Question
Can MetLife decline my claim on the basis on a pre-existing condition? If they do, will I be in a mess with my employer?
I am purchasing both short-term and long-term disability insurance through MetLife via my employer. I’ve had fibromyalgia since 1995 and have had 2-3 different doctors who’ve treated me for it. None of the drugs for the disorder have worked for me — including those for fibroymyalgia, arthritis, depression. I also have panic attacks and take medication for that as well. There is a statement in our group policy that says that they may decline disability for a pre-existing condition. It’s only been in the past 1-2 years that it’s progressed and I’ve been missing more and more time off from work as a result. My question is this, I suppose: Before I subject myself to going through the process of getting my doctor to complete the disability forms, is it a good chance MetLife will deny my claim as a “pre-existing condition”? I’m 60-years-old and it’s getting more difficult daily to even do mundane tasks at home or at work. Also, if my doctor completes the form for disability and then I get denied, will I be in a mess with my employer? Because they’ll then say my doctor stated I’m unable to work. Oh boy, I don’t know what to do. Any suggestions would be helpful. Thank you.
Answer
JuJu, if you are not currently covered under any policy and MetLife does insure you under your employer’s plan then you would have a pre-existing condition for purposes of the plans. Most STD policies do not contain pre-existing limitations, but every long term disability plan would. Under most LTD plans you would have to be covered under the plan for at least 12 months before the pre-existing condition limitation would be waived. So, if you get the coverage chances are you will have to wait at least a year before you could safely make a claim under the policy. That being said, without knowing your exact policy language we would not be able to verify the timeframes accordingly.
