How Pre-existing Conditions Affect Your Disability Benefits Claim
When applying for disability benefits in Ontario, one of the significant challenges many claimants face is the issue of pre-existing conditions. These conditions can complicate the process, as insurance companies often use them as a basis to deny or reduce benefits. Understanding how pre-existing conditions affect your disability benefits claim is crucial to navigating the claims process effectively and ensuring that you receive the benefits you are entitled to.
What is a Pre-existing Condition?
A pre-existing condition is any medical condition that existed before the onset of a new disability or before you applied for disability benefits. This could include chronic illnesses, injuries, or any other health issues that were diagnosed or treated prior to your current claim. In the context of disability benefits, insurance companies often scrutinize pre-existing conditions to determine whether they are related to the current disability claim.
How Pre-existing Conditions Affect Your Claim
- Policy Exclusions and Limitations
Many disability insurance policies include clauses that exclude or limit coverage for pre-existing conditions. These clauses typically state that if your disability is related to a pre-existing condition that was diagnosed or treated within a specified period (usually six to twelve months) before the policy took effect, the insurer may deny your claim. This is particularly common in group disability insurance policies offered by employers.
- Causal Relationship
Even if your policy does not explicitly exclude pre-existing conditions, the insurance company may still investigate whether there is a causal relationship between your pre-existing condition and your current disability. If they can argue that your current disability is directly linked to or exacerbated by a pre-existing condition, they may attempt to deny your claim or offer reduced benefits. For example, if you had a history of back pain and are now claiming disability due to a back injury, the insurer might argue that the pre-existing condition is the primary cause of your current disability.
- Proving the Severity of Your Condition
In Ontario, you are entitled to disability benefits if you can prove that your current disability is severe enough to prevent you from working, regardless of whether you have a pre-existing condition. However, insurance companies may argue that your condition is not as severe as you claim because of your pre-existing condition. They may use medical records, surveillance, or even independent medical examinations to challenge the severity of your disability.
- Importance of Medical Evidence
To overcome the challenges posed by pre-existing conditions, it is essential to provide strong medical evidence that clearly demonstrates how your current disability is distinct from, or significantly worsened by, your pre-existing condition. This may include detailed medical records, doctors’ reports, and expert testimony that can show a clear progression of your condition or how your current disability differs from your pre-existing health issues.
Steps to Protect Your Claim
- Review Your Policy: Before filing a claim, review your disability insurance policy to understand any clauses related to pre-existing conditions. This will help you prepare for potential challenges from the insurer.
- Document Everything: Keep detailed records of all medical treatments, appointments, and any communications with your insurance company. This documentation can be critical in proving your case.
- Seek Legal Advice: Navigating a disability benefits claim involving pre-existing conditions can be complex and overwhelming. An experienced disability lawyer can help you understand your rights, gather the necessary evidence, and represent you in dealings with the insurance company.
Pre-existing conditions can significantly impact your disability benefits claim, but they do not automatically disqualify you from receiving benefits. Understanding how these conditions are viewed by insurance companies and taking proactive steps to protect your claim is essential.
If you are facing challenges with your disability benefits claim due to a pre-existing condition, the experienced lawyers at Hilborn and Konduros in Cambridge, Ontario, can provide the guidance and representation you need. Contact us today to discuss your case and ensure that your rights are protected.
