It seems there are more and more Long Term Disability claims coming to our attention here at Herbert M. Hill, P.A. involving pre-existing conditions. Let me explain generally how this exclusion works. However, let me remind the reader that the governing Plan Documents have to be reviewed to be specific to your circumstance.
Generally, if you become disabled during the first year after the insurance becomes effective, the insurance company will conduct a “pre-existing condition” review. This review is to determine whether there was any treatment or need for treatment of the now disabling condition during the three(3) months immediately preceding the date the insurance became effective. If so, they will deny your claim. The problem is the insurance companies generally will use any medical condition or treatment as evidence of a pre-existing condition.
On the other hand, Courts which have reviewed these claims make it certain that the claimant does not have to be in perfect, pristine health to get past the pre-existing condition exclusion. If there is a question about a pre-existing condition, this is one time I want the client to come to me as soon as possible so that the medical evidence can be presented in a manner which will enhance the chances of successfully getting past this rather dangerous barrier to benefits.
If you would like, after discussing your case, we can set a conference. In most circumstances, that conference would be free of charge but in no circumstance would you be under any obligation to hire me nor would you feel any pressure from me to do so.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida with a practice extending throughout the state of Florida. While the vast majority of cases handled are for disability insurance benefits, areas of practice include employee benefit claims of all sorts. The firm handles any claims arising under the Employee Retirement Income Security Act (known and referred to as “ERISA”) for disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements or the like as well as claims arising under private disability policies.