Today I want to write about a certain provision often found within a long-term disability policy that can significantly impact your ability to collect benefits. I am referring to the “limitation” provision(s) found within your policy, and specifically the catch-all limitations provisions which will limit the payment the benefits for the vast majority of disabling conditions. Each year it seems these insurance companies are modifying their contracts to provide fewer and fewer benefits, and the employer who provided the group policy for you does not understand the actual product it is purchasing.
A Closer Look at a Limitations Provision
All group disability policies contain certain limitations provisions. The most common limiting provisions are those relating to mental disorders or substance abuse claims. Such provisions have been around forever. It is the catch-all provision we has become more onerous over time, in my experience anyway, and is the subject of this blog.
I just finished reviewing a policy of insurance from The Standard Insurance Company. It reads as follows:
Other Limited Conditions means chronic fatigue conditions (such as chronic fatigue syndrome, chronic fatigue immunodeficiency syndrome, post viral syndrome, limbic encephalopathy, Epstein-Barr virus infection, herpevirus type 6 infection, or myaligic encephalomyelitis), any allergy or sensitivity to chemicals or the environment (such as environmental allergies, sick building syndrome, multiple chemical sensitivity syndrome or chronic toxic encephalopathy), chronic pain conditions (such as fibromyalgia, reflex sympathetic dystrophy or mild facial pain), carpal tunnel or repetitive motion syndrome, temporomandibular joint disorder, cranial mandibular joint disorder, arthritis, diseases or disorders of the cervical, thoracic, or lumbosacral back and its surrounding soft tissue, and strains or strains of joints or muscles.
You have got to be kidding me! This has to be the most onerous limiting conditions provision I have encountered yet in my career. Theoretically, this limiting provision would ban the payment of disability benefits to perhaps half of the disabled folks who contact us. Under this particular insurance policy issued by Standard Insurance, someone suffering from one these conditions is entitled to receive benefits but for only 12 months. I wonder if the particular employer who obtained this group policy has any idea this provision exists. I doubt it. Such a provision renders this particular LTD policy almost illusory – meaning the coverage one thought she had in the event of a disability really does not exist.
There are exceptions to the limitations provision which potentially apply for some disabled individuals, but certainly not all.
If your claim has been denied or limited because of the applicability of a provision similar to the above, you should not give up on your claim. There may arguments that could result in continued coverage, beyond the limited provision timeframe. Please feel free to contact the Denver disability attorneys at McDermott Law if you would like us to review your situation. We are here to help.