Long-Term Disability – Pre-Existing Condition Examples

All examples below assume a 1/1/2021 effective date of plan coverage.

Employee 1 Example: 

• Treated for Rotator Cuff Tear February, 2020
• Employee 1 submits a claim in June 2021 for Rotator Cuff related disability. It would not be covered in 2021 since the employee received treatment for it within 12 months prior to the effective date.

Employee 2 Example:

• Last treated for Cardiovascular Disease December, 2019
• Employee 2 submits a claim in June 2018 for Heart Attack related disability. It would not be considered pre-existing in 2021 since there was no treatment within the 12 months prior to the effective date.

Employee 3 Example: 

• Last treated for Migraine April, 2019
• Employee 3 submits a claim in January of 2021 for Migraine related disability. If there is no treatment in 2020 (12 months treatment free) the disability would not be considered pre-existing.

Please refer to the Summary Plan Description for additional details.