Library wiki
CR403 — Pre-existing condition clause — onus and look-back proof
The insurer must prove, on a balance of probabilities, both that the look-back condition existed in the contractual window and that it caused the disablement. A historic injury and a broad ‘chronic since 2003’ sentence are not enough. First consultation in the file was 8 March 2017; a June 2016 heavy-vehicle medical had given a clean bill of health; the leg weakness the insurer relied on started in 2017, after cover.
Where it is defined
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Ombud precedent
The insurer must prove, on a balance of probabilities, both that the look-back condition existed in the contractual window and that it caused the disablement. A historic injury and a broad ‘chronic since 2003’ sentence are not enough. First consultation in the file was 8 March 2017; a June 2016 heavy-vehicle medical had given a clean bill of health; the leg weakness the insurer relied on started in 2017, after cover.