Disability insurance exclusions are any illnesses or injuries that aren’t covered by a disability insurance policy. Disability insurance actually covers a wide range of health issues that can keep you out of work — that’s why it’s such important financial protection — but every policy lays out specific situations that are excluded from coverage.
Pre-existing conditions, meaning any health issues you already have when you buy the policy, are one of the most common disability insurance exclusions. If your medical history is making it hard to find affordable disability insurance, try comparing quotes to find an insurance company that will offer you the coverage you need at rates you can afford.
What is an exclusion in disability insurance?
An exclusion is something that your disability insurance policy won’t cover. Exclusions are listed out in your policy document, so make sure to read the fine print before you sign your policy and send it back, so you know what is and isn’t covered.
Examples of common disability insurance exclusions are:
Purposefully self-inflicted injuries
Illnesses or injuries caused by war
Illnesses or injuries from participating in illegal activity
Illnesses or injuries stemming from a riot or a protest
Pre-existing conditions
Exclusions vs. definition of disability
An exclusion is different from your policy’s definition of disability. Exclusions are specific injuries or illnesses that your policy doesn’t cover, while a definition of disability tells you broadly when you do qualify for coverage.
Usually policies will say that you meet the definition of a disability if you can’t “perform that material and substantial” duties of your job, which just means that you can’t do the actions your job requires.
Can disability insurance policies exclude pre-existing conditions?
Yes, most disability insurance policies exclude pre-existing conditions. A pre-existing condition is an illness or injury that you have before you buy disability insurance. Pre-existing conditions might include:
A past cancer diagnosis
Chronic joint problems
Asthma
Diabetes
Autoimmune disorders
Long COVID-19
An existing injury
Disability insurance excludes pre-existing conditions because they put you at a higher risk of making a disability claim. While you can get coverage with a pre-existing condition, you won’t be able to file a claim and receive payments if that pre-existing condition keeps you from working.
Let’s say you already have a history of chronic back pain when you get disability insurance. Your insurance company can deny future claims connected to your back pain, but you’ll still be able to collect benefits for an unrelated disability, like a new cancer diagnosis or a broken arm from a fall.
Pre-existing conditions and look-back periods
A look-back period is generally the 90-day period just before your disability insurance policy goes into effect, which your insurance company can consider when determining what counts as a pre-existing condition.
If your insurance company finds evidence of a pre-existing condition during the look-back period, like a doctor’s appointment or treatment, it will deny your claim.
Common disability insurance limitations
Your disability insurance may also limit coverage for some conditions (rather than excluding them entirely). Your disability insurance may have limited coverage for disabilities related to:
Mental health issues
Drug and alcohol use
Cosmetic surgery
Organ transplants
Self-reported conditions
Illnesses or injuries related to foreign travel
If your disability insurance company excludes or limits coverage for certain disabling conditions, it may also offer a rider that changes your coverage and allows you to receive full benefits for conditions that would otherwise have been excluded.
For example, if your policy limits coverage for mental illness to 24 months, you may purchase a rider that keeps your coverage the same for these conditions as with any other fully covered disability.
Does disability insurance exclude pregnancy?
While disability insurance does cover complications from pregnancy, some factors that can affect your policy.
You can get disability insurance while you’re already pregnant, usually until the third trimester of your pregnancy, but your policy will exclude your current pregnancy from coverage.
If you’ve had complications with past pregnancies that might keep you from being able to work, like preeclampsia, your insurance company may exclude those complications from future coverage.
How do you know your policy’s exclusions?
Your policy’s exclusions will be listed on your declarations page. A declarations page also lays out the other details of your coverage, premiums, and broad technical information about your policy.
Any exclusions will likely show up under a header like “limitations” or simply “exclusions.” You can always ask your insurance representative or broker for your policy’s exclusions if you can’t find them by yourself.
Can you appeal a denied claim?
Yes, you’re allowed to appeal a denied disability insurance claim. Your insurance company will send you a denial letter that tells you the reason for the decision along with the deadline to appeal.
You can appeal a denied claim yourself, but figuring your way through the process on your own can be difficult, especially if you’re recovering from a serious injury or illness. Consider consulting a disability insurance lawyer or legal professional if you have questions about the process.
Frequently asked questions
Do short-term disability plans have exclusions?
Yes, long and short-term disability insurance plans both have exclusions. They may even have the exact same exclusions.
Does disability insurance exclude coverage for injuries at work?
Disability insurance usually doesn’t exclude coverage for injuries that you get while you’re at work. Policies may lower your benefits by the amount that you collect from workers' compensation.
Can you get around an exclusion for a pre-existing condition?
If you have a pre-existing condition that your insurance company excludes from coverage, you probably can’t get around it. But you might avoid having a claim denied for a past condition if it falls outside of your insurance company’s lookback period.
