Our client, who worked as an engineer, was insured for long-term disability insurance benefits by Principal. Shortly after becoming covered, he was diagnosed with squamous cell carcinoma and submitted a claim for benefits. Principal summarily denied his claim because, according to Principal, his claim was subject to a pre-existing limitation in the insurance policy. Despite the cancer not being identified or diagnosed until after his coverage began, Principal argued that his prior extensive dental treatment supported its position that his cancer was pre-existing. Principal refused to change its position even after we provided it with statements from his treating physicians confirming the cancer was not pre-existing.
When Principal refused to change its position, Grabhorn Law filed a lawsuit on our client’s behalf challenging the denial of his long-term disability insurance benefits under ERISA. Ultimately, the federal court agreed and found that the pre-existing limitations clause did not apply and that our client was entitled to receive his long-term disability benefits.
In a lengthy decision, the court agreed with Grabhorn Law’s legal arguments, finding that “it is undisputed that Plaintiff was not diagnosed with throat cancer until after the relevant three-month period” and “based on the undisputed physician reports, it cannot be said that Plaintiff received medical treatment, consultation, care, or services, or was prescribed medication for squamous cell carcinoma or any related condition before the effective date of his disability policy because the treating physicians neither knew of nor suspected squamous cell carcinoma during their diagnostic efforts.” Judgment was subsequently entered in favor of our client.