Reliance Standard Life Insurance Company (Reliance Standard) says “yes” it can use the “symptom net” to deny claims, but fortunately the 11^th Circuit recently said “no”. Most have heard of a preexisting condition exclusion in a disability policy. But Reliance Standard goes further than just looking at diagnosed conditions. It interpreted its long-term disability policy's preexisting condition exclusion to include preexisting symptoms regardless of their cause.  

To explain, under the Reliance Standard policy, if you are treated for a condition during the 3-months before you are covered and then become disabled due to that condition within the 1st year of coverage, the plan does not have to pay your claim.  For example, if you are treated for cancer in January and your disability plan coverage starts in March, and you are later disabled in December a preexisting condition exclusion will apply.  Simple enough. You cannot expect the disability coverage to pay when you already know you have a condition that will disable you.

But what if you are treated for a headache in January, and coverage starts in March, and then you are diagnosed in December with brain cancer, and then you claim disability in February with this new diagnosis? Will the preexisting condition exclusion apply to the head ache treatment and bar the claim? Even if the headache was not known to be caused by undiagnosed brain cancer, some insurers like Reliance Standard may apply the exclusion since the treatment for the headache was not inconsistent with brain cancer symptoms.

In the case Johnson v. Reliance Standard Life Ins. Co., No. 23-13443, 2025 LX 530674 (11th Cir. Nov. 21, 2025) Ms. Johnson was experiencing some coughing and pain in her hands and feet in December 2015. About 7 months later she was hired by The William Carter Company, a children's clothing company. Her policy became effective in October 2016, three months after she was hired. In January 2017 she could no longer work.  She filed a claim for disability benefits 8 months later.

Reliance noted that she received treatment, during the 3 months after she was hired and before the coverage took place, for fatigue, muscle weakness, nausea and vomiting. She also had an upper gastrointestinal endoscopy. A little later she was treated for vomiting, nosebleeds, body aches, and joint swelling. At that point she had no fewer than 10 different diagnoses including fibromyalgia, lupus, somatoform disorder, and bronchitis to name a few.

Finally in February 2017, she had a lung biopsy and was diagnosed with scleroderma, a rare autoimmune disorder. Then about October 2017, she finally filed a claim for long-term disability benefits.  Reliance Standard claimed that while the treatment during the 3 months before the disability coverage became effective was not specifically for scleroderma the symptoms were not inconsistent with symptoms of scleroderma. Therefore, it denied the claim. After exhausting the claim process Ms. Johnson filed a lawsuit.

The district court agreed with Reliance Standard and dismissed the case. Ms. Johnson appealed. She argued that the language in the pre-existing condition exclusion excluded coverage for “any Sickness or Injury for which the insured received medical treatment …”. This meant that the treatment must be intended to treat scleroderma and not all symptoms that were not attributed to that necessarily.  The majority of the panel hearing this case, Judge Grant and Judge Kidd, agreed and after going through the 6-step 11^th Circuit process to evaluate ERISA claims, reversed the district court.

Reliance Standard and Judge Pryor in his dissent argued that the word “for” should be read as “because of” as otherwise such an interpretation contradicts the overall purpose of the pre-existing condition exclusion. Of course, the obvious pushback to that is that the “symptom net” is cast too broadly if any symptom, which could have different causes other than the later diagnosed condition, can be grounds to exclude a claim. Furthermore, a contract should be interpreted as written and not as an insurer later intends for it to be written. If Reliance Standard wanted to write the policy to exclude symptoms it could.

The majority also took aim at the 6-step process which the 11^th Circuit alone follows noting, “… candidly, while this six-step dance is likely unnecessarily complex (and may even obscure the lawful result in certain cases), we apply it all the same because it is our binding precedent.” Id. at *9. Again, for the second time this year, a panel has taken aim at unfair precedent. Previously, it was the exhaustion requirement for statutory claims such as breach of fiduciary duty claims.  If en banc review is requested perhaps the 6-step process will also be challenged.  For now … contract language matters. And a “symptom net” is not allowed to substitute for a “condition net” exclusion.