Pre-existing Conditions and Your Disability Insurance

Pre-existing conditions clauses appear in nearly all disability insurance policies. It is a common provision that excludes payment of benefits for certain types of disabilities. The typical pre-existing conditions exclusion in disability policies state that benefits will not be paid for a total disability caused by, related to, or contributed to a pre-existing condition. This means that if you have a pre-existing condition that leads to a total disability you may not qualify for disability insurance benefits.

Pre-existing conditions are generally defined as any sickness or injury for which you received medical treatment, consultation, care or services, or took prescription drugs, during the three months immediately prior to your effective date of insurance. The three month time frame is called the “look back period” and may be longer depending on your disability insurance policy.

Unfortunately, this issue can get very tricky. A disability insurance company may try to connect the condition causing your total disability to a pre-existing condition. For example, you have a stroke that leads to your total disability. Prior to your stroke, you suffered from varying heart conditions during the look back period. As a result of your heart conditions, you undergo treatment and take prescription medication to keep it under control. Months later, you suffer from a stroke that leaves you totally disabled. Your disability insurance company, as part of your claim, does a pre-existing condition investigation and finds that you had been diagnosed and treated for various heart conditions. They deny your claim based on the pre-existing condition exclusion in your policy.

This logic is wholly unfair and unlawful under the disability insurance law. The insurance company’s attempt to create a chain link of conditions leading to your total disability, only to deny your claim is improper. In the example above, the stroke caused the total disability. Any connection to what may have caused the stroke is a far reach and inappropriate.

If you feel your disability insurance company has denied your claim due to a pre-existing condition that is different than the condition causing your disability, contact the long term disability attorneys at Dabdoub Law Firm for an evaluation of your case. Our firm has successfully represented people whose claim for disability benefits were wrongly denied based on a pre-existing condition exclusion.


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