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Clarifying Pre-existing Condition; and Unemployment bene's
Sep 23, 2002

In a response regarding pre-existing conditions, you stated: "Most LTD policies have a pre-existing condition clause that excludes coverage for a disability that occurs during the first 12 months of coverage if it is related to an illness the employee saw a doctor for, took medication for or revceived any treatment for in the 3 months prior to the effective date of the coverage."

Does that mean that an HIV diagnosis in 1997 may not qualify as a pre-existing condition because it did not occur within three months of the effective date of coverage?

Here's the situation: I started working for a company in 2001. I was diagnosed with HIV in 1997, took meds for a few months but discontined due to the toxicity. Until recently, I have been fine, with an undetectible viral load, fine T-cell count and overall good health.

Recent events and stress at work have caused my condition to deteriorate, and without going into too many details, I suffer from HIV related exhaustion.

I applied for and received short term disability from my company and have since been awaiting approval for long term disability. The insurance carrier has since rejected my claim due to the before mentioned 1997 diagnosis of HIV. Is there anything I can do? My condition did not deteriorate until I was at my current employer. Further, during my short term disability, I was laid-off. Can I collect unemployment benefits as well as disability insurance?

Thank you, in advance, for your attention to this email.

Best regards.

Response from Ms. Franzoi

You have to check the terms of your LTD plan to see how a pre-existing condition is defined in the plan to determine whether or not your 1997 diagnosis would be considered a pre-existing condition or not. This should be covered in the summary plan description (SPD) for the plan. What I described in a prior response is a typical provision but not necessarily what all LTD plans have. However, if your LTD plan defines a pre-existing condition as I described it in that prior response and you have not seen a doctor, taken any medications, sought any treatment, etc., you should appeal the denial.

I do not know if disabilty benefits will reduce unemployment benefits. You should contact the unemployment office for an anwswer to that question.



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