Pre-Existing Conditions and Disability Claim Denials

Author: Disability Attorneys Dell & Schaefer
Published: 2010/09/18 - Updated: 2026/01/11
Publication Type: Informative
Category Topic: Claims - Related Publications

Page Content: Synopsis - Introduction - Main - Insights, Updates

Synopsis: This information provides practical guidance from disability attorneys on how pre-existing medical conditions affect long-term disability claim approvals and denials. The content holds authority through its source - experienced disability law professionals who handle these cases regularly - and addresses a critical concern for workers with health conditions seeking income protection. People with disabilities, chronic illnesses, or those planning ahead need to understand how disclosure requirements work differently for individual policies versus employer-sponsored ERISA plans, since undisclosed conditions on private applications can result in both claim denial and policy cancellation. The piece clarifies timing rules, particularly the typical one-year safe harbor under employer plans, helping readers avoid costly mistakes when purchasing coverage or filing claims - Disabled World (DW).

Introduction

Can a Long Term Disability Claim be Denied for a Pre-existing Condition?

Your long-term disability claim can be denied for a pre-existing condition; however, it's a very fact-specific analysis as to how it's going to happen.

For instance, on a private policy you purchased on your own, if you failed to disclose a medical condition on the application for benefits and then later on you file a claim for that same condition, the insurance company, in conducting their review of your entitlement to benefits, will get medical records.

Main Content

If they see that there is a condition that you didn't disclose on the application, they will more than likely deny your claim for a pre-existing condition.

On top of that, there's a good chance that they'll rescind the policy, no matter how old it is as for almost making a fraudulent misrepresentation on the policy.

Now on ERISA governed group policies you get through your employer, for the most part, as soon as you become employed if there's a waiting period to become eligible, you're going to be covered under the plan.

However, they do have pre-existing condition clauses contained therein.

Usually a safe bet is if you haven't filed a claim for disability within a year of being covered under your employer's plan, more than likely you're not going to fall into a pre-existing condition situation.

However, all policies do differ, so if you do have questions, contact us and we can definitely review the policy for you.

Insights, Analysis, and Developments

Editorial Note: Understanding pre-existing condition clauses remains one of the most misunderstood aspects of disability insurance, yet it can mean the difference between receiving benefits during a health crisis or facing financial hardship. While regulations continue to evolve, the fundamental principle stays the same: honest disclosure protects your rights, and knowing your specific policy's terms before you need to file a claim gives you the best chance of success. Anyone purchasing individual coverage or starting a new job should carefully review these provisions, as the consequences of overlooking them extend far beyond delayed paperwork - they can eliminate your safety net entirely when you need it most - Disabled World (DW).