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Disability Insurance

What You Need to Know About Disability Insurance and Pre-Existing Conditions in BC

Navigating long term disability (LTD) insurance is complex and often confusing. Vague, jargon-filled language makes it difficult to understand what coverage policyholders actually have, and under what terms. Understanding these intricacies can become even more challenging regarding pre-existing conditions. Unfortunately, insurance companies sometimes use pre-existing conditions as a way to deny benefits that are rightfully deserved. If you have been denied LTD benefits because of pre-existing conditions, or want to be well-informed about how pre-existing conditions can impact your disability insurance, you need to know what to look for in your policy and what steps to take to obtain benefits.

What Is A Pre-Existing Condition?

A pre-existing condition is any kind of health situation where you experienced symptoms or sought out medical attention. This includes a wide range of conditions like chronic illnesses, previous injuries, cancer, mental health afflictions, and even pregnancy. Insurance companies will typically conduct a health history report to determine if you have experienced anything that could be considered a pre-existing condition. Most insurance policies will have language in the terms that define what a pre-existing condition is.

Can I Get Disability Insurance With a Pre-Existing Condition?

In many cases, those with pre-existing conditions can obtain disability insurance. However, there are usually some stipulations. For instance, insurance companies may exclude coverage for pre-existing conditions for certain periods, or they may offer coverage with higher premiums or limitations. When working with an insurance company, be honest about your health history and provide relevant medical documents to confirm all details regarding your pre-existing conditions if requested.

Does Long Term Disability Cover Pre-Existing Conditions?

Generally, long term disability plans have exclusions for pre-existing conditions. So, if you have a disability related to the condition you had before obtaining LTD coverage, the insurance company will not provide you with benefits.

Can Long Term Disability Be Denied for Pre-Existing Conditions?

Though insurance companies can’t deny LTD benefits solely because you have a pre-existing condition, there are exceptions. As mentioned, some policies have clear exclusions for some or all pre-existing conditions. But even insurance plans that don’t exclude coverage for those with pre-existing conditions sometimes try to use them as a reason to deny benefits. They may assert that the current condition or injury experienced is due to or caused by pre-existing conditions.

New disabilities cannot be deemed pre-existing conditions. So, if you are unable to work because of a condition you’ve never had or been treated for, even if it occurs in the same area as your pre-existing condition, you shouldn’t be denied coverage as long as you have had continuous coverage for 12 months. Even if you have a condition that you previously suffered from or were treated for, LTD coverage might still apply as long as the condition and treatment occurred a certain amount of time before the plan was adopted, which should be specified in your policy. For example, if the pre-existing period in your LTD plan is 18 months and your condition and treatment occurred more than 18 months ago, you shouldn’t be denied benefits.

Discuss Disability Insurance and Pre-Existing Conditions

Whether you’ve been denied LTD benefits due to a pre-existing condition and want to appeal or simply want to understand your insurance policy better, a trusted legal team can help. Stephens & Holman works with clients concerning all kinds of disability insurance questions. Reach out today to learn more.