We know that disability insurance is meant to provide coverage if you get sick or injured and can’t work. But what if you’re already sick or injured when you apply for disability insurance coverage? Can you still apply? And will it pay out when you need to file a disability claim?
A pre-existing condition refers to any medical condition you were already diagnosed with prior to applying for insurance coverage. Some common pre-existing conditions include diabetes, cancer, depression, asthma, HIV and epilepsy.
Here are four important facts about getting disability insurance with a pre-existing condition.
1) You may still be able to get coverage.
Yes, many long-term disability insurance policies have exclusions for pre-existing conditions. The good news is that you still can, in many cases, qualify for disability insurance even with a pre-existing condition. You should also be able to collect insurance benefits when you file a claim as long as your disability insurance claim is in no way related to your pre-existing condition.
Some insurers may even approve coverage for someone with cancer, for example, if it has been in remission for a few years. Those with other conditions like diabetes, sleep apnea, lupus and ulcerative colitis can typically be approved for a policy as long as their condition is currently in treatment, but may pay a somewhat higher premium.
2) Some chronic or serious conditions may disqualify you.
Keep in mind that conditions of a serious and chronic nature may disqualify you from securing disability benefits. If you have disability insurance and file a claim for an injury or illness related to your pre-existing condition, it will likely be denied
For example, if you have epilepsy when applying for coverage, and a few months later your seizures become more severe and prevent you from working, your disability insurance policy will likely not approve a claim for lost income, since you already had the condition before getting coverage.
3) You may need to provide extra evidence.
If your disability insurance claim gets denied, the insurance company may open an investigation. Medical records from before your coverage began can help show whether your claim is related to a pre-existing condition or not. For example, if you have a pre-existing injury related to your back, and you injure your back in a new or different way, you can prove this through medical records. Whenever an insurance company denies a claim, they are required to provide a clear reason why, so ask for clarification if you are confused about a denial.
- One thing that can help with appealing a claim denial is to get a doctor’s note that explains the exact cause of your disability. This can help the insurance company determine whether or not it relates to your pre-existing condition.
Always disclose your pre-existing condition when applying for coverage. If you don’t and your insurance carrier learns about your condition down the line, they will likely deny your claim. Disclosure is a required part of most insurance contracts, so be honest about your situation.
4) Look into employer-sponsored disability insurance.
Enrolling in a group plan provided by your employer can be a good way to get coverage. It’s often cheaper than purchasing an individual policy because it’s included in your overall benefits package, and the coverage is automatic. That means there is no underwriting or medical exam, so you can still qualify with a pre-existing condition.
While there are many pros to employer-sponsored coverage, keep in mind that:
- There are fewer coverage options and more limitations than individual policies.
- They still don’t cover all types of conditions.
- You lose your coverage if you leave or are terminated from your job.
You can learn more about disability insurance coverage by contacting an insurance agent. A good way to find a favorable policy for your situation is to work with an independent disability insurance agent who can work with many carriers to find one that will more likely approve your condition.
