What are self reported condition limitations in a group long term disability insurance policy?

    Disability attorney Stephen Jessup discusses the definition of “self reported condition limitations” in a group long term disability insurance policy.

    A self-reported symptom condition limitation are unfortunately starting to become more prevalent in group disability policies. This limitation is aimed at directly trying to limit usually to a 24-month period certain conditions such as chronic pain, fibromyalgia, chronic fatigue syndrome, and in some policies, they even define to include headaches or migraines. These are unfortunately a lot of the claims that you see people are out on disability for.

    So this gives the insurance company the ability to say, “Yes, we agree that you have the condition, unfortunately, it’s capped at a 24-month period.” Now some policies do have exceptions to get around certain self-reported limitation conditions provisions and policies, but each policy, the review and analysis is different on it. So if you do have a question or concern or the insurance company is sending you a letter, usually at the time their initially approving your claim that it’s limited to a two-year period, that’s a good idea to contact our office to take a look at it to see if there’s a way to maybe try to set up your claim to avoid having benefits cease at the end of that 24-month period.

    Comments (4)

    • Michael, yes, your PTSD would likely be limited under most group disability insurance policies. If you have a copy of the policy, please contact us and we will gladly review it with you.

      Alex Palamara Jul 7, 2021  #4

    • Is PTSD affected by this exclusion, as many are self-reported symptom, or is it classified as a mental disorder which would invoke the 2 year limitation that I have seen in my company LTD policy? Thank you for your help.

      Michael M. Jul 7, 2021  #3

    • Rob,

      Good question. The answer to it depends exclusively on the language contained in your disability policy. Some disability insurance policies have a US residency requirement. Some LTD disability policies require you to live in the US for at least 6 out of 12 months of each year.

      Gregory Dell Oct 18, 2012  #2

    • Can you collect disability benefits and live abroad? I have been disabled from lupus and lung disease for 10 years and want to live in Mexico.

      Rob Oct 17, 2012  #1

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