Pre-Existing Condition

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Doctor’s Visit Without Treatment No Reason to Turn Down Benefits Erisa

Issues regarding pre-existing condition exclusions continue to raise concerns in litigation over disability benefits. The principal question raised is whether insurers may use hindsight to establish that any doctor visit prior to the commencement of coverage for symptoms that could possibly be related to the later diagnosed disabling impairment would be sufficient to trigger the […]

Disability Insurance Bars Pre-Existing Conditions

Although the Affordable Care Act prohibits health insurance denials on account of pre-existing conditions, the ACA is inapplicable to disability insurance. A recent federal court case from Massachusetts, Holzman v. Hartford Life & Accident Insurance Co., 2019 WL 181527 (D. Mass., Jan. 14, 2019), examined whether a claim for disability benefits fell within a pre-existing […]

What Are Pre-Existing Conditions?

In a recent Ohio federal court ruling, Linda Hines successfully challenged Unum’s invocation of its pre-existing condition exclusion when she became disabled due to anisometropia, a neurologic condition where the brain is unable to coordinate the separate images generated by each eye.   Unum maintained that the cataract surgery Hines underwent during the 3-month lookback period prior […]

Amputation Cause Is Case Law Worth Reading

Accidental death and dismemberment insurance frequently present fascinating issues, as illustrated by a recent ruling from the 9th U.S. Circuit Court of Appeals. In Dowdy v. Metropolitan Life Insurance Co., 2018 WL 2223722 (9th Cir. May 16, 2018). Tommy Dowdy required a below-the-knee amputation following injuries suffered in a car collision. Although such an amputation […]

When a Chain Has Too Many Links

Although the Affordable Care Act, also known as Obamacare, has eliminated health insurers’ exclusion of insureds who have pre-existing conditions, such exclusions remain enforceable in disability insurance policies. However, a recent non-precedential ruling issued by the 11th U.S. Circuit Court of Appeals, Bradshaw v. Reliance Standard Life Insurance Co., 2017 WL 3774536 (11th Cir., Aug. […]

Insurers should not conflate risk factors with pre-existing conditions

Although health plan exclusions for pre-existing conditions are no longer permissible under the Affordable Care Act, disability insurers may still lawfully invoke such exclusions in their policies. But the exclusions must be applied narrowly. This was illustrated in Meyer v. Unum Life Insurance Company of America, 2015 U.S. Dist. LEXIS 42092 (D.Kan., March 31). John […]