Does a pre-existing condition affect long-term disability?

Asked by: Milton Stoltenberg  |  Last update: October 27, 2025
Score: 4.4/5 (52 votes)

An insurance company will typically (but not always) impose an exclusion for a pre-existing condition, meaning that they will deny your disability claim if you are unable to work due to that pre-existing condition. However, you will still get benefits for any other covered condition.

Does long-term disability exclude pre-existing conditions?

In ERISA governed claims for insured long term disability benefits arising in the Ninth Circuit (California, Oregan, Washington, Nevada, Arizona, Hawaii, Alaska, Montana, and Idaho), pre-existing condition provisions are unenforceable if they are not clear, plain and conspicuous.

Do pre-existing conditions affect health insurance premiums?

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

What are the requirements for long-term disability?

We consider your medical conditions, age, education, past work experience, and any transferable skills you may have. If you can't do other work, we'll decide you are eligible for disability benefits. If you can do other work, we'll decide that you don't have a qualifying disability and your claim will be denied.

Why would a long-term disability be denied?

Insufficient Medical Evidence

A lack of sufficient medical evidence is one of the most common reasons disability insurance claims are denied. Insurers often require objective test results, such as x-rays, MRIs, electrodiagnostic tests, lab findings, or psychological testing, to support a disability claim.

Can My Long Term Disability Claim Be Denied for a Pre Existing Condition?

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Is long term disability hard to get?

Social Security Disability Insurance only covers total disability, is very hard to qualify for, and the average monthly benefit is just over $1,000. If that is not enough for your needs, you should consider other types of disability insurance coverage.

Why do most people get denied for disability?

The most common nonmedical reason for denying a claim is insufficient number of recent work credits.

What is the most common long-term disability claim?

Musculoskeletal disorders are the leading cause of long-term disability claims, according to the Council for Disability Awareness. These claims can encompass back pain, arthritis, joint disorders, and more.

What illness automatically qualifies for disability?

Neurological disorders (e.g., epilepsy, benign brain tumors) Mental disorders (e.g., bipolar disorder, anxiety, depression) Cancer (malignant neoplastic diseases) Immune system disorders (e.g., HIV infection, lupus, inflammatory arthritis)

How much social security disability will I get if I make $60,000 a year?

Someone in their fifties who made $60,000 per year might expect a disability payment of $2,000 per month. You can check your annual Social Security Statement to see your covered earnings history. You'll need to set up an account to see your statement online at my Social Security.

What pre-existing conditions are not covered?

Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.

How far back is a pre-existing condition?

A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.

How do insurance companies know if you have a pre-existing condition?

To determine if a condition is pre-existing, insurers examine medical history, treatment records, and diagnosis reports. They may use “look-back periods,” which are specific timeframes—typically six months to a year before coverage begins—to review medical history.

What is the look back period for long term disability?

In many cases, a long-term disability policy defines a pre-existing condition according to two time periods: a “lookback period” and a “waiting period.” Looking back periods define which conditions are preexisting under the policy. They often range from 90 days to 6 months, but may even last as long as a year.

What is the limitation period for pre-existing conditions?

The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.

What are three examples of pre-existing conditions that may be written into a disability contract as exclusions?

Here are some examples of pre-existing conditions that may affect eligibility for disability insurance coverage: Chronic medical conditions: These are long-term medical conditions that require ongoing treatment or management, such as diabetes, asthma, or heart disease.

What is the most approved disability?

Overall, however, the most approved disability for Social Security is disabilities involving the musculoskeletal system and/or connective tissues. According to the World Health Organization (WHO), such conditions include arthritis, back pain, and lupus.

What gives 100% disability?

The 100 percent disability rating is often awarded to veterans with two or more limbs that have been amputated or paralyzed or for veterans with active service-related diseases such as cancer, severe cardiac conditions, or psychiatric conditions such as PTSD, bipolar, depression, or schizophrenia.

What not to tell a disability doctor?

Exaggerate Your Symptoms or Disabilities

While you should always be open and honest about your condition, do not exaggerate or claim to have symptoms that you do not. The doctor will likely see through it, which could make them doubt other things you tell them, ultimately harming your claim.

What is the easiest condition to get disability?

What Is the Most Approved Disability? Arthritis and other musculoskeletal system disabilities make up the most commonly approved conditions for social security disability benefits. This is because arthritis is so common. In the United States, over 58 million people suffer from arthritis.

What disabilities are hard to prove?

Here are the Top Disabilities That Are Difficult To Prove
  • Mental Health Conditions.
  • Chronic Pain Disorders.
  • Fibromyalgia.
  • Chronic Fatigue Syndrome.
  • Autoimmune Disorders.

What is the average long term disability payment?

The average benefit from private long-term disability insurance (LTD) ranges between 60 and 80 percent of gross salary. The average benefit from private short-term disability insurance (STD) ranges between 40 and 70 percent of gross salary.

What is the hardest state to get disability?

As of 2024, Utah is the hardest state to initially get approved for SSDI. It has an approval rating of 44.64% for first-time applicants. Who Is Eligible for Maximum Disability? A person who meets the SSA's work history and disability requirements is eligible for the maximum disability amount of $3,822 a month.

What should you not say when applying for disability?

Ten Things You Should Never Say When Applying For Social Security Disability
  • “It's not that bad. ...
  • “I'm getting better.” ...
  • “I can work, but no one will hire me.” ...
  • “It hurts.” ...
  • “I'm not being treated.” or “I stopped treatment.” ...
  • “I have a history of drug use/criminal activity.” ...
  • “My relative gets disability.”

What are the top three conditions that cause disability?

In the United States, pain, depression, and anxiety are among the most common causes of years lived with disability (YLD).