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Pre-existing condition clauses and disability

On Behalf of | May 9, 2022 | Long-Term Disability Insurance Claims | 0 comments

For many Texas workers, injuries and illnesses can be overwhelming financially and emotionally. Being protected from this potential challenge is important. So too is it important that they have a certain level of peace of mind that comes from being insured against this possibility. That is where long-term disability coverage comes in. Knowing the facts about this level of coverage is essential. One thing to be careful about is a pre-existing condition clause.

Long-term disability and the challenge of a pre-existing condition

When making a claim to receive long-term disability, the case will be assessed to see if the claimant meets all the criteria for approval. That includes determining whether they had a pre-existing medical condition. This could be an obstacle. If, for example, a person had a back issue within three months before making a claim for disability and received some level of care for it, it might fall into the category of being a pre-existing condition. The care includes medical treatment, medical advice, medical services or prescriptions.

If the back problem required a visit to a doctor and a prescription for painkillers, then the insurer could label it as a pre-existing condition. If the disability is for that condition, then the payments would not start for six months after the disability began. Once that has elapsed, there is a six-month waiting period or the person must exhaust all their sick leave, whichever is longer. These run simultaneously. Those who are getting workers’ compensation or Social Security Disability will have their Texas long-term disability reduced accordingly. This could have an impact on their income and other matters. Those who were expecting to receive these benefits due to their medical issue may be unpleasantly surprised and should understand their options.

Dealing with disagreements over a disability claim may warrant legal assistance

Although long-term disability insurance coverage is meant to protect people who have paid for it, the process to applying for and receiving the benefits can be difficult, time-consuming and stressful. This is made exponentially worse when the claim is delayed or denied. Companies can try to delay or question a claim for many reasons, but one that happens frequently is the allegation that the person had a pre-existing condition prior to seeking benefits.

Appealing could be an effective solution. Or it might even be necessary to file a lawsuit against the insurance company. The entire case must be scrutinized to determine how to proceed. Those worried about their claims at any juncture should consider the value of legal assistance to try and get their benefits.