Risks of accident and sickness cover: Which statement describes a risk to the insurer regarding pre-existing medical conditions?

• A. The insurer will automatically accept claims relating to pre-existing medical conditions.
• B. The insurer might not accept claims relating to pre-existing medical conditions.
• C. Only injuries from accidents are covered.
• D. The policy will never cover anything

Answer: (B)

Pre-existing medical conditions create underwriting risk for accident and sickness cover. Insurers assess the likelihood of future claims and typically exclude or limit coverage for conditions that exist before the policy starts, or charge higher premiums. This means they may not accept claims relating to those pre-existing conditions, which is exactly the risk described. They manage this by applying exclusions, waiting periods, or medical underwriting. The other statements don’t reflect standard underwriting practice: insurers don’t automatically accept such claims, coverage isn’t limited to only accident injuries regardless of medical history, and policies aren’t designed to never cover anything.