Can Your Long-term Disability Claim be Denied over a Pre-existing Condition?

Most long-term disability claims contain a clause that gives insurance companies the right to deny your claim based on a pre-existing condition — and long-term disability claim denials are not uncommon. Why? Because insurance companies typically take a very wide approach to interpret pre-existing condition clauses outlined in policies.

Since the interpretation of your policy can be broad, it’s important to review the policy thoroughly and have all the facts before filing a long-term disability claim. Here are some basic things you should know:

What Defines a Pre-Existing Condition?

During the three months immediately before your effective date of insurance, the insurance company will review the following facts related to your illness or injury to determine if it’s pre-existing. This is also known as the “look back period.”

  • Medical treatment, care, or services
  • Consultations with medical professionals
  • Prescription drugs administered for the condition

Depending on your disability insurance policy, the “look back period” may be longer than three months.

How Policy Clauses Affect Your Claim

Besides pre-existing conditions, your long-term disability insurance policy may have some other exclusions and constraints such as:

  • Mental conditions - disability benefits based on mental and nervous conditions are capped at 24 months; however, some exceptions may apply.
  • Elimination period - the waiting period (typically three to six months) in which you are disabled, but not entitled to long-term disability benefits.
  • Duration of benefits - some policies may only pay you benefits until you are 65.
  • Social Security Disability (SSD) - you may be required to file for SSD benefits. If you receive long-term disability benefits, the insurance company will offset SSD benefits which reduces your long-term disability benefit amount.

There can be a lot of “red tape” surrounding long-term disability claims, especially if you have been denied long-term disability due to a pre-existing condition. You have the right to appeal your denied claim; however, the appeals process can be an arduous task. Having an experienced long-term disability attorney on your side can make all the difference and Dabdoub Law Firm can help! Contact us today at (800) 969-0488 to learn more.

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