Pre-existing Condition Exclusion for Disability Insurance in Texas

ERISA disability benefits could be denied for a variety of reasons. If you applied for disability benefits under an ERISA plan, you may be surprised to learn that you might be denied benefits due to pre-existing conditions.

While health insurance companies cannot deny coverage or benefits due to pre-existing conditions under the Affordable Health Care Act, your disability claim may be denied for a pre-existing condition due to your specific policy. If you were denied access to your benefits based on a preexisting condition exclusion for ERISA disability insurance in Texas, a Texas ERISA disability claim denial lawyer could help you appeal your denial and secure your disability insurance. A well-practiced ERISA attorney may have the experience to guide you through the appeal process and give you a peace of mind.

Pre-existing Condition Exclusion

Based on the case law and the Employee Retirement Income Security Act Of 1974 (ERISA) regulations, an insurance policy is a contract between the insurance carrier and the insured. This contract might often include exclusions or situations under which coverage may not be provided.

ERISA disability insurance policies may often include an exclusion for preexisting medical conditions or conditions the insured had at the time the policy commenced. Pre-existing conditions may generally be defined as any sickness or injury for which the claimant may have taken prescription drugs, received medical treatment, consultation, care, or services. This could bar the claimant from having a claim approved that involves their pre-existing condition.

Policy Wording

While it generally cannot be debated whether a policy does or does not have a pre-existing condition exclusion, the verbiage of the policy and how it applies to a specific claimant’s case may actually favor the claimant receiving their disability benefits. Because of this, claimants who receive denial letters may be advised to carefully examine the insurance company’s reason for doing so.

The exact policy wording that was used to determine a denial of ERISA benefits should be included in the claimant’s coverage denial letter. Ambiguity in the policy language usually works in favor of the claimant when it comes to court decisions. Contact a Texas ERISA disability claim denial lawyer to discuss your policy’s wording.

Time Frame of Pre-Existing Condition Exclusions

Generally, a pre-existing condition exclusion only applies for the first year after ERISA coverage has started. This is known as the look-back period. Some insurance policies may only have a three-month look back period. Either way, the look-back period could help deter people from seeking employment for the purpose of getting long-term disability benefits based on a condition they had prior to their employment.

If an insurance company denies coverage based on a preexisting condition, the claimant may need to determine what the policy states in regards to the time frame of this exclusion. A Texas pre-existing condition exclusion for ERISA disability insurance cannot be used as a valid reason for benefit denial if the time frame for the exclusion has passed.

Litigating Pre-existing Condition Exclusions for Texas ERISA Disability Insurance

If your long-term disability claim is denied, you should know that you have legal rights and options. A knowledgeable Texas ERISA disability claim denial lawyer may be able to guide you on the best ways to appeal your claim or assist you in litigating your claim. A pre-existing condition exclusion for ERISA disability insurance in Texas may not always be a valid or legal reason for insurance companies to deny benefits.

Since deciphering ERISA laws, disability insurance policies, and benefit denial letters could be confusing and complex, consulting with an attorney may significantly benefit your case and increase your chances of receiving claim approval. Call today to find out what help may be available for you.

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