An Ohio District Court Reverses Unum’s denial of LTD Benefits based on the pre-existing condition provision in the Policy.
Ms. Hines filed for disability benefits based on a condition called anisometropia. Anisometropia is a neurological condition which prevents the brain from meshing separate images seen by each eye. It essentially causes blurred vision. Prior to becoming covered under the policy at issue, Ms. Hines underwent cataract surgery in her right eye.
The surgery was seemingly successful, with minor post-op complications. However, many months later, and after obtaining disability insurance coverage through Unum, she complained to her doctor blurred vision and difficulting meshing images seen by the eyes.
The timing of her condition is important. In order to fall under the pre-existing condition limitation, her disability had to be caused by, contributed to by a condition for which you were treated or diagnosed in the three months prior to coverage beginning. In Ms. Hines’s case, her complaints of blurred vision and trouble meshing images was nine months after cataract surgery.
The Court analyzed the medical records and Unum’s review of her claim. Her first treatment and diagnosis for this condition did not come until nearly a year after coverage began. was not until many months. There was no evidence this condition was the result of her cataract surgery. The Court even noted to make that connection is far reaching.
The Court reversed Unum’s denial of benefits and awarded attorney’s fees. Pre-existing conditions can be a tricky provision often misapplied by an insurance company. If a pre-existing review is mentioned or indicated by your insurance company, it is a good idea to contact an experienced attorney. You want to get ahead of a review like that and build up the evidence in support of your claim.
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