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skeeter14

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  1. Hi, Thanks in advance for your time to read my post. I enrolled in an employer disability policy that became effective 9/1/08. Submitted a claim after shoulder surgery July 09. I did not consult medical advise until 10/08. BUT, I did report I thought my symptoms (intermittent shoulder pain) started in 6/08 or 7/08 after doing housekeeping activities. Because it is documented in my medical record that I thought symptoms started before the policy became effective, my claim was denied. My argument is that based on their definition of pre-existing condition. They state it's the existence of symptoms which would cause an ordinarily, prudent perosn to seek medical diagnosis, care or treatment during the 2 years before the effective date. I am an ordinarily, prudent person and I did not think my symptoms were anything more than just "overdoing it" and that I did not need to consult a doctor for diagnosis at this time. When the symptoms worsened and persisted , then I consulted my doctor in 10/08. Has any legal precidence been set for this situation? I know it is very subjective, BUT come on. Average, prudent people don't consult their doctors after every onset of aches or pains. Being a thorough person, I reported to my doctors and documented on claim form that the first sign of illness was June 08 when I think it started after a weekend of heavy housekeeping. I appealed this initial decision on my own and they denied it again based on fact that I had symptoms of a disabling condition before my effective date. Any input or experience with this ordinarily, prudent person definition? Thanks, S [This post has been edited to remove personal information- Moderator]
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