Does Long-Term Disability Cover Pre-Existing Conditions?

Most insurance companies include policy clauses related to pre-existing conditions. Claim denials are not uncommon, and pre-existing condition clauses give insurance companies even more ammunition to deny claims. This can be a gray area since insurance companies often take a broad-approach to interpret pre-existing condition clauses outlined in policies.

What is a Pre-Existing Condition?

Insurance companies use a “look-back period” (the three months immediately before your effective insurance date) to determine if your injury or illness is a pre-existing condition. During the “look-back period” the insurance company will review the following factors related to your illness or injury:

  • Medical care, treatment, and other services.
  • Professional medical consultations.
  • Prescription drugs administered for injury or illness.

Some long-term disability insurance policies may designate the “look-back period” to be longer than three months.

How Claims Get Falsely Denied Over Pre-Existing Conditions

Long-term disability claims are complicated, and since insurance companies loosely determine pre-existing conditions even after looking at all the facts, many claims get falsely denied. There can be a lot of “red tape” surrounding long-term disability claims in general, and getting erroneously rejected for a pre-existing condition only compounds the complications. When up against a long-term disability claim denial, no matter what the reason, it’s imperative to contact a long-term disability attorney to assist you with an appeal.

Other Reasons for Long-Term Disability Denials

A pre-existing condition is just one reason why long-term disability claims get denied. While most policyholders are at the mercy of the insurance company, avoiding these mistakes can increase your chances of a favorable decision:

  • Not submitting medical records on time.
  • Lack of proof/medical evidence.
  • Daily activities - Many insurance companies use surveillance tactics as a way to point out contradictions in your claim.
  • Social media - Social media posts can give insurance companies ammunition in claiming you are performing activities otherwise reported that you cannot do.
  • Filing a claim without a long-term disability attorney.

Filing a long-term disability claim can be stressful, especially for those unfamiliar with ERISA laws. If you have been denied long-term disability benefits or have a new claim, we can help. As an experienced ERISA law firm, we can handle all cases throughout the United States. Contact Dabdoub Law Firm today at (800) 969-0488 to schedule a consultation and learn more about your options.


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