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Pre-Existing Condition Coverage in Disability Insurance?
What is covered?
by Jack Q. Le
E-Mail Jack Q. Le

In general, disability insurance (DI) does not cover pre-existing conditions. The general idea is to purchase disability insurance before you incur some type of medical complications. Any existing conditions or those in recent history will typically be excluded from coverage. As we age we accumulate sicknesses and injuries. It is the nature of getting older. Some of these ailments may be insignificant enough that we may still offer a DI policy. However, the DI policy may have a medical exclusion rider or multiple exclusion riders attached.

The purpose of a medical exclusion rider is to be able to offer DI even to those who have a medical condition that exists before a policy is issued or placed into force. The exclusion rider is an attachment on a DI policy that is used to identify and exclude these conditions. If an exclusion rider is found to be necessary, you will be notified in writing and your acknowledgment signature is required before your policy can be put in force.

Upon review of your current medical profile and your previous medical history, a medical exclusion rider may be necessary when…

1. The insurance company has identified an existing condition that increases the chance of you making a disability claim at some point in the future.

2. You have a medical problem that is clearly identifiable and a history of symptoms is observed. Organs, joints and musculoskeletal disorders are common examples.

3. A medical impairment is severe, recent, specific or likely to recur.

By excluding pre-existing conditions out of coverage, the risk of insurability is lessened and therefore an offer for DI can be made. There are so many different ways a person can become disabled. Having one or a few medical exclusions attached onto a DI policy should not have a significant impact on your decision to purchase DI.

In some cases a medical condition exclusions rider is not permanent and may be re-evaluated later for removal. If you have an exclusion and you believe the condition excluded is no longer a concern, you may have your medical profile re-evaluated. However, before asking for a re-evaluation, note that a favorable judgment may be made if…..

1. Ample time has passed and the insurance company is convinced that the medical problem will not recur or become aggravated again. Ample time varies according to the medical condition; or by reviewing medical records.

2. The medical problem as been completely eliminated and no symptoms have recurred; and medical records support this.

3. Your policy has been in effect for at least two years.


Disability insurance products underwritten and issued by Berkshire Life Insurance Company of America, Pittsfield, MA, a wholly owned stock subsidiary of The Guardian Life Insurance Company of America, New York, NY. Products not available in all states. Product provisions and features may vary by state.
The information in this web site is provided as a courtesy and for educational purposes only. Please consult your legal and tax advisor for specific information pertaining to your situation.