Insurance Claim Denied Due to Pre-Existing Condition in Florida? Here's What to Do

Introduction

Receiving an insurance denial can feel frustrating, especially when it involves a pre-existing condition. Many Florida policyholders are surprised to learn that insurers often use pre-existing conditions as a reason to reject claims. Fortunately, not all hope is lost. With the right knowledge and support, you can challenge the decision and get the compensation you deserve.

What Is a Pre-Existing Condition?

A pre-existing condition is any illness, injury, or medical condition you had before your insurance policy went into effect. Examples include diabetes, heart disease, or even past injuries. Insurance companies may argue that your current claim is connected to a health issue you had before coverage began. This tactic is common in health, disability, and life insurance claims.

Why Insurance Companies in Deny Claims for Pre-Existing Conditions in Florida

Insurers deny claims for a few key reasons:

• Policy exclusions: Many policies exclude pre-existing conditions, especially if you didn’t disclose them.

• Misrepresentation: If the insurer believes you failed to mention a condition on your application, they may accuse you of fraud.

• Connection to prior condition: Insurers may argue your current claim is linked to a past issue and therefore not covered.

This is often a gray area, and companies may stretch the definition to avoid paying.

Your Legal Rights in Florida

Florida law offers some protections to policyholders:

• Time limitations: After a policy has been in effect for over two years, insurers generally cannot deny claims based on pre-existing conditions.

• Good faith requirement: Insurance companies must act in good faith. If they deny your claim without proper investigation or justification, you may have grounds for a lawsuit.

You can learn more about Florida's insurance laws on the Florida Department of Financial Services website.

Steps to Take After a Denial

Here’s what you can do immediately:

• Request a written explanation: Insurers must tell you why your claim was denied.

• Review your policy: Look for any mention of pre-existing condition exclusions or timeframes.

• Gather evidence: Collect medical records, doctor’s statements, and correspondence that support your case.

• Document everything: Keep a log of all communications with your insurer.

These steps help prepare for an appeal or legal challenge.

Appealing a Denied Insurance Claim in Florida

To appeal:

• Write a formal appeal letter: Include all evidence and cite your policy.

• Get expert opinions: A doctor’s letter explaining that your condition is not related to a pre-existing issue can be powerful.

• Consult a lawyer: Insurance law is complex. Legal guidance ensures your appeal meets all requirements.

You can also file a complaint with the Florida Office of Insurance Regulation if you believe the denial was unfair.

How Louis Law Group Can Help

Louis Law Group specializes in helping Florida residents fight denied insurance claims, including those involving pre-existing conditions. We can:

• Review your denial and insurance policy

• Help collect strong supporting evidence

• Represent you in appeals or legal action

With years of experience in Florida insurance law, Louis Law Group can help you level the playing field.

FAQs

Q1: Can insurance deny my claim for any pre-existing condition?

A: Not always. Florida law limits denial based on pre-existing conditions, especially after two years of continuous coverage.

Q2: What if I didn’t know I had the condition?

A: If the condition wasn’t diagnosed or treated before your policy began, it may not count as "pre-existing."

Q3: Should I hire a lawyer?

A: If your appeal is denied or you're unsure how to proceed, a lawyer can greatly improve your chances of success.

Q4: How long do I have to appeal a denied claim?

A: Deadlines vary by policy. Act quickly, and check your denial letter and policy for specific timelines.

Conclusion

If your insurance claim was denied due to a pre-existing condition in Florida, don't give up. You have rights, and you may be able to appeal or take legal action to get the compensation you're entitled to. Louis Law Group is here to support and guide you every step of the way. Are you ready to fight back against your insurance company's denial?

Contact Louis Law Group today for a free consultation. Call 833-657-4812 or submit a free case evaluation form to get started. Don’t wait—let us help you take the first step toward justice and financial recovery.