Disability And Preexisting Condition


If you are a disabled person and want to apply for SSD benefits, the law takes into account any preexisting conditions from which you may be suffering. Here preexisting condition has a particular definition and a role in determining your disability.

The preexisting condition refers to the disease, injury or any other abnormal condition that has a role in making you disabled. In other words, the condition that resulted in your seeking treatment before you became disabled.

However, it does not mean that a simple health problem will be bracketed within the preexisting condition. Preexisting condition comprises any disease or injury that has really contributed to your disability. The net effect is that preexisting conditions that are not of a causative nature will not be taken into account in the determination of the benefits you are supposed to receive.

Secondly, it is also decided that whether the preexisting condition that you are suffering from is the major or minor cause of your disability. In other words, the pre-existing condition should have contributed to at least 51 percent of your disability or the need for your taking treatment.

Moreover, in this case the role of your doctor is very important. The doctor should provide your complete medical history and should also provide a clear view about the role that your pre-existing condition had to play in causing your disability.

In addition, the doctor is also supposed to describe the type of preexisting condition that the claimant is suffering from before the claim is filed.

The doctor’s statement should also substantiate that the said condition be counted as the major contributing factor for disability and the need of treatment. These requirements need to be fulfilled. If any of these requirements are incomplete, then the claimant will not be entitled for benefits. The preexisting condition clause is applicable for both individual and group insurance benefits.