Disability Insurance: Medical Conditions
Oct 21, 2013
Jamie Fleischner

Jamie Fleischner

21 Oct, 2013

When you purchase an individual disability insurance policy, you are required to undergo a medical underwriting process where they will evaluate your medical history.  There are some conditions where you would be outright declined or have a significant rating. If you have one of the following conditions, you may be better off trying to obtain coverage through your employer.

After going through the underwriting process, the company will either approve you, decline you or offer a modified policy with an exclusion or a rating.

  • Standard. If the policy comes back “standard” this means that the offer is the policy for which you had applied.
  • Rating. This means that the company will approve you for coverage but will add an additional cost. The amount of the rating will vary based on the severity of your condition.
  • Exclusion. This means that your policy was approved at the rates for which you applied, but they will not cover a specific condition. An amendment explaining the specific exclusion will be part of the policy.
  • Decline. This means that the company will not be able to offer any coverage. Some declines are permanent and others will reconsider in a period of time if the condition is resolved.

If your policy comes back other than standard, it is important to discuss your options with your agent or broker to evaluate your options.

If you are currently healthy, the best time to purchase a policy is before a medical condition arises. Once you have your policy, the company can never cancel your policy or change your contract.

Here is a list of medical conditions and the probable underwriting offer:

  • AIDS/HIV Positive–decline
  • Addiction to alcohol or substance abuse–decline
  • Alzheimers–decline
  • ALS Amytrophic Lateral Sclerosis (Lou Gehrig’s Disease)
  • Aneurysm–decline
  • Anorexia–decline
  • Arrhythmia–decline
  • Atherosclerosis–decline
  • Arthritis—rheumatoid decline
  • Arthritis—psoriatic decline
  • Asthma—severe would be a rating or decline
  • ADD or ADHD—standard to decline depending on severity
  • Build/BMI—too high would lead to a rating or possible decline
  • Carcinoma—standard to decline depending on pathology
  • Carpal Tunnell Syndrom—most likely an exclusion
  • Cerebral Palsy–decline–decline
  • Chronic Fatigue Syndrome–decline
  • Cirrhosis of the Liver–decline
  • Colitis/Chrohn’s–decline
  • Congenital Heart Defect—standard to decline
  • Coronary Bypass–decline
  • Counseling—standard to decline, depending on situation
  • Cushing’s Syndrome–decline
  • Cystic Fibrosis–decline
  • Depression—standard to rating to decline
  • Diabetes—type 1 decline
  • Diabetes type 2 rating to decline
  • Diverticulitis—standard to an exclusion
  • Drug abuse–decline
  • Emphysema–decline
  • Endometriosis—likely an exclusion
  • Epstein Barr—standard to decline
  • Fibromyalgia–decline
  • Fracture—standard to decline
  • Glaucoma—exclusion
  • Gout—exclusion to decline
  • Heart attack–decline
  • Heart murmur—standard to decline
  • Heart valve replacement–decline
  • Hemochromatosis–decline
  • Hemophilia–decline
  • Hepatitis–decline
  • Hodgkin’s Disease/Lymphoma—after 10 years rating
  • Hypertension—standard to decline
  • Infertility—exclusion
  • Intestinal adhesions—exclusion
  • Insomnia—rating to decline
  • Irritable Bowel Syndrome—exclusion to decline
  • Keratitis—exclusion to decline
  • Kidney stone—exclusion
  • Laser Eye Surgery—over 1 year—standard
  • Leukemia–decline
  • Lipoma–decline
  • Lupus–decline
  • Malaria–decline
  • Mastitis—standard to decline
  • Melanoma—standard to decline
  • Meniere’s Disease
  • Meningitis—standard to decline
  • Mental Disorders—exclusion to decline
  • Migraines—exclusion
  • Mitral Valve Prolapse—rating to decline
  • Mononucleosis Infection—rating to decline
  • Multiple Sclerosis–decline
  • Muscular Dystrophy –decline
  • Myasthenia Gravis–decline
  • Myocarditis–decline
  • Narcolepsy—rating to decline
  • Neuritis–decline
  • Optic Neuritis–decline
  • Osteoarthritis—exclusion to decline
  • Osteomyelitis–decline
  • Osteoporosis–decline
  • Otitis Media–decline
  • Ovarian Cysts—standard to decline
  • Pacemaker–decline
  • Palpitations—standard to decline
  • Pancreatitis—rating to decline
  • Paralysis–decline
  • Parkinson’s Disease–decline
  • Pelvic Inflammatory Disease—exclusion
  • Pericarditis—rating to decline
  • Peripheral Vascular Disease –decline
  • Peritonitis—exclusion
  • Pernicious Anemia—decline
  • Phlebitis—exclusion to decline
  • Pleurisy—if fully recovered, standard
  • Pneumonia—single attack, no residuals, standard
  • Pneumothorax—standard to decline
  • Poliomyelitis—exclusion to decline
  • Polycystic Kidneys –decline
  • Polycythemia—rating to decline
  • Pregnancy—currently pregnant—exclusion
  • Proctitis—exclusion
  • Prostate Gland Impairments—standard to exclusion
  • Psoriasis—exclusion to decline
  • Psychosis –decline
  • Pulmonary embolism—standard to decline
  • Pyelonephritis—rating to decline
  • Radiculitis—exclusion
  • Raynaud’s Disease—exclusion to decline
  • Retinal Detachment—exclusion
  • Rheumatic Fever—rating to decline
  • Rheumatoid Arthritis—exclusion to decline
  • Sarcoidosis—rating to decline
  • Sciatica—exclusion
  • Scleroderma–decline
  • Scoliosis—standard to decline
  • Seizure Disorder/Epilepsy—rating to decline
  • Sickle Cell Anemia—trait only: standard. Others: –decline
  • Sinusitis—standard to exclusion
  • Sleep Apnea—rating to decline
  • Spermatocele—standard to exclusion
  • Spina Bifida—-decline
  • Spinal Cord disease—decline
  • Spinal Disc Disease—exclusion
  • Spinal Fracture—exclusion to decline
  • Splenectomy—standard to rating
  • Spondylolisthesis—exclusion to decline
  • Spondylosis—exclusion
  • Spine Strain—exclusion
  • Stroke—decline
  • Suicide Attempt—decline
  • Syncope—rating to decline
  • Tachycardia—rating to decline
  • Temporomandibular Joint Disorder (TMJ) exclusion
  • Thalassemia Major –decline
  • Thyroiditis—exclusion
  • Tinnitus—exclusion to decline
  • Tuberculosis—standard to decline
  • Ulcerative colitis—exclusion to decline
  • Uterine Fibroids—exclusion to decline
  • Varicocele—standard
  • Varicose Veins—standard to exclusion
  • Vertigo—rating to decline
  • Whiplash—exclusion to decline
  • Zoster–exclusion

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