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

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)

 

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