Why Was I Denied for a Pre-Existing Condition?
Receiving a long-term insurance denial can be frustrating, especially when the reason cited is a pre-existing condition. At Todd Krauss, APC, we have extensive experience dealing with such denials and are dedicated to advocating for the rights of our clients.
Definition and Impact of Pre-Existing Conditions
When it comes to insurance claims, especially those related to long-term disability the term “pre-existing condition” plays a pivotal role in the evaluation process. A pre-existing condition is any health issue that was diagnosed or treated prior to the commencement of an insurance policy within a certain timeframe of your potential long-term disability insurance coverage. Insurers often scrutinize these conditions closely and may use them as a basis to deny claims. This scrutiny arises because insurance policies are typically designed to cover conditions that develop after coverage has begun, leaving those illnesses or injuries that occurred before to possibly fall outside the scope of coverage.
The presence of a pre-existing condition can act to exclude a person from their long term disability benefits. It often leads to increased scrutiny of a claimant’s medical history and can result in longer and more complex dealings with insurance companies. This issue is particularly significant in claims for disability benefits where the stakes are high for both the insurer and the insured.
Reasons for Denial Due to Pre-Existing Conditions
When filing for insurance claims, the accuracy and completeness of the information provided can significantly impact the outcome. Here are the three most common reasons for denials.
- Incomplete Timeline Disclosure
One of the most common triggers for claim denial is the failure of applicants to fully disclose their medical histories on their long term disability applications. If, after submitting a claim, an insurer discovers that a medical condition was being treated within a certain timeframe of coverage, they will use this to deny the claim.
- Insurance Policy Exclusions
Every long-term disability policy has definitions that they follow in determining if a person meets the definition of disability. When it comes to pre-existing conditions, they set forth in the definitions what they are allowed to check to see if a person has what the insurance company deems a pre-existing condition which allows them to try and exclude the person from coverage.
How to Fight Back Against Denials
If you have been denied long term insurance disability benefits due to a pre-existing condition, it’s not the end of the road. Legal avenues are available, and with the right support, you can contest the denial effectively. At Todd Krauss, APC, our skilled California disability denial claims lawyer stands ready to assist you with your disability denial claims, ensuring you receive the benefits you rightfully deserve. If you need assistance or have questions about your specific case, do not hesitate to contact us today. Let us help you secure the benefits you need and deserve.