Disability claim denials and pre-existing conditions: What you must know

5 important things to remember if you are denied disability benefits due to a pre-existing condition

A pre-existing condition is a condition that you previously received treatment for, that is in some way connected to the medical issue that is currently preventing you from working. It does not refer to any condition that you have ever had before.

Sometimes an insurer will rely on an exclusion clause in your policy that says that you cannot receive benefits if you are suffering from a pre-existing condition. This is one way an insurance company tries to avoid paying you benefits.

There are many instances in which insurers try to deny claims on the basis of a pre-existing condition and are later found to have done so incorrectly. A knowledgeable long-term disability lawyer can often find a way around the denial.

Here are five important facts you need to know when your long-term disability claim is denied because you have a pre-existing condition.

1. A pre-existing condition is defined in your policy.

If the definition in your policy does not match or apply to your situation, the insurance company cannot deny you your benefits for a pre-existing condition.

2. Not every policy actually has a pre-existing condition clause.

If  your policy does not have a definition for what a pre-existing condition is, the insurer cannot deny you for a pre-existing condition.

3. Your insurer can’t deny you benefits if your disability arises after the first year.

If your disability arises after you have continuously had long-term disability coverage for 12 months or more (sometimes the amount of time will be less than 12 months), the insurer cannot deny you for a pre-existing condition.

4. If you suffered from a condition before, that doesn’t make it a pre-existing condition.

Just because you are currently off of work for something that you suffered from or have been treated for previously, that does not mean that you are not entitled to benefits. It often depends on when you were treated for that related condition.

5. Pre-existing conditions are written in a very confusing way.

If you are having trouble interpreting what they mean, make sure you contact an experienced long-term disability lawyer as soon as possible. They can help tell you if the insurer was wrong to deny you on the basis of a pre-existing condition.

Disability lawyer James K. Fireman addressed long-term disability claim denials and pre-existing conditions on a season 3 episode of the Disability Law Show.

Has your long-term disability claim been denied?

Call 1-855-821-5900 for a 100% free consultation with a long-term disability lawyer at Samfiru Tumarkin LLP in Ontario, Alberta or British Columbia.  Regardless of where you are in the process of a disability claim denial, we are happy to talk with you and answer your questions, free of charge.  You are not required to sign anything, nor do you need to give a credit card number.  Just ask questions and get answers!