By Matt Wiggins, Founder of I get asked this question all the time: can I still get disability insurance with my health history? Doctors are more keenly aware of their own medical issues and health history than the general public, and therefore, they have a greater skepticism—or sometimes—fear of how they will be treated by insurance companies when they apply for disability insurance. If this is you and you are wondering what sort of coverage you can get, if any, given your health history, read on! In most cases, there is hope to get some type of coverage or at least get on a path toward coverage in the future.
For the purposes of disability insurance (DI), a pre-existing condition is any mental or physical health history item that can be found on your official medical records or in doctors’ notes. As a part of your application for disability insurance, you will be asked several health history questions along with questions about any current medications you are taking or hospitalizations.
If you are a younger physician and applying for a lower amount of coverage to start, you may not have to go through an insurance physical and/or labs. If you are an older physician or are applying for larger amounts of coverage, you may be required to participate in such a physical and have your labs drawn. As the insurance companies learn about your current medical condition and past health history, they will use any and all information to validate giving you the coverage; to make decisions on modifying your coverage; or, in some cases, to decline your application for coverage.
What If You Have a Preexisting Condition for Disability Insurance?
If you are currently on any medications or have a fairly recent health history, you will likely receive some sort of modified offer for coverage that is meant to provide you with the best policy the insurance company can give you while accommodating its extra risk due to the preexisting condition. Modifications include but are not limited to changing the price, excluding coverage for the specific condition, reducing your maximum benefit period, and/or taking away policy riders (including possibly the one that makes your policy specialty specific).
Most modifications are some sort of exclusion. For example, if you apply and have a history of right wrist pain, insurance companies will likely keep your price and coverages the same, other than an exclusion for coverage on your right wrist. This means that if you were to become disabled by the pain in your right wrist, they would not pay anything. However, many companies would not exclude disabilities resulting from new trauma to the right wrist, so be sure to check out the specific language in your coverage offer if you have any exclusions.
If your current health or preexisting conditions can’t be confined to a specific area of the body, other modifications may be made. For example, if you are obese or are pre-diabetic, they may offer you a higher price and/or reduce your benefit period to a maximum of five years instead of the normal maximum of age 65 or 67 that another doctor without that medical history would get.
Mental Health and Disability Insurance
Mental health is obviously a huge area of interest for many doctors. The rigors of medical school and residency/fellowship can cause great amounts of anxiety, stress, and/or depression. If you have experienced this, you are not alone. And you still could get a great DI policy. However, there is a vast discrepancy in the way different companies handle mental health histories, including medications. Some will simply exclude mental health coverage as the only modification, while others will add to the exclusion with a reduced benefit period and loss of other riders. Knowing which companies handle mental health history the best could be the difference between getting an excellent policy with discounted rates and full coverage and getting declined. Consult a DI expert broker before applying if you find yourself in this situation.
A Preexisting Condition Could Eventually Be Covered
Many preexisting conditions start out being excluded, but they can also have reconsideration periods assigned to them. This is not a guarantee that your preexisting condition will ever be covered; it just lets you know that insurance companies realize that you may recover or improve in the area they are excluding and leave the door open to reconsider removing the modifications and/or price adjustments in the future. Usually, they will make these periods 12-36 months after you first acquire the policy, and they may include stipulations such as “must be symptom- and treatment-free for at least 24 months” before they will reconsider the modifications.
I have seen quite a few instances of the “Big 5” true, own-occupation (specialty-specific) companies removing their modifications in accordance with their outlines for reconsideration. To see it from the insurance company’s standpoint: when it issues the policy to you, it's really just met you and it often needs a year or two to make sure you aren’t just gaming the system and getting a policy so that you can immediately go on a 30-year claim for something in your history.
More information here:
How to Buy Disability Insurance
Disability Insurance with a Friend of WCI
Handling a Preexisting Condition with Honesty
The best way to handle your preexisting condition is to make sure that you are applying to the right company for your health history. The DI insurance brokers recommended by WCI have enough experience to guide you toward the specific company that will best fit your individual health profile. Be honest with your broker, as they are not employed by any of these insurance companies and should be able to give you accurate and unbiased advice.
Once you’ve picked the best company for you, be sure to be completely honest without oversharing on your application. For example, if you visited the hospital nine years and three months ago and you are asked if you have been hospitalized in the last 10 years, the answer is “yes.” If it were 10 years and one day ago, the answer is “no!” The insurance company has the right within its contract to not pay a claim arising within two years of the start of your policy if you become disabled and it finds out that you lied or misrepresented your health profile on the application. Believe me, if you have a legit disability within two years of starting your policy, it's going to pull out its magnifying glasses, and you don’t want something that you thought was a harmless oversight to become a reason for the company not to pay your claim.
More information here:
People Aren’t Buying Disability Insurance, But They Should
The Bottom Line
If you have a few minor preexisting conditions or one fairly serious one, disability companies can decline to offer you coverage. If they decline you, this means that they evaluated your health and found it too unclear or risky to offer you coverage. If this happens, it can taint your ability to get coverage from the other companies, and it will most likely cause you to be ineligible for any GSI (Guaranteed Standard Issue) policy opportunities that you may have.
If you have any preexisting conditions or medications that you are concerned about, check for the availability of GSI options since they will provide you with a DI policy without the usual scrutiny of your health. Once again, a WCI-recommended broker can tell you if you have any GSI opportunities and if not, which company will give you the best shot of not getting declined.
Getting DI while you are young and healthy and you have discounts (if you are in training) is one of the wisest and most long-lasting financial decisions you can make. After educating and helping more than 15,000 doctors in my career, I can tell you that while DI is not brain surgery (hat tip to the neurosurgeons reading this), it’s also not always intuitive and should not be approached without some preparation. Educate yourself and find a good broker to be your guide, and you may find a great policy to cover you despite any preexisting conditions you may have. A broker’s unbiased knowledge and experience coupled with your desire to protect your career will create an effective and mutually beneficial partnership to help you get your DI done right the first time.
Have you had to get disability insurance with preexisting conditions? What happened when you applied? What was the outcome?
[EDITOR'S NOTE: Many thanks to Doc Insure and Matt Wiggins, one of our Platinum Level (contributing $8,000+) Sponsors for the WCI Medical School Scholarship, for helping physicians secure the best DI policies. This is the second of our three scholarship-sponsored posts for 2024. Thank you for supporting those who support this site and especially the scholarship. All proceeds go to the scholarship winners.]
If you have any doubts it is critical to use one of the WCI independent agents.
They have the ability to seek a preliminary evaluation from each of the Big Five, if needed.
There is a shared data warehouse that any application rejection is recorded in. If rejection is likely, do not apply. Why? Any application, including GSI, will ask have you been rejected before? Automatic rejected again. They will find it.
My husband has 4 heart stents. He is 48 years old. He is on several meds (for hypertension, hyperlipidemia, a blood thinner, and diabetes). I tried to have him apply for life and disability insurance through my work (thought it would be easier) and he was rejected just based on his history. He didn’t even get offered a physical/bloodwork. I didn’t have time to appeal or look into it.
Any ideas on how to get approved for some life/disability.
Hi M – Thanks for your post! There are options…but that type of cardiac history, along with diabetes, will limit what’s available to him. Here are the main options when you have significant health history:
– Guaranteed Standard Issue: If you are not currently disabled and have not been declined or received a modified offer for DI before, you may be eligible for this type of policy through your employer/institution without any medical underwriting.
– Group Coverage: Most employers have group coverage that will provide some protection, but will also, most likely, exclude pre-existing conditions. So, if your employer offers such group DI, you might want to look into it since it is better to have coverage for everything else besides the pre-existing conditions than none at all.
– Petersen International: Petersen is a specialty insurance company that insures everything from super-high income earners that need more DI than the traditional “Big 5” will provide, to doctors who have a medical history that precludes them from getting coverage from the “Big 5”.
I hope this helps! If you want specific options and feedback, request quotes using this WCI link and let Doc Insure, or one of the other partner agents, look into this for you!
https://www.whitecoatinvestor.com/insurance/#disability
Apply through your work? That’s odd. A very interesting benefit I guess. Too bad it’s not GSI from your work.
I would be very surprised if any life insurance company offered your husband life insurance if they ask any kind of medical questions at all, which most do. So if you want life insurance on him, you’ll need to look at policies that don’t ask questions. Those are usually little policies from a bank, credit union, professional association, or employer (his).
Similar issue with disability. I mean, imagine you’re an insurance company trying to make money. What’s the best way to do so? It’s to avoid insuring people likely to die or get disabled. Can you think of people at higher risk for this than those with known heart disease and 3 cardiac risk factors? Maybe someone with active cancer etc. But basically, he’s just super high risk.
Great post! What happens if you’re diagnosed with a major condition after obtaining disability and life insurance (say within a year)? Am I obligated to let my broker know after the policy is purchased?
No, you’re in like Flynn.
Hi David – Glad you asked! The best way to evaluate how your pre-existing condition might affect your options and the availability of GSI policies is to request your quotes from one of the WCI partner agents. Requesting quotes is simply an inquiry and it is not an application so you can engage someone, like myself, to get feedback directly to the underwriters at the Big 5 companies without triggering any negative repercussions. The WCI page where you can request your quotes and choose a partner agent to help you is here: https://www.whitecoatinvestor.com/insurance/#disability.