Disability Insurance and Pre Existing Condition

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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Written by Jeffrey Johnson
Insurance Lawyer Jeffrey Johnson

UPDATED: Jul 16, 2021

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A disability insurance pre-existing condition is defined as a mental or physical condition that exits prior to the effective date of the insurance policy. Most policies have a disability insurance pre-existing condition exclusion that prevents you from obtaining insurance coverage for any condition for which you were treated or that you knew about or should have known about for two years prior to the effective date of the policy. When you file a disability insurance claim, be wary of the company denying benefits because of a pre existing condition.

What Disability Insurance Pre Existing Condition Excludes

The pre existing condition exclusion exists to prevent insured parties from receiving disability benefits for injuries they had prior to the start of the policy. The disability insurance pre existing condition allows a company to deny a claim if it finds the injury:

  1. Resulted from a pre-existing condition which was not disclosed in this policy’s application; and
  2. Begins within 2 years after the Policy Date. NOTE: So no benefits if you are injured within 2 years of the receiving the policy? Kind of confusing

According to the policy, a disability insurance pre existing condition is defined as any disability:

  1. For which medical treatment was recommended by a doctor or received from a doctor within the 2 year period prior to your Policy Date; or
  2. that has caused symptoms within the 1 year period prior to your Policy Date, which would cause an ordinarily prudent person to seek diagnosis, care or treatment.
  3. Any condition that was misrepresented or undisclosed at the time of application.

According to the pre-existing definition above, if three years or more has lapsed since the onset of a disabling condition which manifested itself from a pre-existing ailment, your disability claim should be paid. However, the insurance compnay may still push the envelope to deny the disability insurance claim. If this happens to you, consult a disability attorney. You can find the pre existing condition insurance definition in your disability policy.

TIP: When filing out your disability insurance application, it is best to explain any and all pre-existing conditions. It is still possible to get a policy, however, you may have to pay a higher rate. If you don’t disclose the pre existing condition, your claim could be denied later.

Pre-existing Conditions and Disability Insurance Claims

Insurance companies have been known to lean on a disability insurance pre-existing condition to deny claims or limit benefits. If the insurance company notices any medical history relating to the injury, then it may try to limit benefits. Any of the following can lead to denied benefits under the pre existing condition exclusion:

  • Medicine taken to prevent the specific type of injury prescribed because the insured is in a high risk group
  • Any treatment for a physical injury that happened prior to purchasing the disability policy
  • A record of any surgery or treatment that indicates the insured is more prone to suffering the disability

If you are concerned about a pre existing condition affecting your disability insurance claim, you can do the following:

  • Read the denial letter closely. It is not uncommon for an insurance company to connect a current disability to an old injury if the two are similar, but unrelated. Do not accept what the insurance company decides without a close review.
  • Make sure your doctor clearly identifies your disability and its cause. The best way to dispute a denial based on a pre existing condition is to have medical records that show your disability is not caused by an old injury.
  • Remember, pre-existing hinges on prior to your policy issue date. If you had an injury after you obtained your policy that did not limit your ability to work, however, over time it became aggravated and limited your ability to work, this would not be considered pre-existing. It would have to exist prior to your policy inception.

If the insurance company denies your claim as a result of a pre-existing condition, you should contact adisability insurance attorney. A disability insurance attorney will have the knowledge to get around a pre-existing condition denial and understand what documentation is needed to prove your case. To get the legal assistance you need, click here to get a free case evaluation today!

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