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Denial of LTD Claim


Guest dhltn
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Need some advice..Have a disability claim in progress for LTD, which was denied due to preexisting condition clause. Was told that HIPAA does not cover Disability Insurance. My research seems to tell me defferently. Heres what my research shows: HIPAA definition of Group Health Plan (Also called employee welfare plan) follows:

"..(5) Group health plan: The term `group health plan' means any employee welfare benefit plan, governmental plan, or church

plan (as defined under paragraphs (1), (32) and (33) of section 3 of the Employee Retirement Income Security Act of 1974 (29

U.S.C. 1002(1), (32) and (33))) that maintains (or makes contributions to) a health plan." Sections of ERISA quoted above reads as follows:

" Sec. 1002. Definitions

For purposes of this subchapter:

(1) The terms ``employee welfare benefit plan'' and ``welfare plan'' mean any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or

unemployment, or vacation benefits, apprenticeship or other training

programs, or day care centers, scholarship funds, or prepaid legal services, or (B) any benefit described in section 186© of this title (other than pensions on retirement or death, and insurance to provide such pensions)." Did I miss something? What is wrong with my research? Why can't I apply my previous disability insurance to help cover the preexisting condition? Appreciate any responses. Thanks in Advance.. My insurance plan is an ERISA plan.

[This message has been edited by dhltn (edited 08-31-98).]

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The following is from IRS regulations on HIPPA:

(1) In General.

The requirements of §§ 54.9801-1T through 54.9801-6T and 54.9802-1T do not apply to any group health plan in relation to its provision of the benefits described in paragraph (B) (2), (3), (4), or (5) of this section (or any combination of these benefits).

54.9804-1T(B)(2) Benefits Excepted In All Circumstances.

The following benefits are excepted in all circumstances-

(i) Coverage only for accident (including accidental death and dismemberment);

(ii) Disability income insurance;

(iii) Liability insurance, including general liability insurance and automobile liability insurance;

(iv) Coverage issued as a supplement to liability insurance;

(v) Workers' compensation or similar insurance;

(vi) Automobile medical payment insurance;

(vii) Credit-only insurance (for example, mortgage insurance); and

(viii) Coverage for on-site medical clinics.

I believe there is matching statutory language that provides that disability insurance is not covered by HIPPA.

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