Long-Term Disability Insurance Disqualifiers Uncovered: The Last One Will Shock You

Disability insurance is like a financial safety net that kicks in if you cannot work due to an illness or injury.

It’s designed to replace a portion of your income when you can’t earn it yourself.

A picture representing what are some of the long-term disability insurance disqualifiers.
Disability insurance companies base their claim decisions on the claimant’s medical restrictions and limitations | Photo done by Michael Ndenga

Here’s how it typically works: when you’re healthy and working, you pay regular premiums to the insurance company. In return, if you become disabled and can’t work, the insurance company pays you a portion of your income, usually around 60-70%, to help cover your living expenses.

What disqualifies you from disability insurance?

Qualifications for disability insurance hinge on your health and lifestyle factors.

If insurers perceive a high likelihood of claims due to these factors, you might face disqualification.

For instance, obtaining coverage with a pre-existing condition, particularly if it’s ongoing during application, can be challenging. Consider cancer treatment, which often poses obstacles to securing disability insurance.

Additionally, engaging in hazardous occupations or habits, such as smoking, could also render you ineligible for coverage.

Factors That May Lead to Disability Insurance Denial

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When applying for disability insurance, you could be denied coverage due to various factors such as:

  1. Pre-existing health conditions
  2. Undisclosed medical issues
  3. Pending medical treatments
  4. Unresolved past treatments or conditions in your medical records
  5. Engaging in high-risk occupations
  6. Self-prescribing medications
  7. Being classified as either overweight or underweight

Additionally, it’s important to note that certain lifestyle choices or activities may also impact your eligibility for disability insurance, such as participating in extreme sports or having a history of substance abuse.

ALSO READ: Social Security Disability Requirements: What You Need to Know in 2024

Let us dive into these factors and talk about them one by one:

  1. Pre-existing health conditions

Finding disability insurance when you have a pre-existing condition, a health condition existing before applying for insurance can be tough.

Some common pre-existing conditions are:

Pre-existing Conditions
Arthritis
Asthma
Cancer
Diabetes
Fatigue
HIV/AIDS
Elective surgery
Epilepsy
Existing injury
Long COVID-19
Vertigo

NOTE:

You may still qualify for disability insurance with a pre-existing condition, but typically it won’t cover you if you need time off due to that condition.

If you’re experiencing symptoms of your pre-existing condition when you apply for coverage, you might not be eligible for insurance at all.

2. Undisclosed medical issues

If you have a medical issue that doctors can’t diagnose, it may prevent you from getting disability insurance.

Even if the problem doesn’t appear serious, insurance providers can’t assess its potential severity or risk without a clear diagnosis.

They often require a doctor’s confirmation before offering disability coverage. For instance, imagine someone experiencing chronic fatigue and pain but doctors can’t pinpoint the cause. Despite their symptoms affecting daily life, without a diagnosis, they might struggle to obtain disability insurance.

3. Pending medical treatments

Before you buy disability insurance, inform your insurance provider about any medical treatments you’re undergoing or planning.

If you have surgery or another procedure scheduled, you might not qualify for disability insurance until it’s confirmed that your operation was successful.

For instance, if you’re planning to undergo knee surgery next month, it’s important to disclose this to your insurance company before purchasing disability insurance. This ensures transparency and prevents any potential issues with coverage eligibility.

4. Unresolved past treatments or conditions in your medical records

If your medical records have errors, insurance companies might refuse to provide disability insurance.

For instance, if a previous medical condition wasn’t labeled as “resolved” in your records, it could cause complications.

To address this, you can request your doctor to update your records to reflect resolved conditions or ask your insurance company for a delay to allow your doctor to resolve the issue.

For instance, if you had a knee injury in the past but it was treated and healed if your medical records don’t clearly state that the issue has been resolved, an insurance company might deny you disability coverage based on the assumption that the injury is still ongoing. In such a case, asking your doctor to update your records could rectify the situation.

5. Engaging in high-risk occupations

Certain jobs, such as roofing, firefighting, piloting, or construction work, pose a higher risk of disability.

Consequently, insurance companies may refuse disability coverage for individuals in these professions.

However, some insurers might provide coverage with the condition that benefits are limited to a few years following a disability, rather than a longer duration.

For instance, a construction worker might find it challenging to obtain disability insurance due to the physical demands and risks associated with the job.

6. Self-prescribing medications

If you’re a doctor, you could lose your disability insurance if you prescribe medication for yourself.

This is because insurance companies can’t verify if your self-prescription was necessary. It’s a conflict of interest and can lead to insurance disqualification.

For example, if a doctor prescribes strong painkillers after a minor injury, the insurance company might see it as suspicious and deny coverage if they become disabled later on.

7. Being classified as either overweight or underweight

Your weight plays a significant role in determining if you’re eligible for disability insurance.

Insurance providers may deny you coverage if your weight exceeds or falls below the range specified in their height-weight chart. For instance, if you’re significantly overweight, insurance companies might see you as a higher risk for health issues and therefore refuse to provide coverage. Conversely, if you’re underweight, they might worry about your overall health and decline coverage as well.

It’s important to maintain a weight within the range specified by your insurance provider to ensure eligibility for disability insurance.

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