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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