Common Exclusions in Long-Term Disability Insurance Policies

Being denied long-term disability benefits due to an exclusion listed in your policy is not uncommon. While insurance policies may stipulate certain limitations and restrictions in the policy, it’s can be a gray area. Here’s what you need to know.

Pre-Existing Condition Limitation

Most long-term disability insurance companies have a pre-existing condition clause attached to their policies. Since insurance companies take a wide approach when interpreting a pre-existing condition, this often leads to a denial. During the look-back period (three months prior to your policy’s effective date) the insurance company will review the following related to your illness or injury:

  • Medial care, treatment, and other services
  • Medical consultations
  • Prescription medications administered

Mental Health Limitation

Most people associate disability claims with physical impairments. However, many people have mental health challenges that leave them unable to work. While most policies include mental health limitations, there are some qualifying mental impairments such as:

  • Depression
  • Autism
  • Mental retardation
  • Personality disorders
  • Bipolar disorders
  • Alcohol/drug addiction disorders
  • General anxiety disorder
  • PTSD
  • Traumatic brain injury

Many mental health disability claims are limited to a certain amount of time, typically up to 24 months. It’s important to have a disability attorney review your claim so you can ensure your disability benefits aren't wrongfully terminated or denied based on a 24-month mental health limitation period.

How Claims Get Falsely Denied

Since insurance companies take a loose approach in determining pre-existing conditions and other limitations, many claims get falsely denied. Appealing a long-term disability claim denial can be complicated. Taking on insurance companies without the help of a disability attorney can be a frustrating task if you aren’t familiar with ERISA laws.

Long-term disability claims can be complicated and riddled with red tape. You need assistance with a new long-term disability claim or you have been denied and need to appeal, we can help. As an experienced ERISA law firm, we can handle cases all 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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