Group Benefits Guide: Can I Get Disability Insurance With A Pre-Existing Condition?

Group Benefits Guide: Can I Get Disability Insurance With A Pre-Existing Condition?

When planning for the future, it is best to remember that life sometimes includes unfortunate, unforeseen circumstances. Participating in group benefits with long-term disability coverage gives you peace of mind and protection for future uncertainties. Disability insurance in Canada can cover up to 70% of your income if you become ill or injured and cannot work. 

Unfortunately, some people face an issue claiming long-term disability benefits due to pre-existing conditions. You may ask yourself, “Can I get disability insurance with a pre-existing condition?” The short answer is yes, but some stipulations could cause an insurance company to deny you benefits.

What Is a Pre-Existing Condition?

When you’re wondering, “Can I get disability insurance with a pre-existing condition,” you must first understand what a pre-existing condition is and how it could apply to you. A pre-existing condition is a term insurance providers use for a health problem or injury you have before obtaining disability insurance. 

Under the “objective standard” definition, insurers can determine any condition for which you have previously received medical treatment or advice to be a pre-existing condition. If you have a disability that requires medical care, the insurance agency may try to deny your claim by arguing that your situation predates the start of your insurance coverage.

How Pre-Existing Conditions Affect Long-Term Disability Law

Pre-existing conditions include, but are not limited to:

  • Cancer
  • Heart disease
  • Asthma
  • Diabetes
  • Severe injuries

Every insurance policy is different. Filing a long-term disability claim with a pre-existing condition will affect the outcome of your benefits. It does not matter if your medical issue is recent or congenital. 

Pre-existing condition exclusions are part of most group long-term disability policies. The exclusion would disqualify you for benefits if your condition developed before your employer-based insurance coverage started. However, the exclusion may also apply to claims for disability benefits within your first year of coverage. 

If the insurance provider can prove you saw a physician or received treatment for any issue relating to your disabling condition within the pre-existing condition exclusion period, they could try to deny your claim.

Purpose of Pre-Existing Condition Exclusions

Insurance agencies often include pre-existing condition exclusions in their group policies because they do not know each participant’s medical history at the time of coverage. The company cannot determine the risk of covering every employee on the group plan. Insurers use the pre-existing condition exclusion to prevent paying benefits to people who gain employment solely to claim long-term disability benefits.

Importance of Applying for Group Insurance with Disability Coverage

Participating in group benefits with long-term disability protects you financially if you lose your income. You would receive monthly payments to replace a significant portion of your potential earnings. Without this insurance coverage, you may have few options for long-term financial support.

Questions to Ask When Applying for Group Insurance Coverage for Long-Term Disability

Before enrolling in group long-term disability coverage, it’s best to ask the following question to ensure that you make an informed decision:

  • What is the pre-existing condition exclusion period?
  • Does the insurer exclude specific medical conditions from coverage?
  • How long do you need to wait for benefits to begin?
  • How long will benefits last?
  • Will specific medical conditions limit benefits?

Group Long-Term Disability and Pre-Existing Conditions

If you develop a condition or injury that prevents you from earning a living, you can file a claim through your employer’s group long-term disability insurance. However, if your claim could fall under the pre-existing condition exclusion, the insurance provider may investigate your medical history before your policy’s start date.

The insurance company likely won’t explore your entire medical history. They may investigate a specific period, such as 90 days before your coverage’s effective date. If you did not receive treatment for the disabling condition during that period, the exclusion does not apply.

Can You Appeal a Denial for Long-Term Disability?

If the insurance company denies your long-term disability claim, you have a right to an appeal. The appeal process lets you ask the insurance provider to reconsider its decision after denying your claim. You may go through an internal appeal process in which the insurance company’s employees handle your written request to appeal.

If the company denies the internal appeal, you could request an external one. The process allows an independent agent like a provincial judge or arbitrator to address your claims. Filing this appeal involves bringing a lawsuit against the insurance company to negotiate a settlement or approve your claim.

Understanding Long Term Disability In Canada

Learn more about the long-term disability qualifications and application process in Canada, with our article.

Choose Group Enroll for Essential Group Disability Benefits

Life-changing illnesses and accidents can happen at any time. Your employees may ask, “Can I get disability insurance with a pre-existing condition?” Though many long-term disability coverages through group benefits include pre-existing condition exclusions, Group Enroll can help you select the most appropriate insurance plans for your workers. 

At Group Enroll, we help business owners find affordable group health, life, and disability insurance coverage by providing quotes from some of Canada’s leading insurance agencies. As an insurance broker, we make it easy to compare rates and find reliable coverage.

Begin your search today by completing our online quote form. You can also send correspondence to [email protected] or 10 Great Gulf Drive, Unit 5, Vaughan, ON, L4K 0K7.

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