A prostate cancer patient’s fight for income protection benefits has failed after the industry ombudsman found warning signs before his cover began were enough to trigger a pre-existing condition exclusion.

The man argued he could not have known he had cancer before taking out insurance, because he had not been diagnosed.

But the Australian Financial Complaints Authority says a history of elevated prostate-specific antigen (PSA) levels, specialist consultations and a recommended biopsy pointed to an underlying medical condition that a reasonable person should have recognised.

The man’s GP had referred him to a urologist after elevated PSA levels were identified, and the specialist arranged blood tests, recommended an MRI and continued monitoring the results. Despite the MRI not indicating a medical condition, the urologist later recommended a biopsy because the PSA levels remained elevated.

The claimant argued the testing was routine surveillance, not treatment or advice for an illness. He maintained elevated PSA levels did not automatically indicate prostate cancer and that he became aware of the disease only after a subsequent biopsy.

AFCA accepts the cancer was not diagnosed when the earlier investigations took place, but it finds the policy did not require a condition to be formally diagnosed to qualify as pre-existing. Receiving medical advice for an underlying condition before cover began was sufficient.

The ombudsman considered section 47 of the Insurance Contracts Act, which can limit an insurer’s ability to rely on a pre-existing condition exclusion if someone could not reasonably have been expected to know about their illness.

AFCA finds the PSA concerns and the specialist’s recommendation for a biopsy meant the man should have recognised there was an underlying medical issue, despite the absence of a diagnosis.