The specific terms of your long-term disability insurance policy will dictate whether you are eligible to claim benefits if a pre-existing condition prohibits you from performing the duties of your job. A pre-existing condition is any type of medical condition that you sustained before your insurance policy went into effect.
Clauses in your insurance policy may stipulate that a specific amount of time must pass after your coverage begins before you can be eligible to receive long-term disability benefits for claims related to your pre-existing conditions. These “exclusionary periods” are put in place to prohibit individuals with previously diagnosed, chronic conditions from immediately submitting a claim for benefits upon beginning their coverage.
Policyholders who neglected to disclose their pre-existing conditions when applying for insurance may not be eligible to receive long-term disability benefits for related claims.
Pre-Existing Conditions and Your Disability Insurance Benefits
According to the Ontario Human Rights Commission report on life and disability insurance, many insurance providers withhold benefits for disabilities related to pre-existing conditions during the first two years of a policyholder’s coverage. This means that, even if an insured employee is no longer able to perform the duties of their job due to a disability caused by a pre-existing condition, their claim for long-term disability benefits may be denied if they have been covered for less than the stipulated exclusionary period.
Once this exclusionary period ends, eligible policyholders may be able to receive long-term disability benefits, even if their disabilities were caused by pre-existing conditions.
The exact length of your insurance plan’s exclusionary period clause should be located within your policy.
Fighting an Unfair Long-Term Disability Benefit Denial
If your insurance company denies your benefits claim because of your pre-existing condition, a long-term disability claims lawyer may be able to review your policy and determine whether the denial was unfair. If your insurer did not fairly evaluate your claim, a lawyer may be able to help you appeal the insurance company’s decision.
Long-term disability benefits claims may be unfairly denied for several reasons, including:
- The claimant’s disability is not related to a pre-existing condition
- The policyholder’s exclusionary period has expired
- Terms stipulated in the insurance policy were misleading or unclear
- And possibly more
If your insurance carrier denied your application for long-term disability benefits, a lawyer may be able to assist you by:
- Filing an internal appeal with your insurance company
- Pursuing an external appeal, or lawsuit
- Negotiating an out-of-court settlement
- Representing your case in court, if necessary
- And possibly more
You Have a Limited Time to Act
There are strict time limits for filing legal actions against a long-term disability insurance carrier. According to the Limitations Act, 2002, S.O. 2002, c. 24, Sched. B. of Ontario Statutes, claimants have only two years to file a lawsuit and pursue compensation.
Filing an appeal with the insurance company will not affect this time limit. If you do not file a lawsuit within this mandated time period, you may lose the right to pursue legal action and recover unfairly denied benefits.
Talk to Preszler Injury Lawyers About Your Claim Denial
If your insurer denied your long-term disability claim, Preszler Injury Lawyers may be able to help you understand if this was a fair decision, and appeal an unfair denial on your behalf. To learn more about options that may be available to you, call Preszler Injury Lawyers today at (416) 364-2000.