Insurance for Pre-existing Conditions
In July of 1997 the federal government enacted a law that protects the rights of individuals seeking insurance for pre-existing conditions in certain circumstances. Prior to this law, insurance for pre-existing conditions has been difficult to attain and outright denied in numerous cases, as insurance companies perceive those with existing medical conditions as a greater liability. Paradoxically, those with pre-existing conditions are often the ones in the greatest need of adequate insurance coverage. In light of these facts, federal and state governments have enacted laws regarding insurance for pre-existing conditions.
A pre-existing condition is any medical condition that a person has knowledge of, and/or was treated for, prior to enrolling in an insurance plan. Many insurance policies have a pre-existing condition clause that excludes coverage for pre-existing conditions for twelve to eighteen months after the effective coverage date. The definition of a pre-existing condition and the provisions of the clause itself can vary considerably from one plan to another. Therefore, it is helpful for a policyholder to familiarize themselves with the terms of their insurance for pre-existing conditions.
HIPAA, or the Health Insurance Portability and Accountability Act of 1997, is a federal law that provides certain protections for people with a pre-existing condition. HIPAA limits the time that a person can be denied insurance for pre-existing conditions, reduces the risk of losing current coverage, provides protection when changing jobs, and a number of other protections. There are also certain cases where insurance for pre-existing conditions cannot be denied by an insurer. Pregnancy is a condition for which denial of insurance for pre-existing conditions is unlawful. The denial of insurance for pre-existing conditions can not be applied to newborns or adopted children under the age of 18 under certain conditions.
When an insurance company unreasonably denies coverage under a policy because of a pre-existing condition, the insured may have the legal right to seek remedy from the insurance company. Insurers have a fiduciary duty to act in good faith and fair dealings in all transactions involving policyholders. Violations of HIPAA and other legal provisions, breech of contract, and bad faith are all viable grounds for filing a lawsuit to seek compensation for denied benefits and related losses.
Typically grievances related to insurance for pre-existing conditions must first be addressed internally by the insurance company. There is typically a certain period of time during which an appeal must be filed. The laws which govern grievances for insurance for pre-existing conditions vary by policy and by location. Therefore, it is advantageous to seek the help of an experienced attorney who can evaluate your case to determine your legal rights and options. You may be eligible to seek compensation for benefits plus interest, emotional distress, and other damages. In cases of willful or malicious denial of insurance for pre-existing conditions, punitive damages may be awarded. Please contact us to speak with a qualified attorney about insurance for pre-existing conditions.
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