Disability attorney Stephen Jessup discusses if a claimant’s disability claim can be denied due to a pre-existing condition.
Your long-term disability claim can be denied for a pre-existing condition; however, it’s a very fact-specific analysis as to how it’s going to happen. For instance, on a private policy you purchased on your own, if you failed to disclose a medical condition on the application for benefits and then later on you file a claim for that same condition, the insurance company, in conducting their review of your entitlement to benefits, will get medical records. If they see that there is a condition that you didn’t disclose on the application, they will more than likely deny your claim for a pre-existing condition. On top of that, there’s a good chance that they’ll rescind the policy, no matter how old it is as for almost making a fraudulent misrepresentation on the policy.
Now on ERISA-governed group policies you get through your employer, for the most part, as soon as you become employed if there’s a waiting period to become eligible, you’re going to be covered under the plan. However, they do have pre-existing condition clauses contained therein. Usually a safe bet is if you haven’t filed a claim for disability within a year of being covered under your employer’s plan, more than likely you’re not going to fall into a pre-existing condition situation. However, all policies do differ, so if you do have questions, contact us and we can definitely review the policy for you.