Applying for long term disability to protect you when you’re not working is a long, difficult process. After the doctor visits, test results and treatment plans, you’ll wait for a decision, sometimes for a while. You may also receive a denial letter, based on your condition.
“Exclusions,” as they are called, are one of the many intricacies of long term disability policies—the things the policy and/or carrier doesn’t cover. The first step is to review your policy and find the Long Term Disability exclusions so you’ll have a better understanding. Here we’ll discuss the different types of exclusions.
What A Policy Won’t Cover
The most common LTD exclusions include:
- Car accidents when you are driving under the influence
- Self-inflicted injuries, whether sane or insane
- Normal pregnancy
- Suicide attempts
Some policies may also exclude:
- Injuries caused by aircraft (exception: passengers on regularly scheduled flights)
- Injuries on the job (these are covered by worker’s compensation)
- Criminal actions you commit (or attempt to)
- Civil disobedience actions, including riots, rebellions and insurrection
- Other intentional acts that cause disability.
Some insurance policies also have a 2-year limitation on disabilities partly caused by substance abuse.
Pre-Existing Conditions
These are conditions that are currently diagnosed and you are currently being treated for when acquiring your policy. A pre-existing condition will require you to wait a designated period of time before you can be covered for it.
If you have a pre-existing condition, there are two periods: a “lookback period,” which can be anywhere from 90 days to as long as a year, and a “waiting period” before you can be covered.
Your insurance company will look back through your medical records for that period to see if you’ve been tested, treated, or otherwise knew that you had the condition.
Once that’s established, you’ll have a period where you must be covered before that condition can be covered. With some conditions, it could be as long as one to two years.
Getting LTD With A Pre-Existing Condition
You can, of course, get long-term disability with the pre-existing condition—you just won’t be covered for it. Anything in your medical records is findable and fair game. Even if you don’t tell them, there’s a good chance they will find out eventually, and will use that as a Long Term Disability exclusion to deny you payments.
Different companies handle them in their own way, and some simply won’t cover you. Coverage will also depend on the severity of the condition, and you will likely pay higher premiums. But insurers also distinguish between recoverable conditions and non-recoverable conditions like cancer.
Mental/Nervous Disorders
One sticking point for a number of policyholders is the limit or exclusion of mental and nervous disorders, such as anxiety, depression, stress, and dementia. While some policies don’t exclude them, many do. Other policies have limits on these disorders, typically for 24 months or less.
However, if your disorder that is the result of a different physical condition or injury, (such as a back injury) there may be no limit or exclusion.
Alcohol/Substance Abuse
While this is classified in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), coverage may only extend for 24 months. Many policies don’t cover alcohol or substance abuse at all, so review your policy for this potential Long Term Disability exclusion.
Houston’s LTD Claims Attorney
Over 4,000 Houstonians have come to us for help with Long Term Disability exclusions, applications, claims, and appeals. With this experience The Herren Law Firm can help you with your LTD legal issues as well. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation with our Houston Long Term Disability attorney. There’s no obligation, no up-front fees, and we only collect if we win your case.
