Can COVID-19 Health Effects Be Considered a Pre-Existing Condition by Your Insurance Company?

Is COVID-19 Considered a Pre-Existing Condition?

The answer to this question is based on a few different considerations. The specific wording of the definition of “pre-existing clause” in your insurer’s policy.  Typically an insurance company will not provide coverage, especially for long term disability, if the disability results directly or indirectly from a health condition or illness that existed on or before the date the insurance coverage began.

There are in some cases, exceptions to this rule, for instance, if you were covered by your insurer for at least 13 weeks during which you have been actively working and you have not gone to see a doctor or sought out treatment for any medical condition during that time or if you have become totally disabled after more than one year of coverage.

Unfortunately, the wording of the pre-existing clause can be applied to undiagnosed conditions, which is problematic in the time of COVID-19.

COVID-19 is a New Disease

We do not know enough about the illness and virus to understand how it impacts the population and what the long term effects of the disease could be.  In some cases, children are showing inflammatory syndromes sometimes, months after being diagnosed with COVID-19, or testing negative for COVID-19 but positive for antibodies.  Others have endured heart damage, permanent lung damage, and damage to their livers which was non-existent prior to their COVID-19 diagnosis.

The problem with COVID-19 is that sometimes a recovery from the disease does not necessarily mean your body has fully recovered.  There is a chance the virus has caused undetectable damage to your body which will not present immediately but rather result in impairment or disability later on in life.  If this condition is unrecognized until it presents with symptoms, it is possible your insurer will not consider the symptoms as arising from a pre-existing condition.  However, this is not guaranteed.

Diagnosis of COVID-19 as a Pre-Existing Condition

Insurance companies will likely do all they can to not pay out on your policy.  With the wide spectrum of symptoms and chronic conditions being connected to COVID-19, there is some reason for concern if a disabling health effect of the disease that presents post-infection could fall within a pre-existing condition category.  As such, you should be wary of coverage issues for conditions linked to the past diagnosis of COVID-19 in your medical records.

The timing of your policy also makes a difference.  A pre-existing exclusion usually only matters when a claim is made during the period that the pre-existing exclusion clause applies.  Usually, this time period is one to two years.  Again when it comes to COVID, you may get the disease, recover but not know about the underlying damage to your body nor feel disabling symptoms until a year or so after you have recovered from the illness.  It is possible to be caught in an exclusion clause time limitation with a COVID connected chronic condition.

Impact of the Virus in the Future

COVID-19 is a young disease.  The impact of the virus is still unknown and it has shown that it can interact with numerous physical and mental health conditions in unexpected ways and cause irreparable damage to people’s health or even make an underlying condition worsen.  For some COVID may take months to recover in hospital.  Some people may experience symptoms from an underlying documented condition which prior to a COVID diagnosis was asymptomatic but since being infected by COVID has become symptomatic or even disabling.  In these cases, it is possible an insurance company may try to rely on their pre-existing clauses to deny coverage.

Only time will tell how COVID-19 will impact insurance coverage and future disability claims have given so many unknowns about the disease and its effect on the human body.