Your Florida Long-Term Disability Claim Was Denied For A Pre-Existing Condition. Now What?
Receiving a long-term disability denial letter is stressful under any circumstances. When the denial is based on a pre-existing condition, it can feel even more discouraging, especially if you believe your current condition has little to do with your medical history.
The good news is that many denials based on pre-existing conditions are successfully overturned on appeal. Our experienced Jacksonville long-term disability lawyer explains what to do next and how to build the strongest possible case.
Pre-Existing Condition Denials in Florida LTD Claims Are Worth Challenging
Insurers are quick to deny or dispute Florida long-term disability benefits due to pre-existing conditions. Fortunately, you have the right to challenge.
The Employee Retirement Income Security Act (ERISA) entitles you to a full written explanation of the denial and a copy of your claims file at no cost. Reviewing that file is an important first step. Look for common errors insurers make when denying LTD claims based on pre-existing conditions, such as:
- Confusing symptoms such as fatigue or chronic headaches with an actual diagnosis.
- Using pharmacy records or a single office visit to establish a pre-existing condition.
- Misidentifying the look-back period, which is generally three to 12 months before coverage took effect.
- Claiming your pre-existing condition is ultimately the cause of your current impairments.
Under ERISA and general insurance law, any ambiguous language in the policy is interpreted in favor of the claimant, not the insurer. If the denial letter relies on a stretched interpretation of the policy’s pre-existing condition definition, that is a strong basis for appeal.
How to Build a Successful LTD Appeal in Florida
Because ERISA limits claimants to one administrative appeal before the matter can move to federal court, and because no new evidence may be introduced after that record closes, the appeal is your most important opportunity.
Pre-existing condition appeals depend on medical evidence that directly counters the insurer’s reasoning. Steps that give yours the best chance of success include:
- Ask your treating physician to provide a detailed written statement explaining the medical distinction between any prior symptoms and the condition currently preventing you from working.
- Gather diagnostic records, imaging results, and specialist notes that document when your disabling condition developed or significantly changed.
- Review the policy’s exact definition of “pre-existing condition” and compare it against the specific evidence the insurer cited.
- Get legal help before submitting the appeal, since the arguments raised and evidence included during this stage determine what a federal court can consider if litigation becomes necessary.
ERISA requires insurers to issue a decision on appeal within 45 days, with one 45-day extension permitted. Act quickly, as missing the deadline can jeopardize your rights to benefits.
Consult Our Experienced Jacksonville Long-Term Disability Lawyer
Denied long-term disability benefits in Florida due to a pre-existing condition? You have the right to appeal the insurer’s decision. For trusted legal help throughout the process, contact our experienced Florida long-term disability lawyer at Farrell Disability Law. Request a consultation at our Orlando or Jacksonville office today.
Sources:
dol.gov/agencies/ebsa/laws-and-regulations/laws/erisa
dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/publications/filing-a-claim-for-your-disability-benefits.pdf
