Have a Pre-Existing Condition? How to Get Disability Insurance

Own-occupation disability insurance provides the strongest income protection for high-earning professionals with specialized training. Although it can be more expensive than group plans, it offers comprehensive coverage for your medical or dental specialty based on your individual risk of becoming disabled. 

This risk is determined by a formula that factors in your age, gender, occupation, lifestyle choices and medical history — which can feel intrusive for someone trying to get long-term disability insurance with a pre-existing condition.

While pre-existing conditions can make it more challenging to find disability coverage, each insurance carrier evaluates your health history differently. You can often find disability insurance with a pre-existing condition but there might be some caveats you need to be aware of.

Can you get disability insurance with a pre-existing condition?

If you have a mild-to-moderate pre-existing condition, you can usually still get disability insurance. The disability insurance company will review your medical records to consider the severity of the pre-existing condition and other factors, such as how long ago you were diagnosed and your treatment plan.

There are a few outcomes the insurance carrier will consider when trying to get disability insurance with a pre-existing condition. This typically translates to one of the following:

1. Your pre-existing condition might have no adverse action on the policy.
2. A policy exclusion might be added that specifically excludes your pre-existing condition.
3. The carrier might modify the policy to minimize its risk.
4. You might be declined altogether.

If a pre-existing condition exclusion is added to the policy, your disability premiums won’t be affected. This simply means any future disability claim won’t be covered if it’s a result of your pre-existing condition. Therefore, it won’t increase your premiums since there won’t be a payout associated with your existing medical condition.

However, the cost of disability insurance might be affected if modifications are made. For example, the carrier might add a rating, which acts as a percent price increase (e.g., 25% increase). Alternatively, the carrier might only allow a reduced benefit period, such as a maximum five-year benefit period.

Note that disability insurance companies can choose to use a combination of modifications for policyholders with pre-existing conditions, including exclusions, ratings and limitations — at which point, your premiums will likely be impacted. But you’ll at least have coverage for the countless other ways you might become disabled throughout your career.

What qualifies as a pre-existing condition for disability insurance?

A pre-existing condition includes any injury, illness or medical condition that you might have been diagnosed with prior to applying for disability insurance. Most people recognize common pre-existing conditions like cancer, back pain and chronic health issues. But surgeries, eating disorders, alcohol or substance abuse, and even past complications with pregnancy or delivery might be considered pre-existing conditions.

Mental health disorders are a common pre-existing condition for physicians applying for disability insurance. For example, if anxiety or depression medications are listed within your health history, all insurance carriers will automatically exclude mental/nervous coverage.

Keep in mind that each insurance carrier will determine what qualifies as a pre-existing condition and how they will treat the condition when underwriting a policy.

However, there are some pre-existing conditions that will generally result in denial when applying for individual disability insurance. This might include AIDS/HIV, Alzheimer’s Disease, Type 1 Diabetes, Multiple Sclerosis, Parkinson’s Disease or being an organ transplant recipient.

Residents and fellows with a pre-existing condition might have another option for disability coverage

Some residency and fellowship programs offer guaranteed standard issue (GSI) disability insurance. This type of disability insurance provides guaranteed coverage with no medical underwriting, regardless of whether you have a pre-existing condition. But it’s typically only available through major residency and fellowship programs, so it’ll depend on where you’re completing your training.

Depending on your medical history, a GSI policy could be your only realistic option with a severe pre-existing condition or if you have multiple pre-existing conditions that could result in denial elsewhere. But you might lose access to a GSI policy if you get denied or offered modified disability insurance coverage through a different insurance company.

Related: Don’t Miss These Residency and Fellowship Training Discounts: How to Save Money on Disability Insurance

Applying for disability insurance with a pre-existing condition

There’s a wide spectrum of health conditions that might be flagged during the medical underwriting process. However, it’s important to remember the insurance carrier will look at your individual situation to determine your insurability. Just because you have a pre-existing condition, doesn’t mean you’ll automatically be denied coverage or charged an arm and leg because of it.

Failing to disclose a pre-existing condition when applying for disability coverage will likely result in claim denial in the future, preventing you from receiving disability insurance benefits. So, even if you think a previous or existing injury, illness or diagnosis isn’t a big deal, it’s better to be upfront about the situation.

If you have a pre-existing condition, it’s best to work with an independent insurance broker who will guide you to available policy options based on your medical history. But they can’t do that if they aren’t aware of potential issues, so always be transparent and honest with your broker.

SLP Insurance starts by discussing your health and medication history prior to application to determine which carrier is the best fit. We’ll also look into available GSI options in case you have access to guaranteed coverage through your residency or fellowship program. Fill out the form below and our team will reach out with next steps.

FAQ: Disability insurance and pre-existing conditions