Disability Insurance: Do Pre-Existing Conditions Affect Your Claim?

disability insurance claims lawyer los angeles

Disability insurance is critical for employees, especially those who are in high-risk industries. The policy protects you from the risk of income loss, giving you a financial cushion in case of an injury.

But what if you already have a pre-existing medical condition when you apply for disability coverage? Will this make it difficult for you to file a claim? The answer varies per case.

Pre-existing conditions are common reasons for disability claim denials. However, you should still be entitled to some disability coverage, even if you have an illness. If you feel that your claim was unjustly denied, a disability insurance attorney can help you file an appeal.

People with pre-existing conditions still qualify for disability insurance. But most insurance companies have an exclusion clause in their policies, limiting your coverage.

Disability Insurance with a Pre-Existing Condition

Pre-existing conditions are a significant part of insurance underwriting, so these can influence your policy’s terms. The carrier can decide to insure you and provide coverage for your condition, but you most likely have to pay higher premiums.

Some conditions are too severe to include in the policy coverage, though. The most common conditions that automatically disqualify the applicant are the following chronic diseases:

  • Parkinson’s disease
  • Blood disorders
  • Multiple sclerosis
  • Renal disorders
  • Cancer

Some carriers may still offer disability insurance to people with cancer if they’ve been in remission for at least three years. In this case, you can get disability coverage, but not for cancer.

Disability Insurance Exclusions

The exclusion clause prevents you from filing a claim for disabilities related to your condition or for undisclosed ailments. For example, if you suffer from kidney failure because of your diabetes, the disability insurance company will likely deny your claim. But if your kidney fails for a different reason, you can collect your benefits.

This is why it’s important to detail your pre-existing condition when you apply for disability insurance. Exclusions are narrowly defined, indicating specifically when you can and can’t collect benefits. As such, you should file a claim if you get a disability for any reason. The insurer may still pay out benefits, depending on the language of their exclusion clause.

Disability insurance exclusions aren’t limited to medical conditions; they also include high-risk activities. The insurer will ask you upfront if you participate in skydiving, rock climbing, or other extreme hobbies. If you do, disabilities caused by these activities won’t be included in your coverage. 

Most exclusions are permanently written on your insurance contract. However, you can get some of them reviewed a few years after your policy goes into force. During the reconsideration period, you may prove that you’ve recovered from your condition or that you’ve been symptom-free for a while. The insurer may remove the exclusion, recalculate your risk, and lower your premiums.

If your claim for disability benefits is denied without a valid reason, seek the legal advice of a disability insurance lawyer. They’ll review your insurance contract, medical history, and the details of the disability to determine if the denial is justifiable. If not, they’ll help you appeal the claim and collect your benefits.

Disability Insurance Attorneys in Los Angeles

Fighting with insurance companies is a problem you don’t need when you have a disability. Haffner Law has a team of experienced insurance attorneys who will assist you with your disability claim. We’ll review your case and help you build a solid argument to make sure you receive the benefits you deserve.

For a consultation with a Los Angeles disability insurance lawyer, give us a call at 213-514-5681.

(This is an attorney advertisement by Joshua Haffner)


Bad Faith Insurance: 4 Tricks Insurance Companies Do to Devalue Your Claim

Bad Faith Insurance Attorney Los Angeles County

Disability insurance provides financial relief to employees who can’t work temporarily due to a disability. Short-term policies offer the worker a portion of their salary if they’re unable to work for three to six months, while long-term policies are for those who need more than six months to recover.

However, plenty of insurance companies aim to pay out as little as possible, which puts you at a disadvantage. If your insurance provider fails or refuses to process, investigate, or pay your claim, you have the right to file a lawsuit for bad faith insurance.

It’s critical to know the signs that your insurance is attempting to low-ball you. These four red flags tell you that it’s time to seek the counsel of an experienced disability insurance lawyer and bring your case to court.

1.       Changing your policy term

Some companies modify the terms of your policy to create a loophole that would let them deny or reduce your settlement. Often, they make the changes without notifying you and hide them behind confusing jargon.

It’s important to keep your copy of your original insurance contract and any succeeding amendments to protect yourself from this kind of deception. This will allow you to compare the documents and determine if the insurance company changed your policy term without your knowledge.

2.       Not acknowledging your claim or your evidence

The elements of bad faith claims differ per state, but one of the most common factors is the insurance company’s failure to acknowledge your claim or even the evidence you provide. Although this is not conclusive evidence of bad faith, it can help you build your case.

When your insurer ignores your medical receipts, hospital bills, or damage estimates, it may be a sign that they are planning to reduce or reject your claim. Some companies will also try to dispute your medical claims, weakening your case by arguing that your disability or injuries are not as severe as you say.

3.       Offering a quick settlement

Some injuries may not immediately show symptoms. Traumatic brain injuries, for example, may have subtle symptoms that lead to severe eventual impairment.

Insurance companies have enough experience to understand that some disabilities take time to manifest. So they will rush the process and offer you a quick settlement before you get a clearer picture of the extent of your injuries.

4.       Advising you not to seek legal counsel

This is the most alarming sign that your insurance provider is trying to low-ball you. It can be an attempt to keep you uninformed of your legal rights and options, which prevents you from fully understanding the terms of your policy.

They will try to convince you that lawyers are expensive, which only adds to your medical bills. But this is not always true. Some insurance attorneys work on a contingency basis, so you don’t have to pay them if you lose the case.

You want a capable lawyer by your side to make sure that you understand your policy, your paperwork is accurate and complete, and your case is as solid as possible.

Disability Insurance Lawyer in Los Angeles

At Haffner Law, our disability attorneys are experienced and aggressive in dealing with bad faith insurance. We will guide you throughout the process and gather as much evidence to establish a strong case. Our lawyers will also assist you in appealing a rejected claim, helping you fight for the settlement you deserve.

We offer a free, no-obligation consultation. Contact us at 1-844-HAFFNER (213-514-5681), and let’s discuss your case.

(This is an attorney advertisement by Joshua Haffner)

Factors Affecting The Timeline For Long-Term Disability Insurance Claim

disability insurance attorney in los angeles

If you’ve applied recently for long-term disability insurance, one of the things you should keep a close eye on is the processing time. The Employee Retirement Income Security Act of 1974, or ERISA, requires your insurance provider to decide on your filed initial and completed long-term disability application within 45 days.

Your insurer, however, can request a 30-day extension if the plan administrator is unable to arrive at a decision and require more processing time. After the first extension, your insurer can request another 30-day extension if more time is required. The insurance provider, however, has to provide you with an explanation of these extensions. All in all, the initial decision can take up to a lengthy 105 days.

Though the ideal scenario is to get your long-term disability claim as quickly as possible, certain factors can extend the overall processing time. These are:

Your Current State of Health

If you are facing a range of health problems, your insurance company will ask for your medical records. They will request more of these records when you have various issues with your health. Sadly, the processing time for each record request could take several weeks. On top of that, your insurer may require you to undergo additional testing to assess the impact of your disability. They may ask you to go through a Functional Capacity Evaluation (FCE) or an Independent Medical Examination (IME).

Response Time to Information Requests from Your Insurance Provider

Your insurer may delay — or in worse cases, deny — your claim if it is missing vital information. The processing time may also protract if you are unable to meet the deadlines set by your insurance provider. Delaying your responses, at the very minimum, can put your application at risk of denial.

The Cooperation and Prompt Response of Your Doctor

Since your doctor will be the one filling out the medical forms provided by your insurance company, the amount of time he/she spends on completing them will affect your application timeline. You can reduce the need to extend the decision-making process by making sure that your doctor delivers timely responses to your insurer.

Get Disability Claims Assistance from Our Law Firm

Some insurance firms are notorious for delaying processing in an attempt to avoid paying out claims. They may make up excuses for failing to return your calls, not receiving the required information you’ve sent to them, and asking further medical documentation already provided by your specialist. If your insurance provider denies your claim and you appeal, they may give you the runaround to avoid transacting with you and giving you the long-term disability benefits you need.

When you find that your insurance provider is unreasonably delaying the processing time of your application, and you need help to appeal a denied claim, you’ll need a reputable attorney on your side. With Haffner Law, you’ll receive the assistance you need to get the benefits you deserve.

Our experienced disability insurance lawyers will work with you to submit accurate and complete paperwork to the insurance provider. If your insurer denies your claim, we’ll review your case and help you appeal a disability denial. On top of that, we’ll pursue legal action against your insurance company if they are unfairly delaying the processing time of your claim.

Call 1-844-HAFFNER (213-514-5681) to arrange a free, no-obligation consultation.

(This is an attorney advertisement by Joshua Haffner)

Why Valid Insurance Disability Claims Get Denied and How You Can Avoid It

Disability Claims Lawyer Los Angeles

Sometimes, even if your disability is genuine, your disability claim may still be denied by your insurance company. It should not come as a surprise.  Insurance companies are not there to help prove your disability even if it’s evident—the burden of proof rests on your shoulders. Specifically, it is dependent on the completeness and strength of the medical evidence you can present.

There are practical steps you can take to avoid getting denied. Whether filing for short- or long-term disability, hiring a disability attorney in Los Angeles will be helpful, to make sure all the bases are covered.

If you feel confident enough to file the claim on your own, make sure you understand your rights in the State of California and your responsibility to present sufficient evidence for your case. Also, be aware that some insurance companies may hire someone to gather evidence that disproves your claims.

Know Your Rights in Los Angeles, CA. Beware of Discretionary Clauses

Beware of disability insurance policies slanted in favor of insurance companies, especially due to discretionary clauses. Discretionary clauses are provisions in an insurance policy or plan that can only be interpreted by the plan administrator or provider.  Although they’re no longer allowed in California, some insurers may think they can still get away with the old system.

The problem with discretionary clauses is obvious. Only the insurer or plan provider can determine who is eligible to receive benefits as a result of the clause or resolve questions concerning it.

Since 2012, the California Insurance Code section 10110.6, which says that grants with discretionary clauses can be made void and unenforceable, have protected California residents from this shady practice. As an insured employee or disability insurance policyholder, you should know that you can contest such provisions should you find them in your insurance policy.

Be Proactive in Submitting Medical Proof

Make sure that you submit the required medical documents on time. Note that some insurers may “fail” to get your medical records on purpose.

Your insurer should give you a list of medical records for submission. If they don’t, ask for it. Make sure you’re not missing anything out. Get receiving copies signed. Once you’ve submitted all required documents, verify with them that they have received every document you sent them.

You should also get a written statement from your doctor or doctors and make sure it’s clear on the severity of your situation and the length of time it takes to recover from it if it’s not permanent.

Be proactive. Most long-term disability cases will be denied due to a lack of medical proof. Telling the truth is not enough. You have to prove that you are telling the truth.

Prevent Counter-Evidence. Be mindful That You’re Under Investigation

Your insurance company may hire an investigator to gather evidence to disprove your disability claims. Evidence can be in the form of surveillance videos, social media posts, proofs of your activities, and even non-appearance to medical appointments.

It is possible to find evidence that misrepresents your true condition. Let’s say your doctor diagnosed you with fibromyalgia. Your particular state will make you unable to work on bad days, but may allow for some good days. Your employer may also advise you not to work during some good days to manage your condition.

If, during a non-working good day, an investigator took a video of you carrying your garbage out or raking leaves on your lawn, your insurer may use the video against you. It wouldn’t be an accurate representation of your condition, but the video will be hard to refute.

You may contest by presenting your doctor’s statement, but what if it’s too late to submit one? And what if your doctor says he doesn’t allow you to engage in such activities? You can’t predict how creative and imaginative people can get when coming up with evidence to contest claims, so it’s best to lie low during an investigation.

Moreover, you have to follow medical treatment and doctor’s orders faithfully. Failure to attend doctor’s appointments and follow treatment procedures may be used as evidence of the absence of your condition.

Don’t Settle

Aside from the above challenges, your insurer may also delay or slow down the filing and investigation process. And after a lengthy battle, they may offer you less than the amount you think you deserve. When this happens, you have every right to appeal your claim immediately or within 180 days, with the help of an attorney.

At Haffner Law in Los Angeles, our disability attorneys are experienced and aggressive in dealing with bad faith insurance. We will walk you through the appeals process and build you a solid case that will help you get the benefits you deserve.

For a free, no-obligation consultation, contact us at 1-844-HAFFNER (213-514-5681).

(This is an attorney advertisement by Joshua Haffner)


Not Having Disability Insurance: The Financial Risks

Disability Insurance Lawyer Los Angeles

While some people are lucky enough to live their lives without ever having to fall back on their insurance, most Americans file claims for something or other. Some of the most common policies that are claimed are health insurance, car insurance, and homeowner’s insurance. These policies are helpful in a variety of ways, but mostly for the payment of some kind of loss.

In spite of this, about 13.7 percent of Americans are uninsured. If people do not apply for something as basic as health coverage, it’s no wonder there are a lot of other types of insurance that get overlooked. Unfortunately, it’s not until a person is in the wrong place at the wrong time that they realize how much insurance policies help.

Take for example disability insurance. According to the Journal of the American Society of Certified Life Underwriters, women are three times more likely to be disabled at work for more than 90 days than their male counterparts. Yet, 52 percent of single female workers in the U.S. do not have disability coverage. Of those who are insured against disability, only 55 percent said they have enough coverage.

Why More Than Half of Single Female Workers Don’t Have Disability Insurance

There are two basic kinds of disability insurance policies: one for short-term disabilities and the other is for long-term disabilities. The former can provide financial coverage for about three to six months, although under California laws, short-term disability insurance policies can last up to a year. Meanwhile, if you become disabled for more than six months, you may qualify for long-term coverage.

Unfortunately, companies aren’t required to offer long-term disability insurance, which, taking the probability of disability among women in the workplace, means one in three women are “extremely unprepared” for any length of disability if they lose their income because they cannot work.

This figure is from the most recent findings of The Council for Disability Awareness (CDA). The CDA added that over half of the women without disability insurance said they didn’t even know enough about it.

Apart from those reasons, women may not have disability insurance because the requirements to qualify are rigorous. What’s more, the benefits of having long-term disability coverage can take months, if not years, to kick in. This means you must have an emergency fund or other financial sources for the period you can’t work, especially if your disability prevents you from doing so for a while.

In addition, some insurance providers do their best to deny you of your rightful coverage, especially for long-term disability insurance, in which case you should consult disability insurance lawyers in Los Angeles. Because of the stringent qualifications, even the smallest paperwork issues can prevent you from filing for a claim.

Turn to Trusted Disability Lawyers in Los Angeles

Insurance companies will be less likely to deny you of your claims or take advantage of your lack of sufficient knowledge about the ins and outs of disability coverage if you have legal representation. You can get that in Los Angeles from Haffner Law.

We understand how challenging it can be to file for a disability insurance claim. That is why our lawyers walk you through the process to help you get the benefits you’re entitled to.

For a free consultation, contact us at 1-844-HAFFNER (213-514-5681).

(This is an attorney advertisement by Joshua Haffner)