What Is A Pre-Existing Condition?


I am David Martin with the Martin Law group. We help people with disability policies and ERISA claims. I post a new term every Thursday. Subscribe to get the Edge in understanding your policy. 

Today we are going to be discussing What is a pre-existing condition? A pre-existing condition is a medical condition for which you received treatment before you were covered under your disability policy. If that condition causes your disability you won’t be covered. Usually there is a time limit as to how long the pre-existing condition will apply after coverage takes effect, such as one year or two years. After that, the pre-existing condition exclusion no longer applies. Obviously the shorter the timeframe after commencement of coverage, the better it is for the claimant.

For group long-term disability policies, there are time limits as to how far back in time the insurance company will look before coverage took effect. For example, if the treatment was farther back than 3 months or 6 months or one year, it is not considered. The insurance company will look at all medical visits during the relevant timeframe and look to see if one of those could relates to your current disability. Many policies also say that it doesn’t matter if the condition diagnosed or misdiagnosed. What matters is that the condition caused or contributed to your disability.

Insurance companies “weed out” claims that involve pre-existing medical problems. The danger is the company may tag a mere for a cold, relates to a long problem that arises 9 months later.

Claimants are wise to be aware of these pre-existing condition limitations. For some conditions, it would be wise to wait to file a claim until after the applicability of this exclusion lapses.

Remember we are here to help if you run into problems. Call us at the first hint of trouble.

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