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Does Disability Insurance Cover Pre-Existing Conditions?

Disability insurance coverage, whether private or ERISA, is intended to help ill or injured workers recoup some of their wages while they are unable to work. Policyholders have the right to expect that if they pay their premiums according to the policy, which is a legal contract, they should receive payment on their claims if and when they need to make them. 

Unfortunately, far too many claimants find out that filing a claim and receiving the benefits they are entitled to receive is rarely this easy. In fact, it’s quite common for insurance companies to attempt to deny coverage whenever possible by interpreting limitations and exclusions in their favor. Having representation from skilled Chicago disability insurance lawyers is usually the best step you can take to ensure a successful claim. 

How Disability Coverage Works

You can’t receive LTD benefits until a waiting period, known as the elimination period, is over. Usually, elimination periods are about six months. During those six months, most claimants can collect short-term disability payments from their insurance company. 

To be eligible for LTD benefits, you or your Chicago disability insurance attorneys must establish that you have:

  • A covered disability as per your policy
  • The inability to perform work because of that covered disability

Once approved, you may receive benefits from two years, up until you retire, or anytime in between. However, keep in mind that if you go back to work, you will no longer be eligible to receive benefits.

Proving Covered Disabilities

Unfortunately, proving that you have a covered disability can be challenging. Many of these types of policies exclude certain types of disabilities. For instance, disabilities related to substance abuse, injuries arising from suicide attempts, or intentional acts that caused your disability are generally not covered.

Another type of injury or illness that might not be covered is a pre-existing condition. Even if your disability is unrelated to a pre-existing condition, insurance companies might attempt to connect the two to excuse their liability for paying your claim. 

If you failed to disclose a particular condition upon applying for LTD benefits or if that condition began during the official “lookback” period, coverage for your disability might be excluded or limited. Lookback periods can be as little as 90 days or as much as one year. The insurer has the right to look back in your medical records and history during the specified time period to see if you received evaluation or treatment for your condition. If your injury or illness began during the lookback period,  it could be excluded from coverage as per your policy terms. 

If they are included in the policy provisions, courts generally uphold these exclusions and limitations. However, some federal courts have ruled that just because you were being treated for symptoms and didn’t receive an official diagnosis, it’s not a basis for the insurance company to deny claims for LTD benefits under the pre-existing condition limitation. Suppose you have what might be considered a pre-existing condition or are worried about your LTD claim being denied for other reasons. In that case, it’s best to reach out to experienced Chicago disability insurance lawyers for help as soon as you can.

Speak with Chicago Disability Insurance Lawyers

At Bartolic Law, our Chicago disability insurance attorneys know how devastating it can be to have your LTD claim denied or struggle to get it approved. We also know how often insurance companies succeed at denying claims when they shouldn’t. If you want a knowledgeable Chicago disability insurance attorney to stand up for your rights and help get your claim approved or help with a successful appeal, you have come to the right place. Contact us today for a free, no-obligation consultation. 

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