The Most Common LTD Policy Exclusions and How They Can Impact Your Claim

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When you have a long-term disability (LTD) policy in place, you expect it – and rely upon it – to compensate you fairly in the event that you are unable to continue working due to a prolonged illness or medical condition. Unfortunately, many employment-based LTD policies include limitations and exclusions that are used to deny claims for benefits. These pitfalls in the LTD claims process are one of many reasons why having an experienced long-term disability attorney in your corner is important. 

At Monahan Tucker Law, we are fierce advocates for clients dealing with a denied or delayed insurance claim, including claims for long-term disability. We know that understanding your policy and its language before filing a claim can be essential. In this post, we’ll identify some of the LTD policy exclusions we see most often.

Long-Term Disability Coverage Basics

If you suffer an injury or illness that is not work-related but that disables you to the extent that you will be off the job, long-term or even permanently, LTD coverage can help. Some employers offer this private benefit as a perk, but LTD insurance policies can also be purchased outside of employment. Benefits are usually paid out as a percentage of the claimant’s pay at the time they were disabled. 

Common Limitations and Exclusions

Policy exclusions are used to limit when benefits are available under a long-term disability plan. The kinds of limitations and exclusions vary by employer and insurance provider, but they generally break down into a few basic categories.

Preexisting conditions – Limitations based on preexisting conditions are exceptionally common. A preexisting medical condition may be excluded from coverage because it is believed to have existed prior to coverage. Many LTD insurance companies will go to great lengths to show the preexistence of a condition – even when doing so is a stretch.

Mental illness – Another common limitation of LTD policies is mental illness or nervous disorder, and many policies limit LTD benefits for these conditions. This is often achieved by limiting coverage to 24 months, and too many insurers are all too willing to conjure loose connections between long-term disabilities and what they deem nervous disorders. 

Self-reported symptoms and conditions – Another major player when it comes to LTD policy limitations is self-reported symptoms and conditions. The crux of the matter is that insurers will seriously limit the duration of LTD benefits in response to a disability that is self-reported. Common examples include chronic pain, cognitive dysfunction that is often referred to as brain fog, and chronic fatigue. Working with an attorney to gather and present evidence of your condition can be vital in these cases.

Alcohol and substance abuse – These limitations are gaining popularity in LTD policies, and they seek to limit the length of coverage for those whose disabilities are related to alcohol or substance abuse. Because insurers are financially motivated to deny claims, they are often too eager to attribute the insured’s condition to these causes.

Protecting Your Claim

The most important point to keep in mind with exclusions and limitations is that they are often applied incorrectly. If an insurer has denied your claim unfairly, you have the right to take action through an appeal or lawsuit, if necessary. A savvy long-term disability attorney can help. 

Reach Out for the Legal Guidance of an Experienced Long Term Disability Attorney Today

You don’t have to struggle with a denied long-term disability claim alone. At Monahan Tucker Law, our long-term disability attorneys have the negotiating skills and courtroom experience to make them formidable opponents for insurers. Serving Arizona, California, Nevada, Oregon, and Washington, we use our deep knowledge of LTD and ERISA laws to benefit those who need it most – hard-working people like yourself. We are well-versed in deconstructing the erroneous claims of insurance companies, and we’re committed to fighting for the best possible resolution in your case. 

If your LTD benefits were denied, learn more about how we can help you by contacting us today.

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