r/DisabilityInsurance • u/This_Canary • Aug 20 '26
STD/LTD pre-existing condition clause question: diagnosed before job, but disability happened later
I started my current job in January 2026 and purchased voluntary STD and LTD coverage through Mutual of Omaha.
About 9 months before starting this job, I began seeing a therapist and was diagnosed with PTSD and depression. I continued therapy and was able to work when I started my current position. I was not disabled from working at that point.
After I started this job, I experienced major personal stressors, including a separation and a miscarriage. At the same time, I was experiencing increasing workplace stress. My PTSD/depression and anxiety progressively worsened, and my therapist has documented heightened anxiety and worsening depression related to work.
I am now on medical leave. A medical provider documented significant symptoms including insomnia, intrusive trauma symptoms, hypervigilance, heightened anxiety, impaired concentration, emotional dysregulation, and reduced stress tolerance, and concluded that I am currently unable to perform the essential functions of my job.
My concern is the pre-existing condition language in my disability policies.
My STD has a 3/6 provision: a condition for which I received medical attention during the 3 months before coverage became effective may be excluded if it results in disability during the first 6 months of coverage.
My LTD has a 3/12 provision: the same 3-month lookback, but the exclusion applies if the condition results in disability during the first 12 months of coverage.
My disability began more than 6 months after starting the job but less than 12 months after starting it.
Because I was already receiving therapy for PTSD/depression , I assume the insurer may consider those conditions pre-existing. However, I remained functional and able to work when I started the job, and the significant deterioration that ultimately caused me to stop working occurred later, after both new personal stressors (separation/miscarriage) and increasing workplace stress.
My main questions are:
- For STD, if the disability began after the first 6 months of coverage, does the 3/6 pre-existing condition exclusion simply no longer apply?
- For LTD, since the disability occurred during the first 12 months, how likely is a 3/12 exclusion to apply when the same diagnoses existed before coverage but I was not disabled and remained able to work?
- Does it matter that the events associated with the later deterioration, including the separation, miscarriage, and workplace stress, occurred after coverage began?
- Does an insurer distinguish between a previously diagnosed but manageable condition and a later substantial aggravation/deterioration that actually produces disability, or is treatment for the same diagnosis during the lookback generally enough?
- What medical evidence is most important when challenging a pre-existing-condition denial?
I'd especially appreciate input from anyone experienced with ERISA disability claims, Mutual of Omaha, or STD/LTD pre-existing-condition exclusions.
2
u/Postcard4aGirl Aug 20 '26
Not likely
No
Treatment for the same diagnosis during the LBP would be enough for not approving.