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What Is A Pre-Existing Condition?

Pre-Existing Condition

A pre-existing condition is a term used by insurance companies to describe a medical condition that existed prior to your disability insurance coverage. If you started a job but cannot continue to work due to a medical condition or symptoms, your insurance company may argue that your condition existed prior to your coverage and may attempt to deny your claim.

How will a pre-existing condition impact my application for Long Term Disability benefits?

Whether you have had a medical problem since youwere a teenager or a more recent condition has developed, being involved in a long-term disability claim with a pre-existing condition can have an impact on your claim.

  • Most group long-term disability policies have a pre-existingexclusion that will disqualify entitlement for individuals who submit a disability claim for a condition that arose in the period prior to them being covered under their employer's group benefit plan.
  • If you have only had disability coverage for a short amount of time (ie: less than one year), then any claim would usually be reviewed to determine whether it can be denied based on the exclusion clause for pre-existing conditions, which is part of most long-term disability polices.
  • The wording of your insurance policy is crucial and can be lengthy. Any insurance policy should be carefully reviewed to determine specific provisions and how they may apply. This should be done by an experienced lawyer.

Will it matter if I have a pre-existing medical condition?

A pre-existing condition will only matter if the claim occurs within the period during the pre-existing exclusion clause applies, so, in most cases, if the disability arises more than one year from when coverage was put into place, the pre-existing exclusion will not apply. The policy wording must be checked to determine the specific clause in each case.

What is a pre-existing exclusion clause?

A pre-existing exclusion clause exists to try to make sure that someone who has a long-standing history of medical problems and has only recently joined a group benefit program should not get coverage for disability benefits.

  • The insurance company can only raise the pre-existing exclusion clause in applicable circumstances.

Watch Our Video:

Find out what David Share, President of Share Lawyers and Adjunct Professor at Osgoode Hall Law School, has to say about a disability claim denied based on pre-existing exclusion and what can be done about it.

Changing Jobs – How can I avoid the pre-existing clause?

  • Changing your place of employment usually means that you will be subject to whatever pre-existing exclusion clause applies to the group benefits at the new employer.
  • If you have been struggling with your health and are dealing with a condition or an illness, even though you are able to work, you should take into consideration the potential impact of changing employers should a disability occur within the initial period.
  • In some cases, you might be able to get your employer to request that the pre-existing exclusion be waived, however, that would require a prospective employee to advise his new employer that he or she is struggling with a chronic illness, which could pose a barrier in the hiring process, so it may not be realistic to broach this subject with a prospective employer. Bottom line is that while one cannot necessarily anticipate and plan for every single contingency, at least be aware of this issue if and when you consider making a career move.

How can I overcome a pre-existing exclusion?

You may be able to overcome a denial from an insurance company if the medical condition that you were suffering from before is different from the medical condition that you are suffering from now. We may be able to argue that the new condition is quite different and distinct from the pre-existing condition that you were suffering with in the past.

At Share Lawyers, we review cases that have been denied based on a pre-existing exclusion and in some cases, it is possible to avoid the applicability of the exclusion clause, but this is an added challenge to a disability case, which can be insurmountable in some situations. If you’re unsure about how this may apply to you, it should be reviewed by an experienced disability lawyer at Share Lawyers who can assess the chances of success.

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