What Tech Workers Should Know About Pre-Existing Conditions and LTD Claims

For tech workers who rely on their health to maintain a demanding career, a long-term disability (LTD) can be devastating. The situation becomes even more stressful when an insurer denies your claim based on a “pre-existing condition.” Understanding what this term means and how it impacts your claim is the first step toward securing the benefits you rightfully deserve.

Here are the key takeaways for navigating this complex issue:

• Understand Your Policy: The “look-back” period and definition of a pre-existing condition are critical terms in your LTD policy that dictate your eligibility.
• The Impact of a Pre-Existing Condition: Insurers use these clauses to deny claims for conditions that were treated or showed symptoms shortly before your coverage began.
• How to Protect Yourself: Proving your disability is not pre-existing requires careful documentation and a strategic approach to your claim.

How Do Pre-Existing Conditions Affect LTD Claims?

Most group LTD policies contain a pre-existing condition exclusion clause. This allows an insurance company to deny a claim for a disability that arises within a specific timeframe after your policy becomes active (usually the first 12 months). The insurer will “look back” at a set period before your coverage started (typically 3-6 months) to see if you received treatment, took medication, or had symptoms of the condition that is now disabling you.

For tech workers, this can be tricky. Say you sought physical therapy for occasional back pain before starting a new job. If you later develop a degenerative disc disease within the first year of your policy, the insurer might call it a pre-existing condition and deny your claim, arguing the earlier symptoms were related, even without a formal diagnosis. This common tactic leaves many professionals without a financial safety net.

How Do I Know If My Condition Is Considered Pre-Existing?

The answer lies in the fine print of your policy. You need to identify two key elements:

• The Look-Back Period: This is the window of time before your coverage began that the insurer will scrutinize for any medical care related to your disabling condition.
• The Exclusion Period: This is the timeframe after your coverage begins during which a disability arising from a pre-existing condition will be excluded.

If you received treatment, consultation, or medication for a condition during the look-back period, and then file a claim for a related disability during the exclusion period, your claim is at high risk of denial.

What Steps Should I Take If My Claim Is Denied?

Receiving a denial letter is disheartening, but it is not the end of the road. You have the right to appeal the decision, but this is a critical stage where your actions can determine the final outcome. The appeal is often your last opportunity to add evidence to your file before a potential lawsuit.

If your claim is denied based on a pre-existing condition, you should immediately:

1. Request Your Claim File: Get a complete copy of your claim file from the insurer to understand the evidence used for your denial.
2. Gather Strong Medical Evidence: Work with your doctors to obtain clear medical opinions that distinguish your current disability from any prior conditions. For example, your doctor could clarify that previous back pain was a minor strain, unrelated to your new disabling spinal condition.
3. Consult an Experienced Attorney: An LTD attorney can analyze your policy and the insurer’s reasoning to build a strong appeal. We can help prove that the insurer misapplied the exclusion or that your condition is new and unrelated to any prior health issues.

Your Success Is Our Priority

At Bartolic Law, we challenge unfair denials based on pre-existing condition clauses. We understand the tactics insurers use and know how to build a case that proves your right to benefits. Don’t let a complex policy detail stand between you and financial security. Contact us today for a consultation to learn how we can turn your denial into an approval.