evidence. 

The insurer will normally explain what is required and how it will be arranged. The exact process will depend on the insurer and policy involved. 

After more than a decade working in life insurance and financial planning, my experience is that most applications do not start with a medical examination. They start with the application itself.

Certain disclosures can trigger medical reports or assessments. Age and the sum insured can also affect what is required, the older the applicant and the higher the amount of cover, the greater the likelihood that additional evidence may be requested.

The practical point is not to assume that applying means immediately booking a medical. Complete the application carefully and allow the insurer to determine whether anything further is needed.

No. A request for medical information is part of the insurer’s risk-assessment process and should not be treated as a decision about your application.

Once the insurer has reviewed the available evidence, possible outcomes may include:

• Cover offered at standard premium rates
• Cover offered with a higher premium, known as a loading
• Cover offered with an exclusion, depending on the policy type
• A decision postponed until more information is available
• A reduced amount or different terms being offered
• The application being declined

The result depends on the complete underwriting assessment. Two insurers may also assess the same medical history differently because their underwriting guidelines and risk tolerances can vary.

This is one reason comparing options can be useful. It is not simply a matter of locating the lowest initial quote; it is also important to understand whether an insurer is prepared to offer cover and the terms attached to it.

You can read How to Compare Life Insurance in Australia for other factors worth reviewing.

Yes, life insurance may be available without a medical exam. Some individually underwritten applications can be approved based on the application answers alone. Default insurance through superannuation may also be provided without individual medical checks, subject to eligibility rules, exclusions and the fund’s policy terms.

However, “no medical exam” does not always mean “no health questions”. An application may still ask detailed questions about your medical history and lifestyle.

Some products promoted as easy or no-exam cover may have different:

• Eligibility requirements
• Maximum cover amounts
• Exclusions
• Policy definitions
• Premium structures
• Underwriting or claim-assessment processes

The absence of a medical examination should therefore not be the only factor considered when comparing policies.

No. Answer the questions the insurer asks carefully, accurately and completely.

For consumer insurance contracts, applicants have a duty to take reasonable care not to make a misrepresentation. That means it is important to respond honestly to the specific questions asked rather than leaving out information because you are concerned it could result in further tests or affect the outcome.

Failing to answer accurately can create serious problems later, including when a claim is assessed.

If you are unsure what a question means, seek clarification before answering. Do not guess at dates, diagnoses or treatment details if you can reasonably confirm them first.

Before beginning an application, it may help to have the following information available:

• The names of any medications you use
• Approximate dates of diagnoses, symptoms and treatment
• Contact details for your usual doctor
• Details of specialists you have consulted
• Dates and outcomes of significant tests
• Information about past injuries or time away from work
• Details of any pending investigations or appointments
• Your existing insurance and the amount of new cover requested

You do not ordinarily need to obtain your own medical tests before applying unless an insurer specifically asks for them. The first step is generally to complete the application and respond to any subsequent requirements.

A medical examination is not automatically required when applying for life insurance in Australia. Most applications start with questions and an underwriting assessment, with further evidence requested only where the insurer considers it necessary.

Your age, health disclosures, pending investigations and the amount of cover can all influence the process.

JIC Insurance can help you compare general life insurance options from leading Australian insurers and understand the application process. We provide general advice and do not assess whether a particular policy is appropriate for your personal circumstances.

Compare life insurance options through JIC Insurance.

If you require personal advice about how much cover to hold, policy ownership, superannuation or how insurance fits into your broader financial plan, you can speak with a JIC financial adviser.

Is a blood test always required for life insurance?

No. Many applications can be assessed without blood tests. A test may be requested because of your age, medical history, amount of cover or the insurer’s underwriting requirements.

Who arranges the medical examination?

Where an insurer requires an examination or test, it will generally explain the process and how the appointment will be arranged. Procedures can vary, so confirm the details with the insurer or insurance representative.

Can I be declined because of a pre-existing condition?

A pre-existing condition does not automatically result in a declined application. Depending on the condition and policy, an insurer may offer standard terms, apply a loading or exclusion, postpone its decision or decline cover.

Does life insurance through super require a medical exam?

Default insurance through super may be available without individual medical checks. However, applying for additional cover will usually require health questions and may result in medical evidence being requested.

Will a medical exam increase my premium?

The examination itself does not automatically increase the premium. The insurer uses the results alongside the rest of the application to determine whether it can offer cover and on what terms.

How long does underwriting take if medical evidence is required?

Timeframes vary. The process can take longer where reports must be obtained from a doctor, appointments are required or the insurer needs additional clarification.

Alex Jorgensen is the Founder of Jorgensen Investment Company (JIC), with over 10 years of experience in financial services. As the Responsible Manager he directly oversees compliance supervision and operations, focusing on creating simple, structured solutions that help clients make confident financial decisions. Alex is a registered provider on the official ASIC Financial Advisers Register. You can verify his independent client reviews on Adviser Ratings or connect with him via LinkedIn. Alex Jorgensen is a registered financial adviser for JIC Wealth AR # 001238139 under AFSL JIC Adviser Network AFSL # 562451.

General Advice Warning
This article contains general information only and does not take into account your personal objectives, financial situation or needs. This website provides general advice only and all information is general in nature. Before making a decision about any financial matters, you should consider whether the information is appropriate for your circumstances and read the relevant Product Disclosure Statement, Target Market Determination and Financial Services Guide. You may also wish to seek professional advice before deciding whether to apply for, change or cancel insurance cover.  

• MoneySmart – Insurance through super
• MoneySmart – Income protection insurance
• AIA Australia – What to expect when you apply for life insurance
• TAL – Medical exams for life insurance
• Zurich Australia – How life insurance underwriting works