Aug 19, 2013
The Pre existing condition exclusion. The policy will not cover any total or partial disability: 1. which is caused or contributed to by, or results from a pre existing condition; and 2. which begins in the first 12 months after the insured employee's effective date. I have worked for this company for over 5 years now, I've been diagnosed with chronic heart failure for the past 10 years, does this exclusion apply to me?
Response from Mr. Chambers
You have nothing to worry about.....regarding the disability benefits. The key is in the word "and" between #1 and #2. You have to meet BOTH conditions before a claim can be denied due to a pre-existing condition.
You do not meet #2 as you did not claim total or partial disability in the first twelve months of coverage, 5 years ago, so the pre-existing conditions exclusion does not apply to you.
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