Pre-Existing Conditions and LTD: 4 Things You Need to Know

Nov 5, 2019 | Blog |

You’ve filed your application for long-term disability (LTD) benefits, meticulously filling out all the necessary information and submitting all of your relevant medical records. When you get the insurance company’s response, you’re shocked to see a denial of benefits. Unfortunately, the insurance company determined that your disabling conditions were pre-existing.

At Bryant Legal Group, we’re used to insurance companies broadly interpreting our clients’ medical records and incorrectly applying pre-existing condition exclusions. Learn how you can fight back to get the LTD benefits that you deserve.

1. Pre-Existing Conditions Can Be Either Mental or Physical

As a cost-savings mechanism, most long-term disability plans exclude pre-existing conditions. While the definition will vary from plan to plan, pre-existing conditions usually include any chronic physical, mental, or emotional condition that you have been treated for shortly before you obtained coverage. Common pre-existing conditions include cancer, asthma, heart disease, arthritis, depression, and anxiety.

However, many long-term disability pre-existing condition clauses cover more than just a diagnosis. If you saw your doctor and complained of symptoms that were potentially related to a pre-existing condition, the insurer might attempt to deny your claim.

For example, suppose you reported moderate back pain and some numbness in your leg two months before obtaining LTD coverage. Later that year, your doctor referred you to a neurosurgeon who discovered a herniated disc in your lower back. Even though you didn’t have a clear diagnosis at the time you got coverage, the insurance company might deny your claim for disability insurance benefits.

RELATED: Disability Insurance: A Look at Ambiguous Exclusion Clauses

2. Insurance Adjusters Broadly Interpret Pre-Existing Conditions to Deny LTD Claims

Before you apply for long-term disability benefits, you should always review your plan documents and identify potential obstacles. Your policy will include a very specific definition of “pre-existing condition,” as well as other exclusions. If these exclusions apply to your claim, you might be ineligible for LTD benefits.

However, these definitions are always subject to interpretation, so you should never assume that the insurance adjuster was correct in their assessment. Many times, an experienced disability lawyer can help you clarify your condition and avoid your plan’s pre-existing condition exclusion.

Refuting a pre-existing condition exclusion is not a simple process. You’ll need to carefully review the plan documents, identify all of your supporting medical records, and might even need to collect statements from your physicians and other experts.

RELATED: Common Insurer Justifications for the Denial of Private Disability Benefits

3. Failure to Disclose Your Medical Conditions Can Mean Trouble

When you apply for a private LTD policy, you typically must provide extensive information about your medical conditions and treatment. Then, the insurance company calculates your premiums based on your likelihood of needing benefits in the short term — and may even exclude specific conditions (like cancer) from coverage.

Sometimes, when you apply for LTD benefits, the insurance company will argue that your disabling condition existed at the time you applied, and that you neglected to disclose it.

It’s always in your best interest to fully outline your known pre-existing conditions when you apply for private LTD coverage. However, it’s also understandable that you might not tell the company about that occasional twinge of hip pain that develops into excruciating pain and turns out to be severe degenerative joint disease.

In these situations, you should consult with an experienced disability insurance lawyer.

4. Group LTD Plans Typically Include Pre-Existing Condition Timelines

Group or employer-sponsored LTD plans can’t examine each covered employee’s medical records. Instead, the insurance company places limits on when it will cover a pre-existing condition. Typically, your condition will be excluded if:

  • You reported symptoms or sought medical treatment within a specific period before you obtained coverage (frequently 90 to 180 days).
  • You file for benefits within 12 months of getting LTD coverage.

Therefore, if you’re able to cope with your condition and continue working for more than a year, you might still be eligible for employer-sponsored LTD benefits. However, every LTD plan is different, and your policy could include a different time period or other exclusions.

If you need help interpreting your LTD policy and calculating your exclusion periods, please contact Bryant Legal Group for help.

Discover Bryant Legal Group’s Innovative Approach to Disability Insurance Appeals

Bryant Legal Group is one of Chicago’s most respected disability insurance law firms. We pride ourselves on our practical, client-centered approach and sophisticated legal strategies.

If you or a loved one were recently denied LTD benefits due to a pre-existing condition, it’s time to schedule a consultation with one of our skilled and experienced disability lawyers. We’ll help you understand all of your legal options and suggest meaningful next steps regarding your claim.

You can contact Bryant Legal Group by calling 312-561-3010 or completing this brief online form.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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