What Are Preexisting Condition Exclusions in LTD Insurance Policies?

What Are Preexisting Condition Exclusions in LTD Insurance Policies?

Most employer-sponsored group long-term disability policies will contain an exclusion for any preexisting medical conditions. This means that if employees become unable to work due to a medical condition that they previously had, they may not be able to collect long-term disability benefits if they are unable to work. Although the language in disability policies regarding preexisting conditions can vary widely, the effect of any such clause is to help insurance companies avoid paying out long-term disability benefits to members of the plan.

In many cases, a preexisting condition clause will refer to two different time periods: the “lookback” period and the “waiting” period. The lookback period provision defines what conditions qualify as preexisting under the terms of the policy. Generally, during the lookback period, any conditions for which you received treatment or services, including diagnostic tests, qualify as preexisting conditions. A lookback period often lasts between 3 and 12 months, although it varies by policy.

The second time period at issue is the waiting period, which is the amount of time that must pass before you are entitled to coverage for a qualified preexisting condition. Many policies require that you be covered under the policy for a period of one or two years before you are entitled to coverage for preexisting conditions, but the length of this period can vary widely from one policy to the next. Some policies also may have a clause that permits coverage of preexisting conditions after a shorter timeframe, but only if you receive no treatment for the condition within that timeframe. Insurance companies often deny initial long-term disability claims, even when you are clearly entitled to benefits, whether based on preexisting conditions or another reason. Bonnici Law Group has the experience and knowledge that you need as you seek compensation for your injuries and struggle to recover from them, both physically and emotionally. We know how to help you create and maintain a strong claim for relief supported by the evidence and obtain the best outcome possible in your case. Do not hesitate to contact Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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