Pre-Existing Conditions

Understanding the Pre-Existing Conditions Clause

 If a person makes a claim within a certain period after obtaining disability coverage (usually within the first year, but every policy is different and has its own language which governs pre-existing conditions) then the insurer will look to see if the person was treated for the same medical condition during a period called the “look-back period” immediately before obtaining the new coverage. A medical condition for which the person was treated may be excluded from coverage as a “pre-existing condition.” Generally, if the insured goes for a certain time without being treated for the condition, (often a year, sometimes longer) it ceases to be pre-existing.  If you are still working and considering filing for disability it may make sense to continue working until the pre-ex period is met when this is possible.  It is not unheard of for people to return to work upon learning that their long-term disability insurance claims will be denied on a pre-ex when there is a limited period remaining for the claim to cease to be pre-existing, but these are unusual cases.  Insurance companies may deny your claim on a pre-ex basis, but that doesn’t necessarily mean your claim is barred.  For example, If you have other non-pre-existing disabling conditions with supporting medical evidence, you may still appeal the denial and seek benefits based on your non-pre-existing conditions. It is best to consult with an attorney experienced in ERISA disability litigation to see if a pre-ex denial can be overcome.  If you have been denied disability insurance benefits based on a pre-ex clause, or any other reason, give us a call to see if we can help!  866-507-7030

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