Disability Insurance

Almost everyone should seriously consider purchasing a disability insurance policy if they haven’t already. When it comes to financial planning, disability insurance is just as important as life or health insurance. Many people find themselves in a position of not being able to work and regret not purchasing disability insurance. If you, through no fault of your own, become partially or totally disabled, it could spell financial disaster for you and your family. But what happens if you have protected yourself and find out that you still aren’t covered because of a limitation in the policy?

Do You Have a Pre-Existing Condition?

You may have a condition for which you have been getting treatment for years. such as high cholesterol or high blood pressure. Many people who are over 55 have some kind of preexisting neck, back, or shoulder injury, whether it was 20 years ago or longer, or have even already had knee surgery or another kind of major treatment. Once you have health insurance, the law now requires that you can be treated even if you have had an illness, injury, or other medical condition for a long time.

Disability insurance is different and may have more limitations and restrictions. Most people purchase disability insurance through group plans, which are less expensive, but which almost always have limitations on pre-existing conditions. This usually applies even to conditions you weren’t being treated for if you should have known about them.

Why Do Insurance Companies Have Limitations on Pre-Existing Conditions?

Insurance companies are a business and their bottom line is that they want to make as much money as possible. Limitations on pre-existing conditions are just a way that insurance companies will try to keep from paying claims. Sometimes insurance companies will even act unethically and deny claims which are clearly good in hopes that the claimant will stop trying.

The Important First Year of Coverage

The most important thing to think of is where you are in your coverage. If you are still in the first year, your claim will undergo a lot more scrutiny. The company will try to figure out if you are making a claim so soon into your policy because you already had the condition before you even signed up for your insurance policy. Check your policy to make sure — some policies only require 3 months.

What Can You Do?

If at all possible, you should try to wait at least 12 months to file a claim once you have disability insurance. Sometimes an injury or condition comes on suddenly, and in those cases, you can’t wait. Sometimes you just have no control over when bad things happen. That is one reason it is good to sign up for long term disability insurance well before you think you really need it.

What If I Have to Renew My Disability Insurance Every Year?

It doesn’t make any difference whether or not you have to renew the policy every year. Once you are enrolled in a policy, and have gotten past the first year, it doesn’t matter if you sign up for a new policy during your open enrollment every year. You will still be covered for any ongoing conditions that started after your original enrollment.

A Recent Case

The Tenth Circuit Court of Appeals recently decided an important case about pre-existing conditions in individuals who are making disability claims. According to Attorney Rachel Alter, a truck driver filed a claim with LINA, otherwise known as CIGNA. Before he had been in his job for even a year, his retina detached and he developed macular degeneration. As a blind person, he not only couldn’t drive the truck anymore, but would have trouble working at most jobs, especially without a period of training.

LINA denied the claim and got multiple experts to testify that the condition which caused the truck driver’s blindness was a pre-existing condition, while the truck driver argued that it was something completely different that caused his blindness. The Court sided with the insurance company, and upheld the LINA’s decision to deny coverage because of the policy limitation. Unlike with a condition like a bad back, where he might have been able to wait, the truck driver had to file, but unfortunately the Court ruled that he was not covered.

A Disability Insurance Lawyer May Be Able To Help With a Disability Insurance claim Denial

A lot of claimants are denied by their insurance companies and feel like they have nowhere to turn. Many of the claims include conditions like Lyme Disease, rheumatoid-type illnesses, cognitive limitations, fibromyalgia, or orthopedic-related limitations. The insurance company will look closely not just for treatment but for any medications you may have been prescribed for any possible pre-existing conditions.

Before you file a claim, talk to a disability attorney. You can get a free consultation to discuss any potential issues in your medical history that may be red flags for your claim. If you already have a denied disability claim, that doesn’t necessarily mean it’s over. Your attorney may be able to prove what you need in order to get your insurance policy enforced. While a disability claim is very personal to you, it’s about business for your insurance company. Let your attorney handle the stress of researching the issues and arguing your case.

Can I get around a pre-existing condition limitation in a disability policy?