CJ Henry Law Firm, PLLC

2303 East Fort King Street
Ocala, FL 34471

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(352) 577-7746

CJ Henry Law Firm, PLLC

Nearly all plans have some limitations or exclusions based on pre-existing conditions. This is governed by the terms of the policy. Whether your pre-existing condition is excluded will depend on how long you’ve been covered by the policy and, if less than the policy guideline, whether you received treatment during that policy look back period. If the policy does exclude coverage for pre-existing conditions and you are covered under the policy less than 12 months and receive treatment during the three months prior to coverage, then the carrier will scrutinize your coverage history.

Each policy is different in terms of the length of time as well as the look back period. Some policies even have language which inquires whether a reasonable person would have received treatment. While you might not have received treatment for that condition based on the nature of the condition, when they’re looking at your medical records, they may say a reasonable person would have received treatment for that condition and therefore, it is excluded.

Will I Be Automatically Denied If I Have Mental Illness Or Alcohol/Substance Abuse Issues?

Virtually all group and individual policies limit benefits for disabilities involving mental disorders, nervous disorders, and substance abuse. Typically, benefits are limited for 12 to 24 months for disabilities caused by these conditions, but not necessarily denied outright. It all depends on the terms of the policy.

What Are Other Employer Provided Benefits That May Be Coordinated With Long-Term Disability Benefits?

If you have other group sponsored benefits such as a life insurance policy or a health insurance policy, the terms of the plan will dictate whether or not that coverage will continue while you remain disabled. Some plans will offer a waiver of premium, as long as you remain disabled under the terms of the plan. Some policies allow you to maintain your health insurance benefits, as long as you pay the premium. It all depends on the employer benefit plan and how they drafted it.

The insurance company may use the term “coordination of benefits” with respect to Social Security disability benefits, or a settlement. Most clients are not aware of this until they get approved for Social Security. Suddenly, they receive a bill from the insurance company that tells them they’ve been overpaid because they received the benefit without reduction for the Social Security which is often paid retroactively.

What Is The Process For Submitting A Long-Term Disability Claim?

Most long-term disability policies require you to submit a Notice of Claim within 20-30 days from the date you became disabled. The notice can be a brief letter to the insurance company, letting them know that you will be submitting a claim. The insurance company then sends you a claim form that you have to submit to complete a claim. Those forms are known as “proof of loss” or “proof of claim” forms and are usually required to be submitted within 90 days from the end of the elimination period. The elimination period is the waiting period from the disability onset date to the first date that you’re entitled to payment of benefits.

In most policies, the elimination period for long-term disability benefit is 180 days. There are some where it is only 90 days and very few have a shorter timeframe. The deadline for submitting your claim, therefore, will depend on your policy’s elimination period, the proof of loss period, and the date of your disability. If your proof of claim is not submitted within the specified time, then the claim can be treated as a late claim, which would require more proof to establish why you could not reasonably submit the claim within the timeframe.

For more information on Denial Due To Pre-Existing Conditions In FL, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (352) 577-7746 today.

Claudeth Henry, Esq.

Call For A Free Consultation
(352) 577-7746