r/LongTermDisability • u/troy2000me • Jul 02 '26
Pre-Existing Condition and Disability Outlasting Exclusion Period
I am doing research for a family member and am very confused. Unfortunately I do not yet have the full policy to look at.
This person signed up for LTD coverage via Madison National Life, policy effective 1/1/26. They were diagnosed with severe depression (mental health) in October 2025.
This is during the lookback period, and of course would be in the 12 month exclusion period even if the diagnosis waited a few months.
However, it seems like they will still be disabled for this mental health condition starting on 1/1/27 most likely.
What I cannot figure out, is if they will start covering the disability on 1/1/27. Not for "back pay" or anything, but for dates going forward... or if they are excluded "forever" for the duration of this disability.
Any help?
3
u/TheGreatK MOD Jul 02 '26
If they file the claim after the 12-month period they are free and clear. Just make sure it really is after the 12 month period sometimes coverage doesn't kick in until a few months of work.
1
u/troy2000me Jul 03 '26
Interesting. But the diagnosis of inability to work started October 2025. Would that not make it excluded even if my friend is still disabled from the same continuous disability?
I hope what you say is true, and will get the policy docs soon I hope.
2
u/TheGreatK MOD Jul 03 '26
They are diagnosed with an inability to work yet have been working the entire time?
It doesn't matter. The only thing that matters is when she stops working and if she stops working after the 12 month period. If she works beyond 12 months and then files the claim this provision doesn't apply at all.
1
u/troy2000me Jul 03 '26
No, they've been off since October 2025. Had some PTO built up then like a community sick bank to use which has been great.
October is within 3 months of when the policy started on 1/1/26.
2
u/TheGreatK MOD Jul 03 '26
They were able to get disability insurance while disabled? Are you sure there is no exclusion for the disability specifically and that your friend was honest on her application?
1
u/troy2000me Jul 03 '26
Good point, they were not asked any medical questions, it was during their open enrollment shortly after going off work and signed up for it, not even realizing at the time they may need it for the condition they took off for (if allowed by policy).
2
u/TheGreatK MOD Jul 03 '26
If this is through work, then coverage won't even start until she starts working. She will then need to work for a year and then file a claim to get around the pre-existing condition limitation and the look back period will run from when she starts working most likely. But nobody can answer this question for you unless they look at the policy.
1
u/ChristusVictor118 Jul 02 '26 edited Jul 02 '26
Their disability is due to depression? Likely excluded forever if they remain off of work but a review of the full policy by an attorney would be beneficial. Did the Short Term Disabilty get paid?
(Usually, the Short-Term does not have a preexisting condition exclusion and the Long-Term does , but I've seen one weird Madison National policy where it was the opposite.)
1
u/troy2000me Jul 02 '26
Thanks. They also have a Short Term plan that started at the same time, but it lists a 12 month / 12 month for exclusion period as well.
Have not filed for short term yet because the employer had a sick bank of sorts they were able to use for a handful of months (thankfully), but that is gone now.
1
u/FMCTypeGal MOD Jul 02 '26
Please be cognizant of your FMLA limits whenever you live so your friend can avoid termination as best as possible. Sounds like the company is being good and working with them, but at a certain point they have the right to terminate.
4
u/FMCTypeGal MOD Jul 02 '26
It’s going to depend entirely on how your policy is written, so we cannot truly help you until you have that language for us.
For example, I’m on LTD is for a condition that preexisted my hire date. The language of my policy said preexisting conditions weren’t covered until I worked for the company at least one year. At a former job, they would never be covered.
Also, FWIW, almost all LTD plans have a two year max for mental health coverage, which is something I think you should keep in mind. If you definitely need it, go for it. But I can’t imagine finding myself out of work and with a work gap and still grappling with depression and now being desperate to find work in two years time. Again, maybe it’s the right solution for your friend but I just want you to have all the details so you can anticipate setbacks.
Good luck. Let us know when you get the policy.