Long-term disability insurance (LTD) is crucial for the breadwinner in your family. It helps you earn a living if you cannot work due to an accident or illness. But did you know it doesn’t cover all disabilities?
We provide information on our policy’s exclusions, limitations, and other conditions that could affect your disability claim.
What Are Disability Insurance Exclusions?
An exclusion clause gets inserted in the contract of the disability insurance policy. It implies that the insurer does not take responsibility for any disability that results from the exclusion. By incorporating exclusion clauses, the insurance company clearly understands the risks or situations it will not take on.
Insurance companies aren’t out to reject legitimate claims. They consider their obligations to policyholders and their claimants seriously. They pledge to:
- Give a complete, fair, and objective assessment of all claims,
- Accept valid claims with the highest level of customer care,
- Assist the claimant in their efforts to return to work if it is appropriate.
Let’s take a look at some specific disability insurance exemptions.
The Most Frequent Exclusions Are on All Disability Insurance Policies
Policies offered by even the top disability insurance providers have clauses that are clauses that exclude them. Three exclusion clauses within the fine text exist on all long-term disability insurance policies. The insurance company won’t cover:
- A disability resulting from an accident or act of war declared or not,
- Normal pregnancy or childbirth cannot cover any disabling complications during birth or pregnancy,
- Any time you are in prison.
Exclusion Clauses That Get Found on Less Robust Longer-Term Disability Policies
There are also LTD policies that have more restrictions than the three above. While these disability insurance policies are less expensive but have fewer guarantees, more significant limitations could be a turnoff for many individuals. Although you may see some of these limitations in the group’s long-term disability policies, other exclusions get covered by private disability insurance.
In these cases, the insurance company denies an LTD claim if the disability result directly or indirectly:
- Self-inflicted injuries, or a suicide attempt, regardless of whether you’re insane or not,
- You are driving a motorized vehicle under the influence of drugs or an alcohol concentration in the blood more significant than the level of 80 mg per 100 ml of blood,
- The illicit or illegal use of any substance or the excessive or frequent consumption of marijuana or alcohol,
- Involvement as a crew member in a flight or attempted flight in any aircraft,
- Participation in the race, competition, or speed race on a motor vehicle, whether as professional or amateur on raceways with official approval or elsewhere,
- Procedures or treatments used for cosmetic reasons,
- Participation in the following events: motorbike, vehicle, and motorized watercraft races, mountaineering, cave exploration, skydiving, parachuting, hang gliding, and bungee jumping,
- Your participation in a sports activity for which you get paid, or
- Suppose you don’t have a job or are on maternity or parental leave. In that case, you may suffer from one of the following conditions: stress, anxiety, depression, neurosis, psychosis, adjustment disorder, fibromyalgia or another chronic pain syndrome, chronic fatigue syndrome, attention deficit disorder, or any other emotional or psychiatric disorder.
The disability insurance policy doesn’t cover the period in which you:
- Are you receiving compensation for your leave of absence by the terms agreed to by your employer or
- Stop working temporarily according to the agreement with their employer.
The Most Severe Exclusions from Policies and Restrictions on Disability Insurance
Exclusions from the shakiest LTD policies can also restrict or prohibit claims arising from:
- Degenerative disc disease,
- Strains, sprains, or strains,
- Anxiety, Chronic fatigue syndrome, depression, chronic pain syndrome, burnout or stress,
- A disorder that results from addiction or substance abuse or
- Any further mental, emotional, behavioral, or neurological issues.
In some instances, LTD policies limit the disability benefits of the conditions. For example, depending on the policy’s language, it could determine the period of use to 60 days for each event of a sprain or strain.
Since musculoskeletal and mental health issues such as neck and back pain are the leading causes of disability claims. It’s best to steer clear of LTD policies with the above exclusions and restrictions.
Exclusion Clauses Based on a Pre-Existing Medical Condition
According to the definition, a pre-existing medical condition refers to an illness that was present before the insurance coverage started. Are there any pre-existing health ailments? Can insurance companies cover an LTD claim for those?
Insurance companies will examine your medical history in detail. It will then determine whether your need is pre-existing and warrants the exclusion of your situation. In the process of applying, it gets required that you declare any existing health conditions.
If it is, then your insurance provider will then apply an exclusion of pre-existing conditions in your disability policy. It will therefore deny claims for a disability caused by the pre-existing condition.
Once the insurance company has reviewed the medical information and determines that there isn’t a substantial risk of disability, they will eliminate the exclusion clause for pre-existing conditions. Although a pre-existing condition excludes your possibility of submitting a claim for disability, it’s not necessarily all negative. It may be feasible to remove the exclusion clause in some circumstances later.
Pre-Existing Condition Exclusion Clause in Long-Term Group Disability
With many of the group policies offered by employers, there’s an exclusion clause for pre-existing conditions to exclude a disability-related illness caused by an existing infection in the first 12 months of insurance coverage.
Specific policy guidelines define a condition pre-existing as an illness or injury that was present within the three months before the date coverage became effective.
Suppose a disability claim gets filed in the first 12 months of insurance coverage. In this case, the insurance company would request you to provide medical information three months before the effective date.
Fortunately, there are no limitations or exclusions to disabilities that happen 12 months after the date of adequate coverage.
Contact Ottawa Life Insurance at info@ottawa-lifeinsurance.ca or (613) 454-1424 to learn whether your pre-existing condition justifies an exclusion if you don’t have a private disability insurance plan. We’ll help you find the most suitable disability insurance plan.
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