Duhaime's Law Dictionary


Pre-existing Condition Definition:

A common exclusion of disability insurance contracts for exacerbation of medical conditions known to have existed within a specified time-frame.

Related Terms: Disability Insurance

Linda LoCoco's disability insurance policy with the Medical Savings Insurance Company defined (and excluded) pre-existing conditions from coverage.

Her policy defined pre-existing conditions as most do, as follows, and as set out in the 2008 United States Court of Appeals case which she lost and bearing her name, Justice John Rogers presiding:

"The term pre-existing condition means an injury or illness, including a pregnancy, for which medical advice, diagnosis, care, or treatment, including use of prescription drugs, was recommended or received from a licensed health practitioner during the 12 months immediately preceding the effective date of coverage.

"We will not pay any benefits of this policy for loss due to a pre-existing condition or a natural progression of a pre-existing condition unless the covered person's pre-existing condition was fully disclosed to us on the person's application for insurance under this policy; and coverage of the pre-existing condition has not been excluded or limited by name or specific description. However, this limitation will not apply to a loss incurred more than 12 months after a person first became a EFERENCES:

  • Lococo v. Medical Savings Insurance Company, 530 F. 3d 442 (2008)

 

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