Having a pre-existing medical condition could make it harder for you to get long term disability (LTD) benefits from your insurance company.
There are limits to what an LTD benefits insurance plan will cover. They’re described in your insurance policy as “exclusions.” Exclusions are written into every LTD insurance policy. The purpose of these exclusions is to manage the amount of risk the insurance company assumes when it provides coverage to an individual.
The Pre-Existing Condition Exclusion
One of the most common examples of an LTD policy exclusion is the pre-existing condition exclusion. Insurance companies define a pre-existing condition as a mental or physical condition that you were aware of and existed before the purchase of your LTD insurance policy.
The pre-existing condition exclusion clause gives your insurance company the right to deny a claim if they determine that the illness or injury that you are claiming benefits for was the result of a pre-existing condition you did not disclose when you applied for disability insurance coverage, or the illness or injury was diagnosed within the policy’s “waiting time” — the period between the onset date of your disability and the time you become eligible to receive long-term disability benefits.
Some of the pre-existing medical conditions most commonly excluded from LTD insurance policy coverage include:
- Heart disease
- High blood pressure
- Cancer
- A medical history of alcohol or drug abuse
- Physical injuries — especially back injuries
- Traumatic Brain Injuries
To determine if your illness or injury may be related to a pre-existing condition, the insurance will usually review your medical record for the year prior to the date of your disability. Here are some of the things they’ll be looking for:
- Any symptoms you’ve complained of;
- Any conditions you have been diagnosed with;
- Any medical care or treatments;
- What prescription medications you are taking.
If any of your current symptoms can be considered to be the result of a pre-existing medical condition, the insurance company will probably deny your claim.
Just because you have a pre-existing condition doesn’t mean you can’t get a group LTD insurance policy through your employer; however, expect an exclusion for filing a claim related to your pre-existing condition. Private, individual LTD policies include pre-existing exclusions as well, but in some cases you can negotiate with the insurance company to have a pre-existing condition covered.
Other Types of Exclusions
In addition to pre-existing medical conditions, your LTD insurance policy may include exclusion clauses for illnesses or injuries related to:
- Alcohol and substance abuse
- On-the-job accidents
- Certain types of occupations
- Military service/war
- Suicide attempts
- Deliberately causing your medical condition
Speak With An Experienced LTD Benefits Attorney About Your Claim
Insurance companies often use a very broad definition of the term “pre-existing condition” in order to achieve their objective of denying a claim. If your LTD benefits claim was denied due to a pre-existing medical condition that you weren’t aware of until the insurance company reviewed your claim, the smart thing to do is hire an experienced LTD benefits attorney. Determining that a policyholder’s illness or injury is due to a pre-existing medical condition is one of the most common reasons insurance companies use for denying a claim for disability benefits.
If your claim has been denied due to a pre-existing condition exclusion or for any reason, please get in touch with the law offices of M. Stanley Whitehead without delay.
M. Stanley Whitehead is a long term disability benefits attorney dedicated to serving the needs of disabled workers and veterans all over the United States. He’s helped clients at all phases of the claim process, from the initial disability claim application, to the administrative appeals level, and even in lawsuits in state and federal courts.
Contact M. Stanley Whitehead to discuss your LTD benefits claim case. Don’t delay, especially if your claim has been denied by an insurance company. You have only a limited time in which to appeal their decision; the sooner we get to work on your case, the better your chances of getting the LTD benefits you deserve.
