Question

Why can Cigna go against their rule that states if a claimant becomes totally disabled due to a pre-existing condition after the LTD policy with Cigna has been in force for 12 months, they will waive the pre-existing condition exclusion concerning payment of benefits?

Asked on June 15th 2014 by Deb Lindstrom
Ok, a new question comes up about the ability to receive Cigna Long Term Disability Benefits following a re-determination review. When I initially applied for benefits, I listed several conditions.One involved a knee problem wherein the physician I have seen told me I needed a total knee replacement as a last course of action regarding the continuing knee pain I had.I also stated that I had bipolar disorder.This “might” be considered a pre-existing condition, but I am not sure, even after reading the policy example for Cigna I found online.I can’t find my old LTD policy docs dating back to 2008. I was actively employed by the company I had the Cigna Long Term Disability Plan with from June 2008 thru early January, 2009.Then I went on company paid disability for the next six months, ending July, 2009.In July, 2009, my Social Security Disability Benefit checks began due SSA’s determination of my total disability status effective, July, 2009, due to my bipolar disorder, the same month the company paid disability ended. So, Cigna has information regarding my continuing knee condition and my bipolar disorder.I was ensured under the Long Term Disability Plan beginning with the first month of my employment, June, 2008.When I went on company paid disability in January, 2009, it was for my bipolar disorder, a pre-existing condition. Now, Cigna’s policy plan states that it will not pay benefits for pre-existing conditions unless the claimant had an in force long term disability benefit policy for 12 months prior to when the claimant became totally disabled due to the pre-existing condition.I did have that, because even while I was on company paid disability for the six months allowed, my Long Term Cigna plan continued in force during all of that time to the best of my knowledge. I’m wondering whether, because I was out of work on company paid disability for a pre-existing condition, while my long term disability policy with Cigna remained in force, and then in the 12th month of that still in force policy, I became totally disabled in the eyes of the Social Security Admin, will Cigna use the exception to their pre-existing limitation rule that states that if a claimant becomes totally disabled due to a pre-existing condition after the Long Term Disability policy with Cigna has been in force for 12 months, Cigna will waive the pre-existing condition exclusion concerning payment of benefits.Do I qualify?Opinions?

Answer

Answered on June 16th 2014 by Attorney Alex Palamara

Deb, From the information you provided the Bi-Polar Disorder would appear to be pre-existing. Typically, if you have been working for a company (or covered under a policy) for less than 12 months and you file a claim for disability it will trigger a review by the insurance company to determine if your disability is due to a pre-existing condition. The language then typically reads that if you were receiving care/diagnosed/prescribed medicine for the condition in the 3-6 months (depending on the policy) before the effective date of coverage then the condition would be deemed pre-existing and excluded from coverage. It would not matter if your LTD was still in force while on STD, as your date of disability is the date used to determine the pre-existing condition review.