Does Your Long Term Disability Result From a Pre-Existing Condition?

Our clients from all over the California Bay Area, including San Francisco, Oakland, and San Jose, have long term disability policies that contain pre-existing condition exclusions.  Many claimants need an attorney to analyze whether or not their disability results from a pre-existing condition.  Although the terms of an employer-provided disability plan will vary, if your disability meets the conditions below, it’s possible that a pre-existing condition exclusion may apply to you.

• You became disabled within 12-24 months of becoming covered under your employer’s long term disability plan.
• In the 3-6 months before you became covered under the long term disability policy, you received medical care or treatment for the condition which is causing your disability.

It’s important that you obtain and review your policy terms to see exactly what conditions apply to your claim.  Sometimes, an undiagnosed condition may be considered pre-existing if you received care or treatment for the underlying symptoms during the relevant time period.  But not always.  In a recent court decision, Langdon v. Principal Life Ins. Co., No. 14-CV-6980, 2016 WL 4720025 (N.D. Ill. Sept. 9, 2016), the court determined that Principal Life Insurance Company abused its discretion in denying Langdon’s claim for long term disability benefits by concluding that his squamous cell carcinoma was a preexisting condition that was not covered under the group policy.  Langdon was not diagnosed with throat cancer until after he had coverage under the policy.  However, just before he had coverage, Langdon saw several doctors who examined and treated the swelling on his neck that was later diagnosed as squamous cell carcinoma.

Not everyone is as fortunate as Langdon.  In Wilkerson v. Riffage.com Disability Income Prot. Program, 303 F. App’x 408, 409 (9th Cir. 2008), the Ninth Circuit Court of Appeals affirmed the district court’s determination that Sun Life did not err by finding that Wilkerson’s multiple sclerosis was a pre-existing condition under the long term disability plan.  In this case, Wilkerson acknowledged that her primary disabling condition is multiple sclerosis and that multiple sclerosis constitutes a pre-existing condition under the Sun Life LTD Plan. Because there was no question that Wilkerson’s multiple sclerosis substantially contributed to her disability, Sun Life was not precluded from applying its pre-existing condition exclusion to Wilkerson’s disability, regardless of whether her later conditions were also substantial contributors.

If you have a long term disability policy and became unable to work within the first two years of coverage, you should consult with an experienced ERISA attorney to help you determine whether or not you have an excluded disability.