You often hear the term “pre-existing conditions” when looking for health or disability insurance. An experienced Oviedo Long Term Disability lawyer can interpret your policy to give you the best chance at receiving benefits.

Navigating Long Term Disability (LTD) claims can be complicated, especially when dealing with pre-existing conditions. As a firm with extensive experience with LTD policies, we know the ins and outs of these cases. Pre-existing conditions can present significant hurdles, sometimes causing denial of benefits for those who need them. We focus on helping clients navigate this complex process, working to secure Long Term Disability benefits even when pre-existing conditions are in the picture.

What Is A Pre-Existing Condition?

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

This rule is in place to ensure people do not take advantage of the system by getting coverage when they know they might need to submit a claim for an existing health issue. It is a way to keep the insurance system fair and sustainable.

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

Accurate disclosure of medical history is imperative for policyholders applying for disability insurance, as failure to disclose pre-existing conditions may lead to claim denials during the exclusionary period if those conditions result in a disability. When disputes arise regarding pre-existing condition exclusions and ambiguous language in disability policies, it is essential to seek legal advice. 

If you have a pre-existing condition, we recommend that you seek legal advice before filing your Long Term Disability claim. An experienced attorney can provide guidance on how your condition may impact your claim and help ensure you navigate the process successfully. 

Additionally, an experienced Oviedo Long Term Disability lawyer plays a crucial role in interpreting policy language, evaluating the legitimacy of claim denials, and advocating for the policyholder’s rights.

The attorneys at Herbert M. Hill, P.A. are invaluable in navigating the complexities of disability insurance disputes and ensuring a fair resolution for the insured individual. Contact us today to discuss your case.