You file a claim for long-term disability benefits under your employer-provided policy. You get a letter back from the insurance company saying – “Sorry, your condition is a pre-existing condition, so we don’t cover you.”
Long-Term Disability Denial for Pre-Existing Condition
Here’s the thing - most long-term disability policies contain a clause that allows the insurance company to deny you benefits on the basis that a "pre-existing" condition exists.
Each group policy is slightly different in how it handles “pre-existing” exclusions, so you want to read your policy to see how your insurer defines it.
What is a Pre-Existing Condition Limitation?
The pre-existing exclusion clause is usually broadly interpreted by insurance companies.
The insurer reviews your medical records for mentions of prescriptions, referrals, and complaints similar to the condition you now claim is disabling.
Disability Insurance companies search for all ways to deny your claim and if you were treated, attended a physician, or were prescribed drugs for before coverage applied or during an excluded period – your claim will likely be “pre-existing.”
What is a Pre-Existing Condition Exclusion Period for Long-Term Disability?
It is important to review the policy to determine what the timeframe for the exclusion period is.
The exclusion period can generally be one or two years, but it will vary by policy.
Based on the wording of the policy, conditions can be considered "pre-existing" if
- You were treated for the condition before you applied for disability coverage and did not disclose it on the application (keep in mind this could be something as basic as being told to take Tylenol for a sore knee)
- The condition began during the initial exclusion period of the policy (usually the first 2 years)
So what does this mean for someone applying for long-term disability benefits who is a newer employee at a company, who has recently become eligible for benefits?
If the person was applying for disability benefits on the basis of lower back pain as a result of a herniated disc and severe pain but had attended physiotherapy, attended a doctor and reported back pain or received a prescription for pain medication during the exclusion period, the insurer can use this information to deny benefits, even if it was one visit to the doctor in the previous year.
Getting Disability Benefits with a Pre-Existing Condition
You should read your policy to see how long the insurer can consider the condition pre-existing and try to work long enough to take the exclusion out of play.
The pre-existing exclusion clause is a hurdle that you have to face when applying for disability benefits soon after coverage has started. An experienced lawyer can help you to understand the claims process and work with you to determine whether or not the disability is caused by a pre-existing illness or injury.
If you or someone you know has applied for long-term disability benefits and your application was denied as a result of a pre-existing condition, or was denied for any other reason, consult an experienced long-term disability lawyer as soon as possible.
Have questions or concerns about your long-term disability claim? Give Louisiana Disability Law a call right now at 985-240-9773. The call is free and with a short conversation, we can help you determine quickly if we can help with your claim.