Why Was I Denied for a Pre-Existing Condition?
A pre-existing condition can become a stumbling block when applying for disability benefits. Many individuals find themselves puzzled when their claim is rejected based on health issues that existed before obtaining coverage. A denial may occur when the insurance company argues that your current health problems are linked to a condition noted on your application. Acting quickly is vital. For immediate assistance, call our office now—your rights deserve protection from a seasoned California disability denial claims attorney.
Understanding Your Pre-Existing Condition
Pre-existing conditions refer to any medical issues that the insurance company thinks were present before the start of your insurance coverage. This arises when a person goes out on disability within the first year of coverage. The insurance company then gets to “look back” to the last three (3) months before a person started working. Insurers often include exclusions or waiting periods related to these conditions in your policy. When a claim is submitted, the insurer reviews your medical history and policy language to determine if the condition should be covered.
Research by the U.S. Department of Health and Human Services shows that many disputes arise over how pre-existing conditions and/or any alleged treatment is interpreted by insurance carriers. A rejection can leave you without needed financial support during a difficult time. Seeking advice from an Encino disability lawyer can help you understand your rights and identify potential errors in the denial process.
How Insurance Companies Investigate
When you file a claim, the insurance company will investigate your medical history. They may request medical records from your doctors, review your dates of application for benefits and time you started working to get the coverage you are seeking. Their goal is to determine if you received any treatment or care for the disability a person goes out of work for. This investigation can be thorough, and even seemingly minor inconsistencies in your records can lead to a denial.
The Most Common Reasons for Denials
The most common reason benefits are denied for a pre-existing condition is that your medical history might show your current disability is directly related to a condition that existed before your coverage started. There may be notes, prescriptions, or treatments directly connected to the basis of the disability. Policies often include specific clauses or waiting periods for pre-existing conditions, and if these are triggered, your claim could be denied.
Research by the National Association of Insurance Commissioners confirms that many denials arise due to a lack of complete or accurate documentation. Another frequent reason is the failure to meet all the policy requirements or deadlines, such as providing necessary medical documentation or appealing the initial denial in a timely manner. In some cases, insurance companies use ambiguous policy language or treatment related to other conditions to justify their decision.
If you believe that the denial was based on an error or oversight, reaching out to an experienced Employee benefits attorney in Encino can provide the support needed to challenge the decision.
Fight Back Against Pre-Existing Condition Disability Denials
If you have been denied disability benefits due to a pre-existing condition, it is crucial to act immediately. A detailed review of your claim file and prompt filing of an appeal can help secure the benefits you deserve. Todd Krauss, APC stands ready to assist you through every step of the process with proven case results and a commitment to upholding your rights. Do not delay—contact us today to schedule your consultation and ensure that your case receives the attention it warrants.
