How should I interpret the language in my insurance policy?
I’m currently in the process of enrolling in disability insurance through my employer. The policy comes with the standard two-page brochure, along with the option to access a lengthy 50-page document that contains more detailed information. In the middle of this document, it states: “No coverage for any disability that existed prior to the start date of coverage. However, a condition that was present but not disabling before the coverage begins will be covered.”
This wording seems quite ambiguous to me. For instance, if someone had previously been diagnosed with stage 3 cancer and experienced disability from it but has been cancer-free for several years, would that person’s cancer diagnosis be excluded from coverage because it was once disabling before the policy took effect? Or does the policy imply that any disabilities present at the start of coverage are not covered, regardless of their current status?
I also have some neurological issues that are currently managed with medication and are not disabling at the moment, but they could potentially become disabling in the future.
I’ve tried reaching out to customer service, but I only get a voicemail and no callbacks. How should I make sense of this insurance language? The policy covers both disability and life insurance.
Interpreting insurance language can indeed be complex and sometimes vague. Based on the verbiage you’ve provided, here’s a breakdown to clarify:
Pre-existing Conditions: The key part of the statement is that any disability present before your coverage starts is not covered. This suggests that if a condition was diagnosed and resulted in disability prior to the start of your policy, that specific condition generally won’t be covered under the new insurance, even if you are currently well or not experiencing disability symptoms.
Not Disabled Conditions: The policy further indicates that if you had a condition before coverage began that was not classified as “disabling” at the time the coverage starts, it may be covered. This means that if you had symptoms but they were manageable and you were not considered disabled, you might have coverage for that condition.
Example of Cancer: Using your cancer example: If you were previously diagnosed with and treated for stage 3 cancer but have been in remission and considered “cured” without any current disabling effects when your coverage begins, you may have a chance to be covered for any future complications directly related to that cancer. However, if the current policy’s language unequivocally states that any previous disabling condition is excluded, then it could lead to a denial of related claims down the line.
Future Disabling Conditions: Your neurological issues that are currently controlled by medication could be a bit more complicated. If those conditions were not considered disabling at the time your policy started, you might be eligible for coverage should they become disabling in the future. However, this is also dependent on how the insurance company defines “disabling.”
Given that the customer service response has been poor, it may help to:
Always make sure to read the entire policy document and keep a record of anything in writing from the insurance company. It’s important to understand how these terms will apply to your unique circumstances.