What is the Pre-Existing Condition Exclusion in Disability Insurance Claims?

All disability claims have limits in what they cover. If you have a group long-term disability policy, there’s a good chance that it includes a complete exclusion for any disabilities caused by a pre-existing condition. Many private long-term disability insurance policies normally include this exclusion as well. To get around this exclusion, some policies force individuals to pay higher premiums for special coverage that does not include this exclusion.

Pre-Existing Condition Exclusion | Houston TX Disability Attorney

With a pre-existing condition, whether physical or mental, you might not be able to receive benefits if your disability arises from the pre-existing conditions. By contacting Herren Law in Houston TX, long-term disability attorney William Herren fully understands the nuances of pre-existing condition exclusions in LTD policies. As such, if you are thinking of claiming disability benefits, call attorney Herren today by dialing (800) 529-7707. Free consultations are always available.

What is the Pre-Existing Condition Exclusion?

A disability insurance pre-existing condition is a mental or physical condition that the applicant has prior to the effective date of the insurance policy. If you have such a condition that you knew about or should have known about for two years prior to the effective date of the policy, then you need to look over your policy, as many LTD insurance policies won’t pay benefits for disabilities coming out of a pre-existing condition.

The company that issued the LTD insurance may deny a claim if it finds that the disability:

  • Resulted from a pre-existing condition which was not disclosed in this policy’s application; and
  • Begins within 2 years after the Policy Date

Additionally, a pre-existing condition is defined as:

  • A condition in which medical treatment was recommended by a doctor or received from a doctor within the 2 year period prior to your Policy Date; or
  • A condition 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.
  • Any condition that was misrepresented or undisclosed at the time of application.

It is important to note that some insurance providers misuse the exclusion to avoid paying disability insurance claims or to delay or deny payment of legitimate claims. As such, when three years or more have elapsed since the onset of a disabling condition which manifested itself from a pre-existing ailment, then, in theory, the insurance company should pay benefits. Nevertheless, the insurance company may still deny benefits, in which it is highly advised to contact an experienced disability insurance attorney.

Disability Insurance and Pre-Existing Conditions

There are virtually endless pre-existing conditions that can form the basis of a disability. However, some of the most common pre-existing conditions to know about include, but are not limited to:

  • Pregnancy — A pregnant woman applying in her first trimester may still receive benefits; nevertheless, the insurance company may deny benefits if she is unable to continue to work as a result of complications arising from her pregnancy.
  • Diabetes — Most people with diabetes have difficulties in even getting a policy. Experts recommend getting the disease under control first to increase chances of finding an insurer.
  • Alcoholism and Drug Use — Getting a disability policy as an alcoholic or drug addict depends on how these conditions contribute to the person’s disabling health condition. A DAA determination (drug and alcohol abuse) will be used to evaluate an applicant.
  • Cancer — Cancer survivors also find difficulties in getting a policy. In general, access to insurance may depend on the individual company or Texas laws.

How to Avoid Claims From Being Denied Because of Pre-Existing Medical Conditions

To minimize the chances of your claim being denied because of a pre-existing medical condition, there are a couple of things you can do. For instance, you should be aware of the medicines you are taking, as some medicines may classify you under a high-risk group. Also, take note of any past injury treatments administered before you purchased your policy; these may be used against your claim. Lastly, simply understand that any record of treatment or surgery that shows you are prone to suffer disability can also be used to deny a claim.

Contact Disability Insurance Attorney William Herren Today!

If your insurance claim is denied due to a pre-existing condition and you might want to appeal, make sure to call Houston TX long-term disability attorney William Herren today. We offer comprehensive legal representation to make sure that your rights are protected and that your voice is heard. In the Houston area, we have helped numerous people just like you with their insurance claims, and we have the resources and legal know-how to represent your interests in front of the major insurance providers, including the Social Security Administration.

For a free, no-obligation consultation with attorney Herren, call Herren Law in Houston today at (713) 682-8194.

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