The Evolution of Disability Policies
Part 5: Limitations

In Part 5 of our series on how disability insurance policies have evolved, we’ll be taking a look at provisions related to limitations on coverage.

Many older individual disability insurance companies contained exclusions or limitations on coverage relating to pre-existing conditions, but as time went on insurers also began to include additional limitations geared at a broader range of conditions, such as mental health, nervous conditions, and/or substance abuse.  For example:

Limitations For Mental Disorder And/Or Substance-Related Or Addictive Disorder. For each separate Disability that is primarily due to a Mental Disorder and/or a Substance-Related or Addictive Disorder, benefits will not be provided for more than 24 monthly benefit periods. . . “Mental Disorder” includes, but is not limited to, any psychiatric, psychological, psychotic, emotional, somatic stress, behavioral or personality disorder.

While this exclusion is pretty broad-reaching by itself, newer policies have expanded the scope of  limitations provisions even more, as the example below shows:

Limited Benefit Periods for Mental or Nervous Disorders. The Insurance Company will pay Disability Benefits on a limited basis during an Employee’s lifetime for a Disability caused by, or contributed to by, any one or more of the following conditions. Once 24 monthly Disability Benefits have been paid, no further benefits will be payable for any of the following conditions:

  1. Anxiety Disorders
  2. Delusional (paranoid) disorders
  3. Depressive disorders
  4. Eating disorders
  5. Mental illness
  6. Somatoform disorders (psychosomatic illness)
  7. Subjective Symptom Conditions

Subjective Symptom Conditions means any physical or mental or emotional symptom, feeling or condition which cannot be verified using tests, procedures or clinical examinations that conform to generally-accepted medical standards. Subjective Symptom Conditions Include, but are not limited to, headaches, pain, fatigue, stiffness, numbness, nausea, dizziness and ringing in ears.

(emphasis added).

This limitation provision is particularly broad, and has a catch-all for conditions based on symptoms that can’t be verified objectively, which can often be very difficult to do with certain disabling conditions. These provisions highlight the need to carefully review your policy applications to make sure you are getting the coverage you think you are, and the importance of reviewing existing policies to make note of any limitations on coverage you may face in the event you need to file a disability insurance claim.

Every claim is different, and these are just some examples of limitation provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation.  If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.

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