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CORAL GABLES, Fla., Sept. 11, 2017 /PRNewswire/ -- Dabdoub Law Firm recently represented a client who suffered a stroke and could no longer return to work. Prior to the stroke, the client experienced a healthy pregnancy and became insured through Reliance Standard, a disability insurance company started in 1907. After the client gave birth, she suffered the stroke. The client then filed a disability insurance claim through her disability insurance company, Reliance. However, the disability insurance company refused to pay for any of her long-term disability benefits, denying her claim on the basis her disability was pre-existing. The company referred to her pregnancy as a pre-existing condition that contributed to her stroke.
Reliance Standard's policy, like many disability insurance policies, excludes coverage for disabilities that were "contributed to" by pre-existing conditions. According to the disability insurance company, preeclampsia, the condition that caused the client's stroke, was caused by her pregnancy. Therefore, the pregnancy contributed to her stroke. Because the client was pregnant before becoming insured by Reliance Standard, the company considered her pregnancy a pre-existing condition and her disability ineligible for coverage.
Edward Dabdoub from Dabdoub Law Firm argued that, although the client was pregnant when the policy began, her pregnancy should not have been considered a pre-existing condition for a stroke. Reliance Standard's "but for" explanation was an illogical reason to deny the client coverage. The court agreed, stating the connection between the pregnancy and the stroke required too much attenuation.
The court ruled in the client's favor after adhering to the "substantially contributed to" test evaluating whether or not the pre-existing condition significantly contributed to the disabling condition. Once the court found the pre-existing condition, or pregnancy, did not contribute directly to the stroke, it also determined Reliance Standard could no longer consider the pregnancy a pre-existing condition and could not, therefore, exclude the client from long-term disability coverage.
The client is now able to obtain benefits through the Employee Retirement Income Security Act of 1974 (ERISA). Interested parties can visit Dabdoub Law Firm's blog here https://www.longtermdisability.net/articles/2017/september/reliance-standard-insurance-loses-case-after-wro/ for more information. The firm's website — https://www.longtermdisability.net/ — can also be referenced for more details, or to begin a disability case.
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