Legal Question in Insurance Law in New York

Pre-existing condition

Most health insurance policies do not provide coverage for an illness that is a pre-existing conditon - i.e. an illnes you have been treated for. My brother is currently living in South Asia and has been for many years. He recently had a mental health ''episode'' and went to the hospital. He was diagnosed and treated, staying in the hospital for 2 weeks. At this point, we are trying to get him back to the USA. What are the rules regarding coverage in this situation? He did not have health insurance overseas. We have since added him to our family's plan, but he has not yet come back to go for treatment. What type of lawyer would be best to consult on this matter?


Asked on 12/07/05, 8:55 pm

2 Answers from Attorneys

David Slater David P. Slater, Esq.

Re: Pre-existing condition

health care. Should you require a referral to one of my NY associates please let me know.

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Answered on 12/08/05, 5:33 am
Mark S. Moroknek Kelly & Curtis, PLLC.

Re: Pre-existing condition

Actually, if an individual has been continuously insured for an existing health condition and gets a new policy of insurnce he should still be entitled to coverage.

That said, mental health is a different situation and it depends on the type of condition, and the type of benefits that are provided under the policy in the first place, irrespective of whether its a pre-existing condition.

Since the episode hospitalized him it may fall under a different type of coverage then say for visits to psychiatrists on an out patient basis.

Before anything else I would sit down and review the policy provisions or booklet, and failing that, call a customer services representative at the company and ask if there is coverage for that

situation in general, without mentioning lack of prior coverage.

As to type of lawyer, a disability or insurance claims attorney if you can find one. While I do handle insurance matters I litigate them after the claims process has failed.

If this situation results in your family member being unable to care for himself there may be other, government benfits he should apply for.

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Answered on 12/09/05, 11:56 am


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