In an occurrence-based life insurance policy with a terminal illness benefit, the occurrence of the illness during the policy period is sufficient to trigger cover; the insurer's opinion as to prognosis need not be formed during the policy period. Evidence admissible for determining prognosis is limited to facts known or knowable at the relevant date. A pre-existing illness exclusion clause applies where the medical condition is the same, regardless of whether the pre-existing condition had the prognostic character required for the terminal illness benefit. Section 47 of the Insurance Contracts Act 1984 (Cth) does not preclude reliance on a pre-existing illness exclusion where the insured was aware of the prior condition at the time of contracting, even if the insured was not aware the condition was still active.
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