What Sort Of Medical Treatment Will Trigger A Pre-Existing Condition Exclusion In An Erisa Governed Disability Plan?
Many disability plans will have a pre-existing condition clause that prohibit the payment of LTD benefits, if you received medical treatment for a specific period of time before the start of the disability.
For example, in the case of Kutten v. Sun Life
Assurance company of Canada, 2014 WL 3562784 (8th Cir. July 21, 2014), Kutten’s ERISA long term disability policy had a pre-existing condition exclusion clause.
The policy defined a pre-existing condition as one in which the employee “received medical treatment, care or services, or took prescribed drugs or medication for the disabling condition 3 months before the start of the policy.
What is Medical Treatment?
Kutten had a progressive eye disease. In 1994, his doctor told him to start taking an over-the-counter Vitamin A supplement. This supplement couldn’t cure the disease, but slowed the disease.
When Kutten applied for disability benefits, Sun Life determined that the Vitamin A supplements triggered the pre-existing exclusion clause as medical treatment.
The court in this 8th Circuit decision found that a Vitamin A supplement was not “medical treatment” because the “use of the supplement didn’t require the same medical intervention as prescribed drugs and medicines.” The court noted that the supplements were medical “in the sense they prevented or alleviated the progression of” the disease.
The appellate court reversed the decision, saying that the ordinary meaning of the phrase, “medical treatment,” encompassed the use of supplements.
What Should I do if I’m Thinking About Applying for Disability Benefits?
Get out your disability policy! You need to review the pre-existing disability clause and determine whether you have received treatment that would disqualify you for benefits. If you have, timing may be the key so that you don’t receive medical treatment, care or services in the applicable period of time that would disqualify you for benefits.
It’s time for you to contact a Disability attorney, like Nancy Cavey, who can help you make the difficult decision about whether to apply for long term disability benefits and when you should apply for benefits.
She can help you, regardless of where you live in the United States. Call today at 727-894-3188.