If you need to apply for long-term disability benefits following a medical diagnosis that prevents you from performing the duties of your job, depending on your insurance policy, a pre-existing condition may complicate the application process.
The rules and stipulations regarding pre-existing conditions differ between insurance companies. In some situations, a claimant’s pre-existing condition may prohibit them from collecting long-term disability benefits, even if their medical conditions prevent them from returning to work.
Unfortunately, since every insurance policy is different, there is no one-size-fits-all answer regarding the impact pre-existing conditions may have on your eligibility for long-term disability benefits. If you have difficulty understanding the conditions of your insurance policy, a long-term disability claims lawyer may be able to review the terms and offer useful advice.
If you have a pre-existing condition and, as a result, your employer’s group insurance plan will not cover your long-term disability benefits, you may wish to purchase adequate coverage for yourself through a private insurance policy. The Canada Pension Plan (CPP) may also offer you compensation if your medical condition prevents you from earning a living irrespective of your pre-existing condition. If eligible, you may apply to the CPP in addition to filing a claim with your insurance company.
Pre-Existing Conditions and Full Exclusion Clauses
If your insurance policy includes a full exclusion clause, the insurance company may deny your claim for long-term disability benefits if your pre-existing condition led to your disabling medical condition. Pre-existing conditions that are often excluded from insurance coverage include:
In many cases, if your policy includes a full exclusion clause, even if you’ve paid into your insurance policy for a long period of time before your pre-existing condition led to a disabling medical diagnosis, your insurer may still deny your claim for benefits.
Pre-Existing Conditions and Limited Exclusion Clauses
Insurance policies featuring limited exclusion clauses for pre-existing conditions may not be as strict as full exclusion policies. These policies may offer disability coverage for disabling medical diagnoses resulting from pre-existing conditions after policyholders have paid into their plans for a set period of time. Claimants with pre-existing conditions may need to work for their employers for several years before they become eligible to recover long-term disability benefits. This predetermined length of time is referred to as an exclusionary period.
Exclusionary periods may vary in length, depending on the policy. If you have a pre-existing condition, speaking with a representative from your insurance company may help you determine if you are currently eligible to receive long-term disability benefits.
Conditions that Long-Term Disability Benefits May Cover
Generally speaking, individuals may only be able to claim long-term disability benefits if they have been diagnosed with an illness or sustained an injury that prevents them from working for a significant amount of time. Before applying for long-term disability benefits, claimants may first need to exhaust their other compensatory options, such as sick leave, vacation pay, or short-term disability benefits.
The Ontario Health Insurance Plan (OHIP) provides detailed information about medical conditions that may qualify claimants for long-term disability benefits include. These medical conditions include:
- Chronic obstructive pulmonary disease (COPD)
- Heart disease
- Neck or cervical disorders
- Chronic pain or chronic fatigue syndrome
- Lupus or Lyme disease
Call Preszler Injury Lawyers to Discuss Your Claim
If your claim for long-term disability benefits has been denied due to a pre-existing condition, and you believe you should be entitled to coverage, Preszler Injury Lawyers may be able to offer useful advice and, if you’re eligible to do so, may help you litigate your insurance company’s decision. Call Preszler Injury Lawyers today at 1-800-JUSTICE to discuss your claim in a free, initial consultation.