Most disability insurance policies contain clauses that provide for the denial of disability claims for the first policy year if the disabling impairment was a pre-existing condition during a period of time immediately before the policy took effect – called the...
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pre-existing condition
How insurers deny long-term care insurance claims, part 1
We are all at risk of needing a long-term care support system should we become chronically sick, sustain a long-lasting or permanent injury, develop problems with cognition or face frailty related to the aging process. When one of these challenges prevents someone...
Unum wrongly denied Long Term Disability as pre-existing condition
Disability insurance policies often ban coverage for disability that stems from pre-existing conditions. In other words, if someone had a medical problem within a specified time frame prior to their effective date of coverage and they became disabled within the first...
Court holds LTD claimant did not have a pre-existing condition
On Sept. 3, the U.S. Court of Appeals for the 1st Circuit held that Aetna had wrongly denied long-term disability insurance coverage to a claimant with malignant melanoma. The opinion turns on a legal issue that comes up often in LTD cases — whether the claimant...
Private disability claims are often denied
There is a great disparity in how people think about insurance. Many Florida residents think of it as a necessary evil and purchase the minimum required for specific purposes, while others seek to protect themselves against risk by acquiring upgraded and broader...
The reason why short-term policies cost less
Individuals in Florida and throughout the country are eligible to buy health insurance through the Affordable Care Act (ACA). About 80 percent of those who buy policies through the ACA receive subsidies to make their policies more affordable. As part of changes to the...
Court Ruling on Mutual of Omaha Pre-Existing Denial of Benefits
In the case of Horneland v. United of Omaha Insurance Company, the eleventh circuit reversed the United States District court for the Middle District of Florida's decision finding for the defendant. In the case, Horneland sued United of Omaha Life Insurance Company...
The Eleventh Circuit Overturns a Grant of Summary Judgment to United of Omaha in an ERISA Long-Term Disability Claim, Determining That Muscle Spasms and Back Pain Are Not Pre-Existing Conditions.
In a recent case, Horneland v. United Of Omaha Insurance Company, No. 16-16935, __F.App'x__, 2017 WL 5508496 (11th Cir. Nov. 17, 2017), the Eleventh Circuit Court of Appeals reversed a federal district court's grant of summary judgment to United of Omaha ("UOO") in an...
Eleventh Circuit Court of Appeals Finds that Reliance Standard Life Insurance Company Acted Unreasonably When it Denied Disability Insurance Benefits Under the Pre-Existing Condition Exclusion to a Woman Who Suffered a Stroke Nine Days After Giving Birth
Julissa Bradshaw had a healthy pregnancy and no other pre-existing medical conditions when she became insured under her ERISA governed disability insurance policy with Reliance Standard Life Insurance Company ("RSL"). Approximately six months after obtaining the...
Cigna Continues to Engage in Unreasonable Delay and Denial Tactics of Disability Insurance Claims, Including Alleging that Disabling Conditions are Pre-Existing, After Cigna was Forced to Overturn Denials Under Similar Circumstances
In 2003, Susan Kristoff was diagnosed with breast cancer. After undergoing treatment, it was determined that she was in full remission and cancer free. As a precautionary measure, she was placed on Tamoxifen to prevent the recurrence of cancer in the future. Later,...