What are pre-existing limitations?

Navigating the challenges of long-term disability insurance can be daunting, especially when dealing with pre-existing limitations. At Bartolic Law, we are passionate about turning denials into payments and are dedicated to helping you understand and overcome these hurdles. This blog will explain pre-existing limitations and provide insights into how they impact your insurance coverage.

Defining Pre-Existing Limitations

Pre-existing limitations refer to conditions—whether physical, mental, or emotional—that existed before the start date of your long term disability policy. Insurers broadly define these conditions to include any ailment for which you received treatment, had symptoms, or were diagnosed prior to the effective date of coverage. The aim is to protect insurers from adverse selection and information asymmetry.

Types of Pre-Existing Limitations

1. Physical Impairments: These include chronic conditions like back problems, hypertension, and diabetes. For example, if you experienced chronic back pain before obtaining insurance, it may be considered a pre-existing condition.
2. Mental Health Issues: Conditions such as depression, anxiety, and ADHD fall under this category. An investment banker treated for ADHD and later diagnosed with depression and anxiety could face scrutiny over whether these are considered pre-existing conditions.
3. Emotional Impairments: Stress-related disorders and other emotional challenges that existed before the policy start date are also considered.

Impact on Insurance Coverage

Pre-existing conditions can significantly affect the extent of your health insurance coverage. Insurers often apply exclusions or limitations to these conditions, which can result in partial benefits or denial of claims. For example, an executive manifesting ALS symptoms initially thought to be a lingering back injury faced a pre-existing condition exclusion. However, Bartolic Law successfully argued against this exclusion, securing full payment for the client without resorting to litigation.

Common Pre-Existing Conditions

• Back Problems: Persistent back issues, even if not formally diagnosed, can be flagged by insurers.
• Hypertension: High blood pressure recorded before the start of the policy can limit coverage.
• Mental Health Problems: Depression, anxiety, and other mental health conditions treated prior to the policy can be deemed pre-existing.

Evaluation by Insurance Companies

Insurance companies meticulously review medical histories to identify pre-existing conditions. They look back one to two years from the policy’s start date to assess any doctor visits, treatments, medications (prescribed and taken), and tests. Claims involving these conditions are often scrutinized heavily, with insurers sometimes initially denying coverage.

Disclosing Pre-Existing Limitations Correctly

1. Complete Health Questionnaire: When applying for long-term disability insurance, disclose all aspects of your medical history honestly. Failing to do so can lead to denied claims.
2. Document History: Keep detailed records of all medical treatments, prescriptions, and diagnoses.
3. Consult Legal Professionals: If you’re unsure about what to disclose, consulting a lawyer can help ensure your application is thorough and accurate.

Contact Us For Guidance

Understanding and navigating pre-existing limitations in long-term disability insurance is crucial for securing the benefits you deserve. By comprehensively disclosing your medical history and seeking legal guidance, you can mitigate the risk of claim denials. At Bartolic Law, we are committed to helping you challenge unjust exclusions and ensuring you receive the full benefits entitled to you.

For more information or assistance with your long-term disability claim, contact Bartolic Law today.