ERISA disablity insurance claim: pre-existing condition denial overturned for executive
Our client suffered from Post Traumatic Stress Disorder and applied for long-term disability insurance benefits under the terms of his group disability policy. His insurance carrier denied his claim, asserting that because he took anti-depressant medication and was also diagnosed with a personality disorder within the three months prior to obtaining insurance coverage, his condition was pre-existing.
After researching his psychological documentation, our firm determined that his prior condition, for which the medication was prescribed, was separate and distinguishable for his current disability. Our firm submitted a lengthy appeal, citing applicable case law and providing significant psychological documentation. Based on this, our client’s insurance carrier reversed its denial of benefits. Our client remains on claim today.