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Pre-Existing Condition Archives

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 to the effective date of her coverage related to the anisometropia.  In Hines v. Unum Life Ins. Co. of Am., 2018 WL 6599404 (N.D. Ohio December 17, 2018), the court overruled Unum's determination.  

How to defeat a pre-existing condition denial

Although the Affordable Care Act (Obamacare) prohibits health insurers from excluding coverage based on pre-existing conditions, in disability insurance policies, pre-existing conditions continue to be excluded.A recent ruling from a federal court in Wisconsin, Kaiser v. United of Omaha Life Ins. Co., 2016 WL 379814 (W.D. Wisc. January 29, 2016,) does an excellent job of explaining what is and what is not a pre-existing condition

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 paying disability benefits to an executive who became disabled due to retinitis pigmentosa.  The policy contained the following exclusion:

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