Pre-Existing Condition

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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 […]

Is taking prophylactic measures a pre-existing condition?

Can taking vitamins recommended by a physician trigger a pre-existing condition exclusion in a disability insurance policy?  That was the holding in Kutten v. Sun Life Assur.Co. of Canada, 2014 WL 3562784 (8th Cir. July 21, 2014) where the court found that taking Vitamin A constituted “medical treatment” sufficient to allow an insurer to avoid […]

Court rejects claim that vitamin supplements are a medical treatment

When to apply a pre-existing condition exclusion is often a battleground issue in disability benefit disputes as illustrated by Kutten v. Sun Life Assur. Co. of Canada, 2013 U.S.Dist.LEXIS 79546 (E.D.Mo. June 6, 2013). There, the court rejected Sun Life’s contention that because the claimant was taking vitamin supplements, he was receiving “medical treatment” for […]

Courts face challenges with ERISA, limitations period

Because the ERISA statute lacks a statute of limitations, courts have had difficulty in determining both the applicable limitations period and affixing a date upon which the limitation period accrues. Wise v. Verizon Communications, Inc., 2010 U.S.App.LEXIS 7244 (9th Cir. April 8, 2010) promotes certainty on these issues. In Wise, the plaintiff, Nancy Wise, was […]

Preexisting conditions: symptoms vs. diagnosis

The 3d U.S. Circuit Court of Appeals recently confronted the question of whether a “preexisting” condition really was preexisting and thus precluded insurance coverage. McLeod v. Hartford Life and Accident Insurance Co., 2004 U.S.App.LEXIS 12253 (3d Cir., June 22). Plaintiff Shirley McLeod, who had been receiving treatment for a variety of illnesses beginning in 1997, […]