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How Does a Preexisting Injury Affect My LTD Benefits?

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Posted By KSK Law | October 31 2022 | Disability Benefits, Long-Term Disability

Pre-existing conditions affect millions of people across the United States. Conditions like diabetes, heart disease, asthma, or back problems can have a major impact on your physical health and well-being. However, a pre-existing injury can also impact your ability to recover long-term disability (LTD) benefits.

Many LTD insurance policies have clauses that limit recovery if the policyholder has a pre-existing injury or illness. If you plan on filing for a disability claim, it is important to be aware of these limitations and speak with an attorney about your options.

What Are Long Term Disability Benefits?

LTD insurance policies pay benefits if the policyholder becomes disabled and is no longer able to work. While the terms of these policies can vary, LTD insurance can pay benefits for several years or even until you reach retirement age. These benefits are usually equal to 40% to 70% of your income before your disabling illness or injury.

You can typically purchase insurance for long-term disability from a private provider or obtain coverage through your employer. LTD insurance is not the same as workers’ compensation coverage, which pays benefits for work-related injuries. You can recover compensation from an LTD plan for injuries and illnesses that were not caused by work.

Do Preexisting Injuries Affect LTD Benefits?

LTD claims are often denied if you have a pre-existing condition. Insurance companies have different definitions for what constitutes a pre-existing injury or illness. As a result, these providers often take a broad approach to handle these cases, which can lead to your claim being unfairly denied.

Usually, these companies look at the three months before your effective insurance date to determine whether your condition is pre-existing. This period is known as the look-back period. The company will examine your medical records to see if you received any treatment, consultation, medication, or services for any illnesses or injuries during this time.

If you did receive medical care, the company may consider you to have a pre-existing injury or illness. As a result, the insurer may deny your claim if it believes that your long-term disability is related to your supposed pre-existing condition. 

For example, you may have suffered a heart attack during your look-back period and later suffered a stroke that left you with a disability. The company may point to your medical history and state that the stroke was a pre-existing condition. You may be denied LTD benefits due to this justification.

Why You Need a Lawyer for Your Long-Term Disability Claim

Insurance companies have a duty to their bottom lines and paying maximum compensation to each policyholder is not in their best interests. Many LTD claims are unfairly denied due to the broad use of pre-existing injury exclusion clauses. If you are denied benefits, you can suffer from undue hardship, even if you paid into the policy for years.

In these situations, you need an LTD benefits attorney who can defend your right to compensation. A lawyer can handle your LTD claim from start to finish, gathering evidence to prove your right to recovery. He or she can negotiate with the insurer if necessary and launch an aggressive appeal if your claim was unfairly denied.

After you suffer your disabling injury or illness, contact an LTD benefits attorney as soon as possible to discuss your claim.

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