What counts as a preexisting condition in terms of long-term disability will vary from contract to contract. Remember that long-term disability claims are contract claims. Unfortunately, many employees do not get a copy of their contract of insurance when they go to work for somebody. All they typically get is a benefits quote. However, there will be a clause in the actual contract that limits coverage due to pre-existing medical conditions under some criteria.
The first place to look for a definition of pre-existing medical condition is in the contract itself. It is important to remember that different contracts define pre-existing medical conditions in different ways. Two companies operating side by side could have two radically different definitions of pre-existing medical conditions. For this reason, you should reach out to a Barrie lawyer for help with determining the significance of a pre-existing condition in your long-term disability claim.
It is important to identify pre-existing medical conditions before filing a long-term disability claim in our area, because many contracts for disability law have what are called exclusions. Even if you meet the test for disability and are unable to do your job, if the insurance company can establish that you fall inside the pre-existing condition clause, they can argue that you are not entitled to benefits regardless of whether you are disabled.
The insurance company may use this clause and a pre-existing medical problem as justification for denying you the benefits you need. This clause is actually getting broader. We are seeing clauses now that talk about whether an employee had a pre-existing condition that caused or contributed to their disability. Even if they have another type of disability, our lawyers are seeing clauses that attempt to limit coverage.
Pre-existing clauses include injuries as well as medical conditions. For instance, the diagnosis of cancer, schizophrenia, HIV, diabetes, or mental health would qualify as much as falling down a flight of stairs or being in a car accident. The typical clause says an injury within X number of months or a diagnosis within Y number of months is either not covered at all or not covered for a certain period of time. This can be used to deny a long-term disability claim.
The challenge of pre-existing condition provisions is determining whether they pose a significant threat to your eligibility for long-term disability benefits in Barrie. Insurance companies tend to adopt a broad definition of a pre-existing condition and have to decide whether it’s applicable on a case-by-case basis.
For instance, if you have pre-existing depression but suffer from post-traumatic stress disorder as a result of an incident, an insurance company might try to deny your claim based on your mental health problems when, in fact, PTSD and depression are two different problems. In this situation, the pre-existing condition exclusion does not apply, but the insurance company will attempt to use it to evade its responsibility to pay benefits.
You must use medical evidence, doctors’ testimony, and coworkers’ testimony to establish that you were able to work without restriction prior to becoming disabled. Next, you have to prove that whatever caused your disability is not a pre-existing condition that might limit coverage.
Our team of lawyers could help you draw a complete picture of your disability. It’s imperative to tell your story with your doctor and others to establish why you were capable of working before even though you had this problem, and what is different now that prevents you from being able to work. Demonstrating the significance of a pre-existing conditions in a long-term disability claim could be made easier with the help of a skilled Barrie lawyer. Call Rastin Law today to learn more.