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Can my disability insurance claim get denied for a pre-existing condition?

On Behalf of | Jun 30, 2023 | Long Term Disability Claim Denial

When you begin long-term disability coverage through your employer or a private policy, you might be perfectly healthy. But if you are like a lot of people, you begin coverage dealing with an injury, condition or illness that is arguably somewhat disabling, though you are still able to work.

Having one or more medical issues as pre-existing conditions should not prevent you from getting LTD insurance. But it might give the insurance company a reason to deny a future claim.

How a pre-existing condition can affect your disability coverage

When the insurance company writes its policy, it often includes an exclusion for pre-existing conditions.  Once you become unable to continue working, the insurance company will review your medical records for pre-existing conditions. If it finds one, it will assert the pre-existing condition exclusion.  As stated above, exclusions are things for which the insurance company will not pay  a claim. In this context, the insurer excludes disability claims based on a condition for which the claimant had already been treated when the policy went into effect.

For example, say you were diagnosed with rheumatoid arthritis before your LTD policy began, and if you file a claim within the first year of coverage, the condition grows worse and treatment can no longer manage the pain enough for you to keep working,  you have to go out on disability.   But when you file a claim, the insurance company denies it based on an exclusion for claims related to pre-existing conditions in your policy.

How you might qualify for coverage anyway

As with most legal matters, there are exceptions, and every policy is different. Many LTD policies require the adjuster to at least consider a claim based on a pre-existing condition if the policy has been in effect for more than a year. And if you fully recovered from your pre-existing condition and remain free of symptoms for a specified number of months or years, you may be able to no longer fall within the pre-existing condition exclusion.

Dealing with exclusions and denied claims is difficult and confusing for most people, especially when they are dealing with a disabling condition and financial difficulties at the same time. An attorney experienced in representing LTD insurance claimants on appeal can help you make sense of what is going on and what your options are for challenging the denial.