Short-Term Disability Insurance Covering Pre-Existing Conditions

The topic of short-term disability insurance and pre-existing health conditions is confusing because there is no single correct answer, two key underwriting decision points, and at least three policy types.

For instance, an issuing company might approve your application to purchase income protection and deny your claim for benefits if you sought treatment for the physical disorder during the 12 months preceding the effective date.

Then, the policy type influences the correct answer. Individual plans bought outside employers have the most stringent criteria, while large-group employer-funded coverage is more lenient, and government-mandated benefits are most generous.

Individual Plans With Pre-Existing Condition

People can buy individual short-term disability insurance with a pre-existing medical condition but should not expect the new policy to cover losses caused by the same problem immediately.

Expect lesser benefits when an organization does not force healthy people to pay income protection premiums. Two types of policies fall into this category.

Pre-Existing Pregnancy

Women can buy individual short-term disability with a pre-existing pregnancy but should not expect maternity-related benefits for at least twelve months.

You can get short-term disability approved while pregnant and qualify for benefits immediately for future injuries and illnesses. Meanwhile, two exclusions will rule out maternity leave claims for a period.

  1. No pregnancy-related benefits during the first twelve months
  2. No claim payments for normal childbirth within nine months

Coverage Decisions

People can buy individual short-term disability insurance with specific pre-existing medical conditions but not others. Your ability to win approval depends on the severity and recency of the health event.

Denials

You can be denied short-term disability coverage with a pre-existing condition that is severe and recent. For instance, any of these events in the last five years will knock you out.

Heart AttackHeart SurgeryHigh Blood Pressure
Heart DiseaseStrokeTransient Ischemic Attack
CancerKidney DiseaseDiabetes
EmphysemaLung DiseaseLiver Disease
HepatitisCirrhosisNeurological Disorder
Multiple SclerosisChronic Fatigue SyndromeFibromyalgia
Intestinal DiseaseAlcohol or Drug Abuse

Approvals

You could be approved for short-term disability coverage with a pre-existing health condition when a severe problem has been in remission or under control for a lengthy period, or a more recent issue was minor.

  • Severe: you pass the test if you have not received medical advice, sought treatment, or taken medication for over five years for the illnesses listed above
  • Minor: you could score an approval if you have not missed five consecutive days of work during the last twelve months for any injury or illness other than cold, flu, or maternity

Request a short-term disability quote if you satisfy these criteria. An agent licensed in your state may contact you to complete an application for coverage.

12/12 Limitation

Finally, you can buy an individual short-term disability policy with a pre-existing health condition, but the 12/12 limitation will restrict your benefits for one year. This definition has two parts.

  1. If you become disabled because of a pre-existing condition, we will not pay for any loss if it begins during the first 12 months the policy is in force
  2. A pre-existing condition means having a sickness or physical disorder for which you were treated, received medical advice, or had taken medication within 12 months before the effective date

Group Plans With Pre-Existing Conditions

Group short-term disability insurance covers pre-existing medical conditions more frequently because there is safety in large numbers. The premiums paid by employers covering hundreds of healthy people fund benefits for the tens most likely to file claims.

If your employer does not offer this benefit, three other group programs might provide the income protection you need.  

Social Security

Social Security short-term disability covers pre-existing medical conditions with no limitations because the federal government forces hundreds of millions of healthy people to participate and pay premiums through FICA payroll taxes.

Apply for disability benefits through Social Security if you cannot perform any work for twelve months or longer. The words you use matter, and the word temporary is exceptionally vague.

Instead, pay attention to the legal definition published by Social Security, which clearly states, “expected to last for a continuous period of not less than 12 months.”

State-Mandatory

State short-term disability programs cover pre-existing medical conditions with no waiting periods or exclusions. The local government forces hundreds of thousands of healthy people to sign up and pay the premiums.

Unfortunately, state-mandated temporary disability programs exist in only seven regions: California, Hawaii, Massachusetts, New Jersey, New York, Rhode Island, and Washington.

Even the tiniest state has over 600,000 civilians in its workforce, most of whom will never file a claim. Yet they still pay premiums every month, year, and decade.

Workers Compensation

Workers’ Compensation short-term disability covers pre-existing medical conditions because each state requires employers to buy a policy and pay the premiums for all employees in their group.

Apply for temporary disability benefits through Workers’ Compensation if an on-the-job accident aggravates a previous injury. For instance, a person with joint problems (ankle, knee, hip, shoulder, etc.) could slip and fall at work, making the problem worse, which then interferes with their ability to perform the duties of their full-time occupation.