How Pre-Existing Conditions Affect Your Disability Insurance Claims

When applying for disability insurance benefits, a pre-existing medical condition can complicate the claims process. Insurance companies often scrutinize these conditions to determine whether they impact your eligibility for benefits or limit the compensation you can receive. 

Understanding how pre-existing conditions affect disability insurance claims and partnering with a skilled Philadelphia disability insurance lawyer can help you prepare for potential challenges and protect your rights.

What Is a Pre-Existing Condition?

A pre-existing condition is any medical issue you were diagnosed with or treated for before obtaining your disability insurance policy. These conditions can range from chronic illnesses like diabetes and arthritis to mental health disorders such as depression or anxiety. 

Insurers consider these conditions a higher risk and may use them as grounds to deny or reduce benefits.

How Insurers Handle Pre-Existing Conditions

Insurance companies have different approaches to handling pre-existing conditions, which typically fall into the following categories:

• Exclusions: Some policies outright exclude coverage for pre-existing conditions, meaning that if your disability is related to a condition you had before coverage began, you may not qualify for benefits.
• Waiting Periods: Many policies impose a waiting period during which disabilities related to pre-existing conditions are not covered. After this period, you may be eligible for benefits if you meet other policy requirements.
• Medical Underwriting: When you apply for disability insurance, the insurer may review your medical history to assess your risk level. This process could lead to higher premiums, exclusions, or modifications to your policy terms.

Proving That a Disability Is Unrelated to a Pre-Existing Condition

One of the biggest challenges claimants face is proving that their disability is unrelated to a pre-existing condition. Insurance companies often use past medical records to argue that a current disability stems from an older condition, even if the two are not directly linked. To counter this, you may need:

• Medical evidence from doctors explaining how your disability is new or unrelated to past conditions
• Expert opinions supporting the cause of your current disability
• A detailed work history demonstrating how you were able to perform job duties before the disability occurred

What to Do If Your Claim Is Denied

If your disability insurance claim is denied due to a pre-existing condition, do not assume the decision is final. Many denials are based on broad interpretations of medical history rather than concrete evidence. Steps to take include:

• Requesting a copy of the denial letter: This will outline the insurer’s reasons and provide guidance on appealing the decision.
• Gathering additional medical evidence: Consult your doctor and obtain updated medical reports clarifying the nature of your disability.
• Consulting a disability lawyer: An experienced attorney can help you navigate the appeals process and challenge unfair denials.

How Edelstein Martin & Nelson Can Help

If your disability insurance claim has been denied due to a pre-existing condition, the attorneys at Edelstein Martin & Nelson can help. Our Philadelphia disability insurance lawyers understand how insurers operate and can fight for the benefits you deserve. Contact us today at (215) 731-9900 to schedule your free consultation to discuss your case.