Long Term Disability insurance companies can deny your claim for a number of reasons, including a denial due to pre-existing conditions. In almost all Long Term Disability insurance policies, pre-existing conditions are excluded and not covered. Essentially, if your injury or disability existed prior to the policy becoming effective, or prior to you being employed with your employer, that disability may be excluded.

However, sometimes insurance companies can get things wrong. In fact, sometimes it seems like insurance companies misstate your diagnosis or try to connect your current disability with a prior disability or injury just so they can deny your claim based on a pre-existing condition.

Certain Long Term Disability policies also have “look-back” periods. Typically, these can range anywhere from as little as three months, to up to a year, prior to and after your start date of employment or the policy taking effect. If your disability or injury occurred within this time frame, it may be excluded.

Exclusions and limitations for pre-existing conditions have been upheld by courts and it is legal for the insurance company to incorporate these exclusions and limitations into their policies, if in fact your condition was pre-existing.

Appealing A Denial Due To Pre-Existing Condition

The Long Term Disability attorneys at Fields Law Firm have successfully appealed cases where our clients were wrongfully denied Long Term Disability based on pre-existing conditions. Here are just a few situations where our attorneys were able to help our clients receive the Long Term Disability benefits they deserved.

Insurer Claimed Conditions Were Pre-Existing and Excluded From Policy

A young woman developed fibromyalgia, which began to interfere with her ability to carry out her desk job. She also suffered from migraine headaches. She applied for Long Term Disability benefits through her Long Term Disability insurance company.

At first, the insurance company denied her claim indicating that her conditions were pre-existing and therefore, excluded from the policy. She turned to Fields Law for help.

Our Long Term Disability attorneys crafted an appeal and made the insurer realize that her conditions were not pre-existing. However, the Long Term Disability insurer still denied her claim, alleging her conditions were not severe enough to prevent her from doing her job.

The team at Fields Law filed a second appeal for Long Term Disability benefits on our client’s behalf. We worked with her doctors to show the insurance company that her conditions were severe enough to prevent her from working.

The Long Term Disability insurance company ignored this evidence, so Fields Law filed a lawsuit on our client’s behalf. Before the lawsuit went to trial, our attorneys were able to reach a settlement with the insurer and avoid further delays with a lengthy court case.

Benefits Denied Because Pre-Existing Conditions Could Not Be Ruled Out

Our client’s doctors took her off of work from her job as a store manager due to significant cognitive and memory difficulties, as well as severe anxiety and depression. She applied for Long Term Disability benefits through her employer’s plan. At first, our client’s claim was denied because it could not “rule out” that her claim was barred by a pre-existing condition.

After our client was able to establish her conditions were not pre-existing, the insurer once again denied her claim for benefits based upon a medical record review that asserted our client’s doctor’s failed to support their opinions with objective evidence.

The Long Term Disability lawyers at Fields Law were able to successfully argue that our client’s doctors had provided objective testing evidence to establish her disability. Moreover, our team successfully secured narrative letters from multiple providers and persuasively argued that she satisfied the definition of disabled under the policy; and that the insurer misstated and ignored vital evidence.

After reviewing our appeal, the Long Term Disability insurance company reversed its denial, paid over a year’s worth of back benefits, and began paying regular monthly disability benefits.

Insurer Claimed They Were Unable to Complete a Pre-Existing Condition Check

A receptionist in Minnesota began suffering from chronic migraines and regular disabling dizziness. Her doctors struggled for an extended period to precisely narrow down her diagnosis, but all of her providers agreed she could not work with her severe symptoms.

She applied for Long Term Disability through her employer’s disability insurance plan. However, the disability insurance company denied the claim. Initially, the insurer alleged it had insufficient information to complete a “Pre-Existing condition check.”

After receiving the information needed to show the disability was not pre-existing, the disability insurance company again denied the claim 5 months later. The insurer now claimed it had performed a “Peer Review” by a doctor and that doctor disagreed with our client’s treating doctors.

The Long Term Disability attorneys at Fields Law filed an appeal based on the clear opinions of our client’s treating doctors and the clear documentation contained in her medical records.

Additionally, Fields Law attorneys argued it was impossible for our client to perform her job duties given the severity of her conditions and how required tasks such as looking at a computer screen for extended periods of time caused a worsening of her symptoms.

After receiving our appeal, the disability insurance company approached Fields Law about settlement of our client’s claim. Our attorneys negotiated a settlement, ensuring our client never had to fight with the insurance company again.

Our Long Term Disability Attorneys Can Help

With the help of your medical providers and records, our experienced Long Term Disability attorneys may be able to assist you when a pre-existing exclusion issue arises. Contact us today to discuss your legal options confidentially and without obligation.

Our attorneys will answer your questions and explain what you can expect while your appeal and denial are pending. If you do choose to hire our law firm, you can count on our legal expertise to guide you through the legal process to appealing your denied Long Term Disability benefits.