Question
Can MassMutual deny my claim based on a pre-existing condition?
I took out a disability insurance policy and shortly after I had a unplanned pregnancy with complications. I’m a RN and my doctor took me off work because I was unable to perform my duties. I then went to file a claim with my new insurance and it has been months. Today I was notified because I failed to acknowledge a previous back condition which I recovered from 100 percent and have no deficits they were going to probably deny my claim for pregnancy complications. Can they do that? They said one possibility is they will make the policy null and void and reimburse me my monthly premium I’ve been paying. I just don’t feel it’s fair for them to back out on my policy for a previous back injury because I’m having complications d/t pregnancy which has nothing to do with my back. I’m just at a loss! We get insurance in case we need it and then when we need it we can’t use the insurance! I’m just at a loss.
Answer
Monique, it will depend on the language in the policy as it relates pre-existing conditions. When a claim is filed within 12 months of the purchase of a policy, a carrier will review the application submitted to obtain the policy to see if there was any “material misrepresentation” made on the application that would have resulted in the carrier denying coverage, excluding a medical condition, or adjusting premiums on account of a prior medical condition. That may not be the case with your situation, but it is a starting point. When you receive a copy of the denial letter please contact our office so we can discuss your situation in detail to determine if we can be of assistance.
