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.