Legal Question in Insurance Law in California
Long Term Disability
My LTD ins. co. has declined my claim based on what they claim was a preexisting condition. Prior to a recent kidney transplant I was on dialysis preceded by progressive kidney failure yet I had no diagnosis of symptoms of my disability. Soon after the transplant I had acute, severe symptoms of neuropathy in my feet leading to my inability to sit or stand for any extended period of time. At the time of my transplant prior meds were discontuined and a new anti-rejection drug was prescribed to me. Since the neuropathy was so severe and concurrent with the prescribing of the new drug, I contend the drug and not some unnamed preexisting condition caused the neuropathy thereby creating a ''New Condition'' independent of the previous conditions i.e. not caused by the kidney disease itself, the original diagnosis. The drug co.'s website states a 23% chance neuropathy can occur in patients using the drug. My neurologist concedes there is a good probablity it is the cause of the condition but won't be definitive. There is no definitive way of knowing the exact etiology of the condition. Do I have a good case for a bench hearing? Is there any precedence in arguing the case of a ''new condition'' in regards to preexisting clauses?
1 Answer from Attorneys
Re: Long Term Disability
If expert medical testimony can establish that the drug was the "efficient proximate cause" of the disability, then the drug is a new condition (cause) of the disability.
But there are many facts missing - when did you buy the policy, is it through your employer or private, when did you have first diagnosis of kidney problems, when did you have the transplant, why and when was the first time the new drug was taken, etc. With these facts an intelligent answer to the legitimate issue you have raised is possible.
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