If you have a pre-existing condition, it may be excluded from your disability insurance coverage.
Disability insurance is protection from the risk of losing our income when you become injured or sick. The higher your risk, the higher your rates. Aside from your coverage needs — the amount of disability benefits you’ll need and the duration — premiums are a factor of your age, occupation, medical history, and lifestyle.
You can often get disability insurance without paying higher rates if you have pre-existing conditions, but your benefits will not cover injuries or illness caused by your pre-existing condition — also known as an exclusion.
In insurance, a pre-existing condition is a medical issue you have that may influence whether or not you qualify for the insurance coverage you’re trying to get.
Rules against insuring people with pre-existing conditions exist to protect insurance companies from someone buying a policy after they become ill. Insurance companies protect you from future risk, not risk you already incurred. They’re betting that you’ll pay premiums and not die or become disabled, which allows them to pay benefits when claims are made.
Common pre-existing conditions that impact a disability insurance application include:
Insurers assess your pre-existing condition based on the treatment you received for it. It will show up in your medical records, and disability insurance companies will be poring over those looking for anything that could complicate your health picture, including visits to the doctor’s office and any prescriptions you’re taking.
But insurance companies also count on you to be honest about any conditions you have if you’re aware of any symptoms when you first apply, and they could deny you or your beneficiaries benefits when needed most if they determine that your claim is related to a pre-existing condition.
If you have a pre-existing condition, whether you qualify for disability insurance and how much you pay for coverage will vary by insurance company. It also depends on the severity of the condition and whether the condition is covered by the policy.
Some pre-existing conditions will automatically disqualify you from coverage if you’re still suffering from the condition when you apply for disability insurance. Cancer is one of these conditions, but disability insurance companies may still offer you coverage if you’ve been in remission for three to five years (the time frame varies between companies). In such a case, you can get coverage but not for the cancer — it will be excluded.
You could also be declined for disability insurance if you have a condition that you wouldn’t otherwise associate with a debilitating illness, such as anxiety. If your anxiety requires medical treatment or medication, your insurer may consider you higher risk.
If you don’t mention your pre-existing conditions when applying, and the underwriters somehow don’t find out about them, they may cause you to be denied benefits when you do file a claim. The best way to ensure that you’ll receive disability insurance benefits when you become injured or ill and can’t work is to lay everything out when you apply.
Disability insurance is unique among insurance products in that each policy comes with specialized riders, called exclusions, that describe the types of conditions that you can’t receive benefits for. Exclusions apply not just to health issues but also risky activities and hobbies. If your claim for disability insurance benefits is based on one of these exclusions, it will be denied.
If you become disabled due to a condition that you didn’t have previously or wasn’t caused by something that was excluded, you’ll be able to collect benefits.
For example if you have a bad back — a ligament strain or arthritis, for example — your policy will exclude a disability caused by that condition from coverage. But if you happen to injure your back in another way, such as from a ruptured disc, you can still get coverage despite the exclusion.
Exclusions are a way for disability insurance companies to offer coverage to people with health issues. If you’ve got a chronic condition that you’ve been steadily treating for years, you’ll probably just get an exclusion. But if the condition has only recently developed or had an acute flare-up, you could get declined, or your policy could get postponed until your condition has stabilized.
Exclusions also won’t increase your premiums, since the premium is a calculation of how much coverage you need, and exclusions aren’t part of that coverage.
Every disability insurance provider has different rules on how it treats exclusions. Have a look at your exclusion rider to make sure it’s what you were expecting. Even if your disability insurance policy has an exclusion rider, you should still file a claim if you become disabled. Because exclusions can be narrowly defined, the provider may still pay out benefits.
If you had a pre-existing condition for which an exclusion rider was included on your policy, that generally means you’re stuck with the rider indefinitely. Occasionally, though, you may recover from the condition, in which case you may want the disability insurance company to reconsider your risk and thus lower your premiums.
The reconsideration period lasts for the first few years of your policy. During that time, if the treatment for your condition has concluded and you’ve been symptom-free for two years, the insurance company may remove your exclusion rider.
Insurance companies make a distinction between conditions you can recover from and those that are permanent, such as cancer. The reconsideration period usually applies to physical injuries from which you have a reasonable expectation of making a full recovery.