Long-term disability insurance provides individuals with benefits when they are unable to work for a lengthy amount of time due to injury or illness. However, long-term disability insurance policies often contain exclusions, which can result in the denial of benefits in some situations. While no two insurance policies are alike, some exclusions are common to many long-term disability insurance policies.
First, many disability insurance policies contain a preexisting condition clause. If you have a medical condition for which doctors had diagnosed and treated you for before you applied for disability insurance within a designated amount of time, your insurance company is likely to invoke this clause. Your insurance policy may impose both a “look back” period and a “waiting” period to place limitations on paying benefits for preexisting conditions.
Another common type of exclusion is the mental/nervous limitation. Under this exclusion, payment of benefits is limited for any disabilities that arise from mental or nervous conditions, such as depression, anxiety, or dementia. While coverage periods may vary, a standard coverage period is one to two years. As a result, even if you still are disabled after two years, you no longer will be able to receive benefits for a mental/nervous condition.
Long-term disability insurance policies often limit or exclude coverage for disabilities related to alcohol and substance abuse. In some cases, long-disability insurance policies do not cover these disabilities at all, and in other plans, there are limitations on the timeframe for which you can receive benefits, such as 24 months.
Other standard exclusions may include denial of benefits for suicide attempts, healthy pregnancies, and work-related injuries. Some policies also may exclude injuries caused by aircraft on scheduled flights, wars or acts of wars, and intentional actions that cause disabilities.
Bonnici Law Group has handled the claims of countless individuals who have encountered difficulties in procuring long-term disability benefits under their employers’ ERISA-governed insurance policies. We will protect your rights and advocate on your behalf throughout every stage of the claims process. Call our office at 619-259-5199 to set up an appointment to speak with us today.