Recent Answers to Insurance Agreement Law Questions
Can an insurance company deny a claim based on a pre-existing condition?
Health Insurance
Insurance Agreement
North Carolina
I recently filed a claim with my insurance company for medical expenses related to a chronic condition that I have been managing for several years. However, the insurance company has denied my claim, stating that my condition was pre-existing and therefore not covered under my policy. I believe that my condition should be covered as I disclosed my medical history when applying for the insurance and was approved without any mention of exclusions or limitations related to pre-existing conditions. I would like to know if the insurance company has the right to deny my claim based on a pre-existing condition and what steps I can take to dispute their decision.
Jeff G.
Hi. Unfortunately, the policy and the application for that policy CAN exclude pre-existing conditions. The best place to start is with a copy of the policy document and a thorough review to see what you agreed to when signing up for insurance. Now, it's also possible that there are conditions to those conditions: for example, if you were under continuous care before this new policy was purchase and the prior coverage DID cover the issue (it occurred during the prior continuous coverage), that it might not be considered pre-existing. But again, you'd need someone to review the policy document completely, as well as prior policies and your medical records to give you a completely accurate answer. I'm sorry that this isn't the answer you want to hear.
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