Arthritis: Outcomes Vary In Disability Insurance Cases

Assuming an exclusion is made, does that mean that when the insured is disabled, the person will never be paid for that condition?

Not necessarily. The person might receive payment, especially if the exclusion was for a specific period of time, say one year, and at the end of that period, the carrier favorably reconsidered its removal and the claim occurred thereafter.

Note: There are no guarantees that a carrier will remove an exclusion. But, once removed, even if there is a re-occurrence, the exclusion cannot be reinstated.

In any event, even with an exclusion, there is a chance the insured will still be paid for the excluded disability.

How does that happen, if there is an exclusion in place? First, most exclusions are written in very broad language, perhaps excluding more than the specific problem. This then allows some leeway at claim time, especially if the excluded condition wasn't a factor in the claim, e.g., the insured suffers a burn to the wrist which is independent of the exclusion.

What to keep in mind about arthritis: There are two types of arthritis– rheumatoid arthritis (RA) and osteoarthritis (OA).

These both affect joints in two different ways. RA is an autoimmune disease, in which the body turns on itself and attacks the tissues that line the ends of bones, causing serious inflammation. It's a body-wide ailment. OA, by contrast, is often confined to one joint and occurs when the cartilage breaks down, causing the bones to rub together.

For both arthritic conditions, medical treatment begins with the simplest and least risky intervention and then progresses to more intense medicine such as cortisone shots. There are nine general categories of treatment: topical, supplements, strength and balance, exercise, anti-inflammatory drugs, disease-modifying drugs, opioid analgesics, joint lubrication, surgery and replacement.

If a client who wants DI insurance has arthritis, the underwriting outcome may follow along these lines.

o If the person has rheumatoid arthritis, this will normally be a decline. However, there are carriers that might issue the case as a sub-standard risk.

o If the client has osteoarthritis and if the condition is localized, it can be excluded from DI coverage. Note: occupation is also an underwriting factor.

Larry Schneider is a disability specialist and owner of Disability Insurance Resource Center, Albuquerque, N.M. His e-mail address is [email protected].