Question
Should I file an appeal if Guardian denied STD due to a preexisting condition that is not actually preexisting?
I have had a seizure disorder (Grand Mal) for 15 years. The disorder has always been controlled with medication and I have always been able to work. In September 2015, my wife started noticing changes in my behavior and memory. We thought it was due to my diabetes. As it turned out, I was having absence seizures. The doctors have told me that I can not drive anymore, or at least not until we can get the absence seizures under control with a new dosage of medication. I became eligible for STD through Guardian on February 1, 2015. I was denied STD due to it being considered a “pre-existing condition.” The doctor reports clearly state that the “absence seizures” are totally new as I’ve not had them before, but I was still denied. Do I have any recourse? Would filing an appeal be a complete waste of my time?
Answer
First and foremost, when was the denial? You only have 180 days to submit an appeal of a denial and if your claim is from February the first concern would be timeframes. Beyond that we would need to see the denial letter as well a copy of the policy to better assess the likelihood of prevailing on an appeal. Please feel free to contact our office to discuss same.
