Watch Out for Limited Coverage Conditions and Hidden Policy Surprises

Posted on Wednesday, January 26th, 2022 at 10:25 pm    

The coverage offered by Long Term Disability (“LTD”) insurance policies can significantly vary across insurance companies and different employers. However, it is increasingly common to see policy language with broad exclusions or limited pay periods for certain medical conditions. Studies have found that these are the five most common medical conditions (in order) that result in a disability claim1:

  • Musculoskeletal disorders
  • Cancer
  • Fractures and muscle or ligament strains
  • Mental health issues
  • Heart attack or stroke

Of the five conditions listed above, two of these are commonly listed in LTD policies as limited conditions only eligible for 24 months of benefits or less. Mental health conditions have limited benefit durations in almost every LTD policy we come across. It has been that way for quite some time now. However, it is becoming significantly more common to see limitations periods related to other conditions where claimants experience “subjective” complaints that can be difficult to verify through “objective” testing.  For example, we often come across policy language specifically limiting musculoskeletal conditions unless there is certain, sometimes very specific, “objective” evidence available. Headaches, migraines, and cognitive complaints are also conditions that we are increasingly seeing limitations period being applied to.

These issues can be extremely nuanced and difficult to properly evaluate. It is important to know if this issue could affect your claim as early as possible, so we recommend you contact a competent ERISA attorney when you are considering filing for disability. Sometimes there are exceptions that apply to these limitations conditions and/or other options we can explore with you to help prepare you for (or even entirely avoid) the application of a limitations period to your LTD claim.

The attorneys at Abell and Capitan Law have the experience and expertise to help you navigate these treacherous waters. If you are considering filing for Long Term Disability benefits, you are welcome to reach out to us for a free consultation and Policy review. If you have already filed a claim and this issue is of concern in your claim, our experienced ERISA LTD attorneys are here to help.

[1] See Integrated Benefits Institute, Health and Productivity Benchmarking 2019 (released September 2020), Long-Term Disability, All Employers. Condition-specific results.

Written by : Erik Abell & Joe Capitan

Last Updated: January 26, 2022
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