Disability insurance protects you from losing your income when you become injured or sick. The higher your risk of becoming disabled, the higher your rates. Insurance companies factor in your age, occupation, medical history, and lifestyle, in addition to how much coverage when calculating premiums.
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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 — this is known as an exclusion.
What is a pre-existing condition?
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. They’re betting that you’ll pay for a policy during your life without becoming 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 benefits when needed most if they determine that your claim is related to a pre-existing condition.
Disability insurance with 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 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 this case, you can get disability insurance, but you won't be able to claim due to cancer.
You could also be declined for disability insurance if you have a mental or behavior conditions, such as anxiety. If your anxiety requires medical treatment or medication, your insurer may consider you higher risk and treat it as a pre-existing condition when you apply for disability coverage.
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. If you have a pre-existing condition, a licensed agent at Policygenius can help you get disability quotes and find a long-term disability policy that meets your needs.
Pre-existing conditions as disability insurance exclusions
Exclusions are things that aren't covered under your policy. If your claim for disability insurance benefits is based on one of these exclusions, it will be denied.
For example if you have a bad back — arthritis, for example — your policy will exclude a disability caused by that condition from your coverage. But if you happen to injure your back in another way, such as ruptured disc or getting into an accident, you can still receive benefits despite the exclusion.
Exclusions are a way for disability insurance companies to offer coverage to people with health issues, including pre-existing conditions. If you’ve got a chronic condition that you’ve been steadily treating for years, you’ll likely get disability coverage, just with an exclusion. But if the condition has developed recently or you 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 disability premiums, since the cost 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.
The reconsideration period
Exclusions for pre-existing conditions in disability insurance are generally permanent. 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 usually applies to physical injuries from which you have a reasonable expectation of making a full recovery and 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.
Frequently asked questions
What is a pre-existing condition for disability insurance?
Physical or mental conditions and illnesses that you have before applying for disability insurance are usually seen as pre-existing conditions. You usually need to have been treated for the condition in the last 90 to 180 days before applying for it to be considered a pre-existing condition.
Can disability insurance be denied?
Yes. Insurance companies can deny you coverage for pre-existing conditions, but they can also extend disability coverage with exclusions. A licensed expert at Policygenius can help you find a disability insurance policy for your situation.
Does short-term disability cover pre-existing conditions?
Most people can get short-term disability insurance without applying and even if they have a pre-existing condition because they get coverage through an employer. However there may be limits to filing a claim for short-term benefits with a pre-existing condition, so make sure to check your benefits summary and the terms of your policy.