Ophthalmologists and orthopedists are seeing the physical cost of the country’s fast growing sport – – pickleball. While it might seem that most injuries result from falls, a JAMA Ophthalmology study cross-sectional analysis reports the largest number of injuries on the pickleball courts involve the eyes and surrounding ocular structures.
Players are suffering from corneal abrasions, bleeding in the eyes (ocular hemorrhaging) and fractures of the bones surrounding the eyes (orbital fractures) at alarming rates. Surprisingly, the eyes are more commonly injured than wrists, ankles, or knees.
Here’s the thing: pickleball, while accessible, is deceptively intense. The smaller court and slower ball speed make it appealing, but fast stops, lateral motions and quick reflexes demanded by the game put stress on the musculoskeletal system. Add in close quarters and frequent rushes to the net and player collisions become a real hazard.
When a Sports Injury and Preexisting Condition Collide
Pickleball collisions are common, and when a chronic orthopedic condition exists before the injury, filing a long-term disability (LTD) insurance claim becomes more challenging.
Consider this common scenario:
A 50-something professional has lived with chronic back pain for a decade. They’ve been under the care of a number of doctors — orthopedists, chiropractors, pain management specialists, and rheumatologists. Treatment has been ongoing in a variety of modalities over the course of ten years. They manage their symptoms, stay active, and maintain full-time employment. They also enjoy sports: cycling, hiking and yes, playing pickleball.
Then they experience a serious injury while playing pickleball – a torn meniscus or a fractured vertebra. The injury leaves them unable to work. They file a claim against an employer-sponsored LTD policy (ERISA) and two privately purchased long term disability insurance policies. All are denied.
When claimants call us before filing a long term disability claim, we can help. We strategically prepare initial claims so there is no question their claim stands on its own. Getting out in front of the denial is far better than battling the denial, although we do that every day for clients who thought they could manage their initial filing on their own. The initial claim is prepared to prevent the insurance adjuster’s knee-jerk reaction to denying the claim because of a previous medical condition.
Denied Long Term Disability Claims: “Preexisting Condition” as a Catch-All Denial
If you have a pre-existing condition, the LTD company is going to do whatever it can to tie it to the current claim. If you have a bad back and suffer an ocular injury on the pickleball court, the rationale used will connect the two. If that sounds illogical, we agree, but this is how the claims are addressed.
It’s preventable by retaining an experienced long term disability insurance attorney at the onset of the claim.
Understanding Pre-Existing Condition Clauses in Long Term Disability Insurance Policies
Most long term disability insurance policies include some form of a preexisting condition exclusion. The language of the provision may vary, but basically it states that if someone received treatment, consultation, care, or services for a medical condition in the months prior to the coverage date, or, in some cases, at any time, the insurer can deny a claim if the current disability is “related to” or “results from” the earlier condition.
The interpretation of “related to” is broad and subjective and it will be used to deny a claim. Even if the injury is completely distinct from the chronic condition, the LTD company will use this as a reason to deny your claim.
What Can You Do to Protect Your Claim?
Start out with a stronger position by retaining an LTD law firm from the onset. Don’t file an initial claim without the protection of a professional advocate who knows how the game is played and what it takes to win.
What if You’ve Already Filed an LTD Claim and It Was Denied Based on a Preexisting Condition?
If your LTD claim is denied, request a full copy of the denial letter. It should contain specific policy language.
Start gathering your entire medical record from all treating physicians. You’ll be needing this to challenge the claim.
Talk with all treating physicians. You’ll want to gather medical options clarifying the cause of your disability.
Don’t try to appeal an LTD denial on your own. Many people try to do this and further weaken their case. Call our office to find out what your options are. If you submit the wrong evidence, or flawed evidence, it becomes part of the administrative record and cannot be changed or withdrawn. It’s too big a risk.
Be Proactive About Protecting Your LTD Claim
If you have a chronic condition and suffer an injury while playing sports, your LTD disability claim is likely to be complicated. The injury may be new and serious, but if it occurs against a backdrop of a documented history of musculoskeletal issues, the disability insurance company is going to argue it’s all one condition. This is when legal help is essential.
We focus on disability insurance law. We know how the policies work, the tactics used by insurance companies and how to build a strong appeal grounded in medical and legal facts. Call us for a free consultation.
