can an insurance company limit coverage for disability for substance abuse to a once-per-lifetime occurance?
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can an insurance company limit coverage for disability for substance abuse to a once-per-lifetime occurance?
I received long-term disability benefits in 2014 due to substance abuse. I
became disabled again in 2016 and began receiving benefits for the same
condition from the same company met-life I just got a letter from them
stating that they just discovered my prior claim and that they would be
terminating my benefits. They state that there is a clause in the policy that
there is a once-per-lifetime restriction for claims for substance abuse in their
plan. Is this legal?
Thanks.
Asked on September 30, 2016 under Insurance Law, Washington
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 7 years ago | Contributor
It's legal if that clause is in the contract or policy. Insurance is a contract: the insurer has to pay when the terms of the policy require it to pay, but does not have to pay if the contract gives them grounds to not pay. Check the terms of the contract/policy to see what it says; if you don't understand the contract, bring it to an attorney to review with you. If you believe that under its terms, they have to pay you, you could sue them for breach of contract--for not honoring their contractual obligations as to when to pay.
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