How Does the Claimant's Pre-Existing Condition Affect His Claim for Long-Term Disability Benefits?

The claimant, a former truck driver, was diagnosed with two primary medical conditions. Initially, he was diagnosed with Posterior Vitreous Detachment (PVD) in his right eye. Subsequently, a retina specialist diagnosed him with Macula-off Retinal Detachment, a more severe condition where the retina detaches from its normal position. In the claimant's case, this led to significant vision loss after three unsuccessful surgeries.Following this diagnosis, the insurance company, Life Insurance Company of North America (LINA), denied the claimant's claim for long-term disability benefits, citing the Pre-Existing Condition limitation outlined in the disability plan. LINA contended that the PVD, diagnosed during the look-back period, was highly likely to have caused a retinal tear, which in turn led to the retinal detachment and the claimant's subsequent vision loss. This presumed causal connection between the pre-existing PVD and the later disability was pivotal in their decision to deny the claim.In response, he appealed the denial of his long-term disability benefits by adhering to the procedures set under the Employee Retirement Income Security Act (ERISA).  The appeals revolved around disputing the insurance company's interpretation of the Pre-Existing Condition clause and their assertion of a direct causal link between his diagnosed PVD (considered a pre-existing condition) and the subsequent retinal detachment that resulted in his disability.This is the oral argument in the 10th circuit court of appeals.These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.