If you are planning for the future, it’s essential to know that life is full of unexpected, unplanned events. Participating in group benefits, including long-term disability insurance, provides future security and peace of mind.
Some people have issues getting long-term disability insurance because of pre-existing medical conditions. If you’re thinking, “Can I get disability insurance for a pre-existing condition?” The short answer is yes, although specific circumstances can cause the insurance company to deny compensation.
What Is a Pre-Existing Condition?
If you’re wondering, “Can I acquire disability insurance if I have a pre-existing condition?”. Pre-existing conditions are insurance terms used by insurers to describe a health issue or injury you’ve suffered before applying for disability insurance. You need to understand what a pre-existing health condition can include and how it might impact you.
Suppose your state did not exist before the insurance term. In that case, an insurance company might contest your claim if you have a disability that needs medical care. According to the “objective standard” definition, insurers can decide on any health condition you’ve received treatment from a medical professional or advice as an existing condition.
What Is the Impact of Pre-Existing Medical Conditions on Long-Term Disability Law?
Pre-existing medical conditions can be but get not restricted to:
- Cancer
- Heart disease
- Asthma
- Diabetes
- Severe injuries
Every insurance policy is unique. It doesn’t matter whether the medical problem is new or congenital. You are claiming a long-term disability with a pre-existing medical condition can influence the outcome for your benefit.
Exclusions for pre-existing conditions are a part of most long-term disability group policies. This exclusion would make you ineligible to receive benefits if your illness began before you established your employer-based insurance coverage. However, the exclusion might be applicable on claims to disability insurance in the first year of insurance.
Suppose the insurer can prove that you have seen an errand doctor or sought treatment for a problem related to your health condition during the pre-existing exclusion period. In that case, they may argue against your claim.
Reasons for Pre-Existing Condition Exclusions
Insurance companies do not have a complete picture of each participant’s medical history at the time of coverage. The insurance company cannot determine the probability of covering every participant in the policy. Pre-existing conditions often get excluded from policies for group insurance. Insurance companies use the pre-existing condition exclusion to avoid the payment of benefits to those who get employed only to get long-term disability insurance.
The Importance of Applying for Group Insurance That Includes Disability Insurance
Participation in group benefits for long-term disability helps your financial security if you lose your earnings. The monthly payments get designed to cover a substantial part of your income. Without insurance, you might have fewer alternatives for long-term financial assistance.
Questions to Ask While Requesting Group Insurance Coverage for Long-Term Disability
Before enrolling in the long-term disability insurance coverage offered by the group, you should consider the following questions to ensure you’re making an informed decision.
- Which is your pre-existing conditions exclusion time frame?
- Does the insurance company exclude certain medical conditions?
- How long do you have to wait until benefits start?
- How long do benefits last?
- Do certain medical conditions restrict uses?
The Group Long-Term Disability and Pre-Existing Conditions
Suppose you are diagnosed with a condition or injury that stops you from earning a livelihood and cannot work. In that instance, you can submit a claim through your employer’s group long-term disability insurance plan. Suppose your claim falls under the pre-existing condition exclusion. In that case, insurance companies may investigate your medical history before your policy’s commencement date.
The insurance company may not look into your medical history for the entirety of your life. They might look into a particular time frame, like 90 days before your coverage’s start date. The exclusion does not apply if you have not received treatment for your illness.
Can You Appeal a Denial of Long-Term Disability?
You are entitled to appeal when the insurer refuses to pay your long-term disability claim. You can go to an internal appeal procedure where the insurance company employees take care of your written request for appeal. This process allows you to request the insurance company to reconsider their decision after the decision to deny your claim.
If the company refuses to accept an internal appeal and you wish to appeal to an outside company. This appeal gets filed by bringing an action with the company to reach a settlement or accept your claim. This process permits an independent agent, such as an arbitrator or provincial judge to consider your case.
In Ottawa Life Insurance, we have been offering health, life, and group insurance to businesses and individuals in Ottawa. Call (613) 454-1424 or email info@ottawa-lifeinsurance.ca if you want further details.
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