LTD Pre-Existing Condition Denials

This article offers insights into what qualifies as a pre-existing condition, how pre-existing conditions affect disability insurance claims, and the potential hurdles posed by pre-existing conditions when switching jobs. It's essential to grasp the significance of this clause, especially given the growing trend of frequent changes in occupation in the Canadian workforce.

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LTD Pre-Existing Condition Denials: What You Need to Know

Being well-informed is the first step toward your empowerment and success in this process. Let's delve into the essential factors you should be aware of in dealing with LTD pre-existing condition denials.

Understanding Pre-Existing Conditions

The interpretation of a pre-existing condition hinges on the precise language used in the pre-existing clause of your disability insurance policy. In this exploration, we dissect a clause that is commonly found in group policies, highlighting potential consequences for individuals grappling with undiagnosed conditions.

"We do not pay benefits if your disability results directly or indirectly from a condition which existed on or before the date your coverage began. However, this limitation will not apply to you if you have been covered for Long-Term Disability with your employer for at least 13 weeks during which you have been actively working continuously (up to 3 days of absence does not count) and you have not been treated by a doctor, or any medical personnel under the direction of a doctor, for the condition, or you became totally disabled more than 12 months after your coverage began.” (Excerpted from a Sun Life Group Benefit Booklet)

This clause defines a pre-existing condition quite broadly—and intentionally so. When assessing your claim, insurers closely examine your attendance record and medical treatments to determine if they can apply the pre-existing condition denial to avoid providing coverage and benefits.

When Does a Pre-Existing Condition Matter?

The relevance of a pre-existing condition hinges on whether the disability claim arises within the period covered by the pre-existing exclusion clause. Generally, if the disability occurs more than one year after the coverage initiation, the pre-existing exclusion typically doesn't come into play.

In rare occurrences, some policies extend this exclusion for longer, such as two years. It is essential to carefully review the policy wording to ascertain the specifics of the exclusion clause in each case.

Impact of Job Changes on Pre-Existing Conditions

Shifting to a new job typically entails adhering to the pre-existing exclusion clause outlined in the group benefits of your new employer. If you've been grappling with health challenges or managing a chronic illness while still capable of working, it's vital to weigh the potential ramifications of changing employers, mainly if a disability arises within the earlier-mentioned initial period.

In certain instances, you might explore having your employer request a waiver for the pre-existing exclusion. However, this entails disclosing your health struggles to your new employer during the hiring process. While this might only be practical for some, as it could pose challenges in securing the job, it's crucial to be aware of this consideration when contemplating a career move.

Key Takeaway

While it's challenging to foresee and plan for every possible scenario, knowing the impact of pre-existing conditions when changing jobs can inform your decision-making process.

What To Do After a Pre-Existing Condition Denial

Pre-existing conditions can be insurmountable in some cases. If you’re unsure about how this may apply to you, the denial should be reviewed by an experienced disability lawyer who can assess the chances of success. The disability lawyers at Share Lawyers review cases that have received a pre-existing condition denial, and in some cases, it is possible to avoid the applicability of the exclusion clause.

The experienced LTD lawyers at Share Lawyers are in your corner when you need us.We help you understand your disability claim denial and guide you through the following steps. We won’t stop fighting until you get the benefits you deserve.

Did you have a pre-existing condition denial? It’s not the end of the road.

Contact Share Lawyers today and put our experience to work for you. Our 35+ years of experience can help you win your case against Canada Life, Desjardins, Manulife, RBC Insurance, Sun Life, and other insurance companies. Our legal team offers a free consultation and works on a contingency basis - there are no fees unless you win your case.

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