Greetings,
I would like to know the meaning of the wording in the pre existing exclusion in my group LTD policy.
The pre existing condition exclusion reads as follows:
We will not cover any disability:
1. which is caused or contributed to by, or results from a pre-exiting condition; and
2. which begins in the first 24 months after your effective date, unless you have had no treatment of the condition for 6 consecutive months after your effective date.
Treatment: means consultation, care or services provided by a physician including diagnostic measures and taking prescribed drugs and medicines.
Pre -existing condition means a diagnosed sickness or injury for which you received treatment within 12 months prior to your effective date.
My effective date for this group LTD policy was August 2010. During the 12 month look back period I was taking Tamoxifen. I had stage 3 breast cancer in 2007 with no evidence of disease from 2008 on but continued taking Tamoxifen until August of 2009.
I have not taken any medicine for cancer control or management since August 2009. I was diagnosed with stage 4 breast cancer to the bone in April 2011 and then to the brain in December 2011. Since May 2011 I have been taking femara and biphosphanates as treatment.
I have not stopped working and hope to continue working for another year before applying for LTD.
My questions are:
1. do I qualify for the ltd even though I filled a prescription for Tamoxifen during the12 month look back period? In other words, am I disqualified from LTD benefits if either condition listed below is not met or do both conditions have to be unmet to be disqualified?
2. Is the date of my disability the day I stop working or the day I was diagnosed? I was diagnosedwith stage 4 cancer to the bone and brain within the 24 month period but I probably will not be applying for LTD until after the 24 month period.
3. Does having several brain tumors and some problems with balance which impedes my function at work qualify as total disability? My policy states total disabiility means 'unable to perform all of the material and substantial duties of your occupation on a full-time basis that started while you are insured under this plan.' I am already having some difficulty performing all of the duties of my work as a teacher and wonder how disabled I need to be to qualify for benefits.
Thank you for any information you could give me. I tried to post this earlier but am posting again as I don't see that my first attempt has appeared in the forum.
Lee
I would like to know the meaning of the wording in the pre existing exclusion in my group LTD policy.
The pre existing condition exclusion reads as follows:
We will not cover any disability:
1. which is caused or contributed to by, or results from a pre-exiting condition; and
2. which begins in the first 24 months after your effective date, unless you have had no treatment of the condition for 6 consecutive months after your effective date.
Treatment: means consultation, care or services provided by a physician including diagnostic measures and taking prescribed drugs and medicines.
Pre -existing condition means a diagnosed sickness or injury for which you received treatment within 12 months prior to your effective date.
My effective date for this group LTD policy was August 2010. During the 12 month look back period I was taking Tamoxifen. I had stage 3 breast cancer in 2007 with no evidence of disease from 2008 on but continued taking Tamoxifen until August of 2009.
I have not taken any medicine for cancer control or management since August 2009. I was diagnosed with stage 4 breast cancer to the bone in April 2011 and then to the brain in December 2011. Since May 2011 I have been taking femara and biphosphanates as treatment.
I have not stopped working and hope to continue working for another year before applying for LTD.
My questions are:
1. do I qualify for the ltd even though I filled a prescription for Tamoxifen during the12 month look back period? In other words, am I disqualified from LTD benefits if either condition listed below is not met or do both conditions have to be unmet to be disqualified?
2. Is the date of my disability the day I stop working or the day I was diagnosed? I was diagnosedwith stage 4 cancer to the bone and brain within the 24 month period but I probably will not be applying for LTD until after the 24 month period.
3. Does having several brain tumors and some problems with balance which impedes my function at work qualify as total disability? My policy states total disabiility means 'unable to perform all of the material and substantial duties of your occupation on a full-time basis that started while you are insured under this plan.' I am already having some difficulty performing all of the duties of my work as a teacher and wonder how disabled I need to be to qualify for benefits.
Thank you for any information you could give me. I tried to post this earlier but am posting again as I don't see that my first attempt has appeared in the forum.
Lee
Last edited:
