What is a “Look-Back” Period in Long-Term Disability Claims?

When it comes to long-term disability applications, it’s not uncommon for insurance companies to find a reason to deny a claim. While most long-term disability policies hold a pre-existing condition clause, it can be loosely interpreted due to the broad approach insurance companies take when using the “look-back” period in determining pre-existing conditions. Here’s how the look-back period plays a role in your long-term disability claim.

How is a Pre-Existing Condition Determined?

Insurance companies use the look-back period (three months before your effective insurance date, but in some cases longer) to determine whether or not your injury or illness is a pre-existing condition. The insurance company looks at the following factors related to your illness or injury:

  • Medical care and treatments
  • Professional medical consultations
  • Prescriptions administered for your injury or illness

What is the Waiting Period?

Also known as the elimination period, the waiting period is the time between the beginning of your disability and when you are eligible to receive long-term disability benefits. The waiting period starts on the day the disability began, not the day your claim was filed. However, you may still have to wait out the remainder of the waiting period before you can receive benefits — even if the application has been approved. Typically, waiting periods last 90 days, however, in some cases it could be longer — from 180 days to 365 days.

What to Do if You’ve Been Denied Over a Pre-Existing Condition

Numerous claims are falsely denied over insurance companies using pre-existing conditions as the reason. Besides pre-existing conditions, other policy clauses and exclusions can affect your claim. Should you be denied long-term disability benefits for any reason, it’s critical to contact a disability attorney that is experienced in ERISA laws.

If you or a loved one has been denied long-term disability benefits, we can help. As an experienced ERISA law firm, we can handle any case throughout the United States. Contact Dabdoub Law Firm today at (800) 969-0488 to schedule a consultation to learn more about your right to file an appeal.


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