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Appealing a Long-Term Disability Claim Denial Based on Pre-Existing Conditions

Appealing a Long-Term Disability Claim DenialWhen you buy long-term disability insurance, you expect that, if you become disabled your insurer will timely pay. That is not always the case, especially if you have a pre-existing condition. The insurer may try to use your pre-existing condition as a reason to wrongfully delay or deny your long-term disability claim.

If you find yourself in this unfortunate situation, you need to speak with an experienced long-term disability lawyer right away. Your legal representative can help you understand why your claim was denied and take proactive and aggressive steps to file a timely administrative appeal if you have group coverage. Your lawyer will also review and prepare your complaint if you have purchased individual disability insurance.

Long-Term Disability Benefits With Pre-Existing Conditions

Long-term disability insurance provides benefits to people who are unable to work after a specified elimination period due to a sickness or accident. Generally, these plans cover 60% of your regular salary. While this money will not replace all you earn, it can help cover essential bills and is certainly better than nothing.

To receive benefits under your plan or policy, you must have a covered disability. Some policies has pre-ex provisions that look back 3-12 months before the effective date of the coverage if you have been diagnosed with a disease or disorder. Other policies may say any symptoms that could relate to a disease or disorder won’t be covered. Under either pre-ex definition if the policy is in force for over a year before disability begins, most carriers will pay the benefits.

The insurance company purposely has exclusions and limitations and they will use these exclusions to deny your claim. Having a pre-existing condition may limit your ability to receive benefits under your long-term disability policy.

Pre-Existing Condition Limits

Before you file your initial long-term disability claim, it’s best to review your plan documents with your LTD lawyer to understand what a pre-existing condition is under your specific insurance. Working with a trusted disability insurance lawyer can really help you in this process. Your lawyer can also help you understand that the insurance company will broadly interpret what qualifies as a pre-existing condition to deny your claim. With this knowledge, you can make certain that you have adequate evidence, including complete medical records, to add to your initial claim filing.

If you did not disclose your pre-existing condition when you applied for benefits, your provider may deny your claim outright. The insurance company may find out, by using an authorization to search medical care, treatment, tests, prescriptions as they conduct thorough investigations. They will use what’s called a look back period. This period can range from 90 days to two years. The insurance company will look through your medical records for all conditions that may have contributed to your long-term disability. If they find some, they will deny probably your claim.

This does not mean, however, that you are out of luck. In fact, some courts have held that simply receiving treatment for symptoms during a look back period is not enough to deny an otherwise legitimate disability claim. If your claim for long-term disability benefits is denied because of a pre-existing condition, you can administratively appeal this wrongful decision if you have group coverage or file your lawsuit if you have individual coverage.

In addition, if your long-term disability policy excludes a condition, it might not exclude symptoms caused by or associated with it. Your LTD insurance may exclude diabetes, but not the heart problems it causes. A thorough review by a long-term disability insurance lawyer can help you find out what your policy will cover and determine how to get the benefits you richly deserve.

An Administrative Appeal of Your Claim Denial

Insurance companies look for any reason to deny a claim. They are in the business of making money and if they can hold onto your premium, then deny your benefits, all the better. That’s frustrating because you have paid your premiums and now, when you most need your benefits, you meet a brick wall.

Partnering with an experienced long-term disability lawyer can help you get the benefits you deserve. Your lawyer will first review your policy documents, which will define what a pre-existing condition is as it pertains to your long-term disability coverage. You need a trusted legal advisor combing through your plan documents and medical records looking for answers, because that’s exactly what the insurance company will do.

Your insurance carrier will look closely at your medical history and related treatment to see what pre-existing conditions you might have. They will use this information to delay then deny your claim. That’s why you need a skilled long-term disability attorney at your side looking for the answers to overcome the pre-ex problem.

Insurance companies are not perfect, and they often get things wrong. They may deny your long-term disability claim stating that you have a pre-existing condition. If you accept this determination as final, you cannot collect the benefits you deserve. By working with a seasoned long-term disability attorney, you can file a timely administrative appeal of your group claim denial. If you have individual coverage your disability lawyer can file your lawsuit without appealing.

Time is certainly not your friend so you must not delay. The moment you receive your wrongful claim denial, the clock starts ticking on your deadline to file a timely administrative appeal. If you miss this deadline, you have little recourse and could end up missing out on the benefits you deserve. Every day you wait to speak with an experienced long-term disability lawyer is one day less that your lawyer has to investigate your claim denial and build a case for your administrative appeal.

Fight Your Claim Denial Now

Long-Term Disability Lawyer
Long-Term Disability Lawyer, Frank N. Darras

Do not delay any longer. Your ability to receive the long-term disability benefits you deserve depends on how long you wait to contact an experienced legal advisor. The lawyer you choose will play a vital role in your ability to overcome your long-term disability claim denial.

Insurance companies are known to deny claims and hope that victims like you just go away. The insurance company may even try to claim that you have a pre-existing condition justifying the denial. Remember, you do not have to accept the insurance company’s decision—you can fight. Contact DarrasLaw for a free consultation today.

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DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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