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Cok Kinzler PLLP

Can you be denied coverage due to a brain injury?

When you think about the expenses associated with an accident in Bozeman, you likely only consider the immediate costs, such as medical care. Yet if you were to suffer a brain injury in said accident, you might very well have to deal with the after effects for several years (potentially even until the end of your life). The good news is that if you require medical care related to your brain injury in the future, your health insurance will cover those costs. That is true even if you switch plans. The Affordable Care Act prohibited insurers from denying coverage for pre-existing conditions back in 2014. Yet what if your brain injury disables you, making you unable to work? 

You may be counting on long-term disability insurance to cover a portion of the funds you lost from having to stop working. Information shared by the U.S. Bureau of Labor Statistics shows that as of 2014, 33 percent of American workers carried such coverage. However, the requirements imposed by the ACA do not apply to long-term care coverage. Thus, there are certain scenarios where such coverage may be denied. 

Many group health plans have pre-existing condition clauses. While the time frames on them vary, they generally consider claims initiated within one year of the commencement of your coverage to be due to a pre-existing condition. Say you suffer a brain injury, attempt to return to work with a new employer, but are forced to seek disability coverage soon after starting. The long-term disability insurance carrier could deny you coverage. 

Knowing this, you may be tempted to simply omit the details of your injury from your insurance application. Know, however, that if you are forced to apply for coverage, the provider will pull your medical records and likely discover your condition. 

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