You often hear the term “pre-existing conditions” when searching for health or disability insurance. An experienced Long Term Disability lawyer in Oviedo can help interpret your policy and significantly enhance your chances of receiving the benefits you need.

Navigating Long Term Disability (LTD) claims can be complex, especially when pre-existing conditions are involved. Our firm specializes in LTD policies, and we understand the nuances of these cases. Pre-existing conditions can create significant hurdles, often resulting in denials of benefits for those who genuinely need assistance. Our focus is on guiding clients through this intricate process to secure Long Term Disability benefits, even when pre-existing conditions are a factor.

What Is A Pre-Existing Condition?

A pre-existing condition refers to any health problem, injury, or illness a person has before obtaining insurance coverage. Many insurance policies exclude coverage for pre-existing conditions to prevent individuals from acquiring an LTD policy only after discovering or anticipating a condition that could lead to a disability claim.

This rule helps ensure that individuals do not exploit the system by obtaining coverage when they know they may need to file a claim for an existing health issue, thereby maintaining a fair and sustainable insurance system.

What Is A Pre-Existing Condition Exclusion?

A pre-existing condition exclusion is a provision in insurance policies that limits coverage for health conditions that individuals already have before obtaining the insurance. It allows insurance providers to exclude coverage for claims related to pre-existing conditions for a certain period after the policy is issued.

By implementing a pre-existing condition exclusion, insurance companies aim to discourage individuals from obtaining coverage only when they foresee the need for medical care or disability benefits due to an existing health condition. Policyholders must understand the terms and duration of pre-existing condition exclusions in their insurance policies.

Ambiguous Language In LTD Policies

In legal cases involving pre-existing condition exclusions, a significant point of contention revolves around the ambiguity found in the policy language. If the exclusion wording is vague, courts typically favor the insured party, potentially supporting the insured’s claim.

Disability insurers might try to interpret the language of a pre-existing condition exclusion broadly, including treatment for conditions not diagnosed or suspected during the lookback period. In some cases, the courts have ruled against insurers for denying disability benefits due to a pre-existing condition. 

In one case, a breast cancer patient undergoing a mammogram during the lookback period faced benefit denial. The court emphasized that the mammogram was not to treat breast cancer but to monitor an existing fibrocystic breast condition. 

The distinction between treatment and diagnostic procedures, as highlighted by this case, points to the need for clear and specific language in pre-existing condition exclusions. Courts are likely to closely examine interpretations that may put the insured at a disadvantage, reinforcing the importance of precise language in these policies.

Our Oviedo Long Term Disability Lawyer Can Help

Providing accurate disclosure of your medical history is crucial when applying for disability insurance. Failure to disclose pre-existing conditions can lead to claim denials during the exclusionary period if those conditions result in a disability.

When disputes arise concerning pre-existing condition exclusions and ambiguous language in disability policies, seeking legal advice from a knowledgeable Long Term Disability lawyer is essential. If you have a pre-existing condition, we recommend consulting with an experienced attorney before filing your Long Term Disability claim.

A skilled Long Term Disability lawyer can guide you on how your condition may impact your claim and help ensure you navigate the process successfully. Additionally, an expert Long Term Disability lawyer in Oviedo plays a vital role in interpreting policy language, evaluating the legitimacy of claim denials, and advocating for your rights as a policyholder.

The attorneys at Herbert M. Hill, P.A. possess the knowledge and experience necessary to navigate the complexities of disability insurance disputes, ensuring a fair resolution for insured individuals. Contact us today to discuss your case and explore how we can assist you in securing the benefits you deserve.