can an insurance company limit coverage for disability for substance abuse to a once-per-lifetime occurance?

UPDATED: Sep 30, 2022

Advertiser Disclosure

It’s all about you. We want to help you make the right legal decisions.

We strive to help you make confident insurance and legal decisions. Finding trusted and reliable insurance quotes and legal advice should be easy. This doesn’t influence our content. Our opinions are our own.

UPDATED: Sep 30, 2022Fact Checked

Get Legal Help Today

Compare Quotes From Top Companies and Save

secured lock Secured with SHA-256 Encryption

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?

Asked on September 30, 2016 under Insurance Law, Washington


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 6 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.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

Get Legal Help Today

Find the right lawyer for your legal issue.

secured lock Secured with SHA-256 Encryption