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Denied Short Term Disability
Jul 26, 1999

At the beginning of this year my company switched insurance carriers and gave the option of purchasing short term disabilty insurance. I was denied this coverage because HIV is a pre-existing condition. I have LTD because the company provides that for all employees and has to offer it to all regardless of any pre-existing condition. The short term disability option was given during the annual open enrollment period. I also have not had to use my health insurance for any HIV treatment because I am in a study that provides for meds, blood work, and Dr.'s visits. The only thing ever charged to my insurance company was my HIV test in May of '98. So technically I haven't been treated for a pre-existing condition in over a year. So, can I be denied short-term disability because I am HIV? And THANK YOU, I just found this web site and this page and ya'll have answered MANY questions! :)

Response from Ms. Franzoi

You haven't provided enough information to fully respond to your question. Is the new short term disability (STD) plan a replacement for an existing plan? If it is a replacement for an existing STD plan and you were covered under that STD plan, coverage should continue under the new plan regardless of your medical status. Is the STD plan a group plan or an individual policy? If it is a group plan, I would question why there isn't guaranteed issue for everyone eligible during the open enrollment period.

However, let me address your more specific question regarding whether or not you have a pre-existing condition. A pre-existing condition is usually defined as any illness or injury that you have received treatment for, seen a doctor for or taken medication for during a specified period of time prior to the effective date of the plan. Even though you haven't seen a private doctor or submitted claims to your employer's health plan, you are under treatment with a doctor and taking medication. Therefore, if the plan has a pre-existing condition clause, you would be considered to have a pre-existing condition.

Lynn Franzoi



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