Insurance Waiting Periods Are Sometimes Used to Deny Coverage

Jun 27, 2018 | Blog |

In the private insurance context, the existence of a “waiting period” is to be expected, and in fact, waiting periods are nearly ubiquitous.

Whether you are signed onto a health insurance policy, a disability insurance policy, or some other form of insurance, in all likelihood, there is a waiting period provision written into the insurance agreement.  Insurers frequently use these waiting period provisions as the basis for a claim denial — even when the claim is otherwise legitimate.

Fortunately, the waiting period restriction is not always applicable.  Let’s take a brief look at some of the basics, first.

Waiting Period Provisions

Waiting period provisions are rather straightforward.  Stated simply: a waiting period — for example, a six-month waiting period for your health insurance coverage — precludes coverage during the specified time.  Once the waiting period is over, coverage will resume as per the insurance agreement.

Suppose that you have been injured in a car accident, and you obtain treatment for your various injuries (along with rehabilitation services) in the following months.  You are a relatively new policyholder, however, and the applicable waiting period for your health insurance coverage is still running.  Your insurer therefore denies your claim for benefits on the basis of the waiting period.

What can you do?

In some situations, you can obtain pre-approval for the necessary treatment, even if you are precluded from reimbursement due to the waiting period.  In other situations, an exception may apply.

Exceptions to the Waiting Period May Apply

There are a number of exceptions to the standard waiting period exclusion.  Some policies may include an exception that applies when one’s financial resources are insufficient to cover their various losses, and some include an exception that applies for catastrophic injuries or complete disabilities.

Perhaps the most commonly encountered exception is the emergency exception.  The emergency exception gives policyholders the right to obtain benefits — even during the waiting period — if they can show that their situation qualifies as an “emergency” in accordance with the language of the insurance policy.  In the health insurance context, for example, the exception may be quite narrowly-tailored, and may only allow coverage (during the waiting period) for injuries that are diagnosed and treated in the Emergency Department of a medical facility.  A different policy may only grant health insurance coverage (during the waiting period) for injuries that are life-threatening.

Speak to an Experienced Chicago Insurance Attorney for Assistance

If you have had a legitimate claim for insurance benefits denied, then you may be entitled to challenge the adverse decision of your insurer and not only secure the insurance benefits that you’re owed, but — in some cases — obtain damages pursuant to a bad faith lawsuit.  There are a broad range of justifications for denying coverage to policyholders (in Illinois and elsewhere).  Among them, waiting period exclusions are rather common.

Here at Bryant Legal Group, P.C., our attorneys have decades of experience representing policyholders in disputes with their insurers.  We are apprised of the strategies typically employed by insurance companies in order to minimize their liabilities and are well-equipped to help our clients circumvent their defenses.

Call (312) 561-3010 or submit an online form today to speak with a skilled Chicago insurance attorney at Bryant Legal Group, P.C.

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