Treatment For Heart Condition Met Pre-Existing Condition Exclusion
ESTATE OF BLANCO v. PRUDENTIAL INSURANCE CO. (May 21, 2010)
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Norman Blanco was hired by Porsche Engineering Services in April of 2005. After one month of employment, he was covered by Porsche's benefit plan. The plan included both short and long term disability benefits. Blanco suffered a heart attack in July and, by the end of August, was no longer able to work. The long-term disability plan had a pre-existing condition exclusion. It precluded coverage for conditions for which the beneficiary, in the three months prior to his coverage effective date, had either a) received care or took medication or b) had symptoms for which a prudent person would have sought care. Pursuant to the pre-existing condition exclusion, Prudential denied Blanco's claim for long-term benefits. Blanco filed an ERISA suit. Judge McKinney (S.D. Ind.) granted summary judgment to Prudential.
In their opinion, Judges Cudahy, Flaum, and Evans affirmed. Before addressing the core issue, the Court noted that a) Blanco had a long history of heart problems, including congestive heart failure (CHF), for which he was being treated and b) pre-existing condition exclusions were regularly upheld. On the merits, the Court found that he failed to qualify under either prong of the exclusion. He was taking heart medication. The fact that he was taking it for hypertension as well as CHF does not matter. Even if it did, the hypertension and CHF are related and taking medication for the hypertension would disqualify him. The Court also found that Blanco was excluded under the second prong of the policy. He had an episode of high blood pressure for which a prudent person would have sought treatment.
