Most disability insurance will exclude or limit coverage for certain conditions. The applicability and impact of a limitation on your claim requires careful analysis of the policy language, facts of your case, and the applicable law. Still, the following information may help you identify whether you have a potential coverage limitation issue.
Pre-existing condition limitation
A pre-existing condition limitation can exclude coverage for disabilities caused by conditions that you had, or for which you received treatment, before you were covered under the policy.
Mental Illness limitation
Commonly, benefits for mental illness such as depression or anxiety are limited to 12 or 24 months. Mental illness limitations can vary greatly. Your claim may be wrongly denied or limited if you are disabled from a physical illness, but also suffer from mental illness. If you are disabled from physical illness and also suffer from mental illness, you should consult with an experienced ERISA attorney as soon as possible.
Appropriate care and treatment
Most policies will not pay benefits unless you are receiving appropriate care and treatment for your disabling condition(s). While that usually does not mean that you must engage in all possible therapies, yYou and your care providers should agree on a course of therapy and stick to it unless it is appropriate to modify it. Failure to do so can result in a benefit denial or termination.« Return to the ERISA & Insurance Litigation Resource Center