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Filing for disability benefits can be tough. This is true especially if you had a health issue before your injury or illness. Many worry that their past problems will stop them from getting benefits. At Pond Lehocky, we understand this concern.
The good news is that having a pre-existing condition doesn’t mean your claim will be denied. However, it can change how insurance companies review your case. You should contact a lawyer. We’ll help if your long-term disability benefits claim was denied for pre-existing conditions.
What Is a Pre-Existing Condition?
A pre-existing condition can be a health problem you had before you applied for benefits. Examples of common pre-existing conditions include:
- Chronic pain in your back or joints
- Arthritis
- Heart disease
- Diabetes
- Mental health issues like depression or anxiety
- Sleep apnea
- Previous surgeries or injuries, such as from a car accident
Many adults have at least one pre-existing condition. As we age, it is common to have one or more complex medical issues. Federal law recognizes this. What matters most is not if you had a disabling condition before, but how it affects your ability to work now.
Why Insurance Companies Care About Pre-Existing Conditions
Insurance companies look closely at your medical history. They do this to limit payouts. They look for anything they can use to deny benefits. This is what they are trained to do. If you have a pre-existing condition, they may say your disability isn’t new or serious enough.
Many people have a disability claim denied for pre-existing conditions. The letter might say your symptoms were present before your coverage started. Or it might claim your disabling condition was already there, so it doesn’t count. Have our lawyers read your denial letter. We can read through any vague language to see if the claim denial was because of a pre-existing condition.
These decisions often focus on paperwork instead of your health or work limits. Insurance carriers don’t get to know you. They make guesses about your work ability from your records. This usually doesn’t give them the whole picture of your disability.
When Can a Disabling Condition Still Get You Benefits?
Many people with ongoing health issues still get disability. You can still qualify for disability if:
- Your condition worsened after an injury or illness
- A new event made your symptoms much worse
- You could work before, but now you can’t
- Your job became impossible because your symptoms got worse
For instance, someone with mild back pain might later suffer a serious spinal injury. They may no longer be able to work. Even if the back pain existed before, the new injury changed everything.
Disability benefits depend on your current limits, not just your medical history. You need the insurance company to look at your overall health. They should not only look at your pre-existing condition.
LTD Claims Can Be Denied Because of a Pre-Existing Condition
Many insurance companies deny disability insurance claims when they claim you can work. Instead of considering how your health affects daily life, they focus on paperwork. This can be unfair to those who genuinely can’t work. If you don’t fight for benefits, you can have no support while you can’t work.
Common disability insurance claim denials include:
- Incomplete medical records
- Doctor notes that don’t clearly explain your work limits
- Gaps in your medical care history
- Forms that list your diagnosis but don’t detail your daily struggles
Insurance companies may argue your prior condition is the reason for your disability. They might overlook how your symptoms got worse or how a new injury made work impossible. Often, a denial for a pre-existing condition is based on paperwork, not your actual limits. You need to show them your whole situation.
Clear records can help avoid these issues. When your records explain what changed and why you can’t work, it’s hard for insurance companies to deny you. Your attorney can help with this.
Why Medical Evidence Matters When Filing for Disability Benefits
Solid medical evidence is needed for disability cases with a pre-existing condition. Insurance companies rely on written records. Your documents must therefore clearly tell your story.
Helpful evidence includes:
- Updated medical evaluations of your current condition
- Clear explanations from your doctor about your work limits
- Statements showing how your symptoms have worsened
- Records showing you tried to keep working or return to work
Your doctor should explain how your condition affects your daily life. This includes your ability to stand, walk, sit, lift, or focus throughout the day. Just listing a condition isn’t enough.
Medical proof should show you can’t work. This helps your long-term disability benefits claim. It also reduces the chances of denial.
Employer Disability Plans and Pre-Existing Condition Rules
Some disability plans address pre-existing conditions. They may limit your benefits if you were treated shortly before your coverage began.
These rules can be confusing. Insurance companies can make mistakes and deny the wrong claims. Understanding your plan is important, especially if you need to appeal.
You Can Appeal a Disability Claim Denied for Pre-Existing Conditions
A denial doesn’t mean it’s over. Many people succeed in getting benefits through appeals. An appeal lets you submit:
- Additional medical records
- Updated statements from your doctor
- Vocational evidence
- Personal statements about your daily challenges
Appeals have strict deadlines and procedures. Missing a step can hurt your case. This is when having a disability lawyer can be very helpful.
Why Legal Help Matters in Disability Insurance Cases
Disability insurance claims with pre-existing conditions need a review of all your records. At Pond Lehocky, our disability claims show the impact your condition has on your daily life and work. We help you find peace of mind and make the insurance company pay benefits that are fair for your condition.
Call Our Disability Attorneys for Help with Your Long-Term Disability Claim
If your disability claim was denied, don’t give up. This is also true if you’re worried about applying due to a pre-existing medical condition. Successful claims often have conditions you had well before you needed benefits. Our experienced disability lawyers carefully review claims. We help people challenge denials and prove why they cannot work.
You can appeal a disability claim denied for a pre-existing condition with legal help. If you have questions or need assistance, contact our disability lawyers today. Talking to a lawyer can make all the difference in your case.