Q: Can short-term disability classify a hematoma after heart ablation as pre-existing?

A: What you’re experiencing sounds incredibly painful and stressful, especially when you're trying to heal and now facing uncertainty with your disability benefits. In Alabama, short-term disability policies can legally include clauses that deny coverage for pre-existing conditions, but the definition of "pre-existing" must align with what’s written in your specific policy. Most policies define a pre-existing condition as one for which you received treatment, medication, or had symptoms during a set lookback period—often 3 to 12 months before the policy started or before coverage became effective.

If your hematoma developed after the heart ablation and wasn’t diagnosed, treated, or symptomatic before your coverage began, it may not meet the policy’s own definition of pre-existing. The insurer might be attempting to link the hematoma to your prior heart condition to avoid paying the claim, even though it's a separate and new complication. If the hematoma was caused by the ablation procedure itself, that could further support your case that it is not pre-existing but a post-treatment complication.

You should ask the insurer for a written explanation of their denial and a copy of the policy language they’re relying on. Also, request a copy of your medical records related to the hematoma and the ablation to clarify the timeline. If their reasoning doesn't match the facts or their own policy terms, you have every right to file an appeal. You paid for coverage and deserve a fair review, especially when you're dealing with a real, debilitating condition that arose after your procedure.