What Do You Mean It's Not Covered: How the Policy Defines "Sickness"

Policies only provide benefits for sickness which begins or becomes evident while the coverage is in force (a sickness that began earlier would be a preexisting condition). Normal pregnancy is not a sickness, but complications of pregnancy are treated as a sickness or disease. Sometimes disputes over what constitutes an illness or disease can turn a little obscure. In the 1993 decision -- Anna Bartolina v. Investors Life Insurance Co. -- a Florida appeals court had to sort through some considerable obscurity. Bartolina received periodic treatment for asthma beginning in April 1985 and continuing through December 1988. She controlled her asthmatic condition with treatments prescribed by her physician. In April 1989, however, she required hospitalization for treatment of her asthma. The hospitalization occurred within the preexisting condition exclusionary period of a Life Investors group health plan she'd recently joined. But the two sides didn't agree over whether the reason for the hospital stay counted as a preexisting condition. Bartolina's doctor said that the need for treatment resulted from heavy environmental pollution from smoke caused by wildfires over the Everglades. Life Investors refused to cover the hospitalization because it treated a preexisting condition. Bartolina claimed this event had triggered a new condition -- not a preexisting one. She sued the insurance company. Life Investors pointed to two parts of its policy to defend it refusal of coverage.