Contract trap · Insurance
Pre-existing condition exclusion
Excludes any claim 'arising directly or indirectly' from a condition that existed, was diagnosed, treated or showed symptoms before the policy (look-back of 60-180 days or unlimited), including undiagnosed and 'related' conditions and bilateral conditions in pet cover.
- Severity
- Severe
- How often it turns up
- Common
- Holds up?
- Usually enforceable
- Clause phrases
- 20
What it looks like in a contract
Redline matches these phrases against your document verbatim. Drafters rarely invent new wording — they copy it, which is why the same sentences turn up across unrelated contracts.
In English-language contracts
- pre-existing medical condition
- look-back period
- any condition for which you have received or been recommended treatment
- whether or not diagnosed
- chronic condition
- bilateral condition
- arising directly or indirectly from
- symptoms for which a reasonable person would have sought treatment
- stable for 90 days
- related condition
In Russian-language contracts
- хронические заболевания
- обострение хронических заболеваний
- заболевания, диагностированные до заключения договора
- имевшиеся до начала действия договора
- ранее существовавшие заболевания
- о которых Застрахованный знал или должен был знать
- заболевания, требующие постоянного лечения
- лимит на обострение хронических заболеваний
- последствия ранее полученных травм
- врождённые заболевания
Check your own contract
Paste a clause, a page or the whole document. Nothing leaves your browser: the matching runs here, on this page, against the phrases above.
Why it bites
Hospital bills abroad, pet surgery or a borrower's disability claim are denied on the basis of an old GP note or repeat prescription; 'chronic' and 'related' are defined so widely that most adults over 40 have something; credit-protection policies bury these in group terms the borrower never sees.
Is it enforceable where you are
The same clause can be routine in one country and void in another. What follows is what the law says where you are — not advice on your particular contract.
In the UK, the Insurance Act 2015 and Consumer Insurance (Disclosure and Representations) Act 2012 restrict what an insurer may avoid; in the EU, the IDD and Directive 93/13 apply, and in the US, insurance is regulated state by state.
United States
Banned in ACA-compliant health plans (PHSA §2704) but permitted in travel, pet, short-term, supplemental and credit insurance; group disability '3/12' clauses standard; look-back windows regulated by state; health coverage rescindable only for fraud/intentional misrepresentation with 30 days' notice (45 CFR 147.128).
- Cited
- 45 CFR 147.128
- PHSA §2704
European Union
Permitted as a risk definition if transparent (Van Hove); EIOPA 30 Sept 2022 warning criticised CPI products with numerous exclusions; Germany VVG §19: disclosure duty only for questions asked in text form.
- Cited
- EIOPA
- Van Hove
- VVG §19
United Kingdom
Permitted; FCA signposting rules (PS20/3) require travel insurers to direct consumers with serious conditions to specialist providers; under CIDRA 2012 an insurer cannot void for a condition it never asked about.
- Cited
- FCA
Russia
Permitted (ст. 942-943 ГК); ДМС/ВЗР programmes routinely exclude chronic diseases; the insurer cannot void for facts it never requested or when it concluded the contract without the answer (п. 19 Пленума ВС № 19/2024) and bears the burden of proving deliberately false statements (п. 20); Bank of Russia 2025 report flags such exclusions in borrower insurance.
- Cited
- Пленума ВС № 19/2024
- ст. 942-943 ГК
Where this has actually happened
Regulator actions, court rulings and the contracts they were fought over.
- EIOPA warning to insurers and banks on credit protection insurance products (30 September 2022) — poor-value products with many exclusions sold with loans
- US 45 CFR 147.128: health coverage may be rescinded only for fraud or intentional misrepresentation, with 30 days' advance notice
What to do
In order, from the thing that takes a minute to the thing that takes a letter.
- Declare everything and complete medical screening in writing
- Buy the pre-existing-condition waiver (US: usually only within 14-21 days of the first trip deposit)
- Get a vet baseline record
- RU: choose ВЗР tariffs with an «обострение хронических заболеваний» sub-limit
- If the insurer never asked about a condition it usually cannot rely on non-disclosure (CIDRA 2012
- Ст. 944 ГК, п. 19 Пленума ВС № 19/2024).
Traps that travel with it
Drafters who use one of these usually use several.