Pregnancy and Disability Insurance: Are You Prepared?
For many women, pregnancy is one of their first encounters with disability insurance. If your state or employer doesn’t provide for paid maternity leave, there’s a good chance you will end up filing for short-term disability insurance benefits. And, if you suffer complications that make it difficult to return to work, you could also qualify for long-term disability benefits.
So, while you are researching childcare options, preparing the nursery, and looking for a pediatrician for your new baby, it is also worth checking your disability insurance policies. In this article, our respected disability attorneys explain how disability insurance for pregnancy or pregnancy complications works.
Is Pregnancy a Disability?
Pregnancy itself is not a disability. However, you may be unable to work due to complications or while recovering from labor and delivery.
Roughly one in five women experience complications during pregnancy. These can include:
- High blood pressure
- Gestational diabetes
- Hyperemesis gravidarum
- Preeclampsia and eclampsia
- Preterm labor
- Cesarean section (c-section)
- Uterine rupture
- Postpartum hemorrhage
- Respiratory distress and embolism
- Postpartum depression
- Infections and sepsis
- Stillbirth and miscarriage
- Worsening or acceleration of an underlying medical issue like multiple sclerosis, asthma, or epilepsy
Notably, women with pre-existing conditions, like diabetes, hypertension, obesity, or substance use, are more likely to experience pregnancy and labor complications. Older expectant mothers are also more prone to pregnancy and labor-related issues.
These conditions can make it difficult to work during your pregnancy and after labor and delivery. In this case, you could be eligible for short-term or long-term disability benefits.
Insurance policies define “disability” in one of two ways:
- Own occupation: you are eligible for benefits if you cannot perform the duties of your job due to an illness, injury, or chronic medical condition.
- Any occupation: you must prove that you cannot perform any type of work because of your health conditions.
If pregnancy-related conditions make it impossible to do your job or any job in the economy, you might qualify for a monthly benefit payment. You can determine which standard applies to you by reviewing your policy or plan documents.
Filing a Claim for Short-Term or Long-Term Disability for Pregnancy
While many women can manage work and their pregnancy complications, others cannot. Bed rest, significant physical restrictions, or severe postpartum depression or anxiety can make getting “back to normal” challenging. If you can no longer work due to your physical or mental health issues, you should consider filing a pregnancy-related disability insurance claim.
Step 1: Review Your Plan or Policy Documents
Disability insurance policies are contracts, and each one is unique. As we mentioned above, they can define “disability” in different ways. They can also include specific limitations, exclusions, terms, and conditions. If you do not understand your policy’s specific requirements, you might lose out on benefits.
Therefore, you should always carefully review your plan documents or policy before you file for short-term or long-term disability. If you need help understanding or interpreting your policy’s language, consult with a disability insurance lawyer.
Step 2: Collect Your Evidence
Now that you understand how your policy defines “disability,” you can start building your claim. This might involve collecting your medical records, getting written statements from your OB-GYN and other doctors, and compiling information from your employer and other sources. If you have a lawyer, they may do this for you.
Step 3: File a Claim With the Insurance Company
Filing a disability insurance claim typically involves completing a series of forms, answering the claims adjuster’s questions, and sometimes participating in a field interview. While the adjuster might seem professional and nice, their top priority is processing disability claims and quickly as cheaply as possible.
If you are frustrated with the adjuster’s tactics, consider working with a disability insurance attorney. Unlike the adjuster, your lawyer is firmly on your side and will work tirelessly to get you the benefits you deserve.
Step 4: File an Appeal (if Needed)
If the insurance company denies your claim for disability benefits, you have the right to appeal. However, this is a highly technical process. If you have not yet consulted with an attorney, now is the time.
Different procedural rules will apply, depending on whether you have an individual or employer-sponsored disability insurance plan. But either way, you will face strict filing deadlines. If you miss these deadlines, you may lose out on your right to disability insurance benefits.
Look Out for These Limitations in Your Disability Insurance Policy
Disability insurance policies are filled with exclusions, limitations, and loopholes. Here are a few examples that every woman should look out for in their policies.
There Are Often Limits on How Long You Can Receive Short-Term Disability After a “Normal” Labor and Delivery
Most new mothers take between five and ten weeks of maternity leave, and the Family and Medical Leave Act (FMLA) might give you up to 12 weeks of unpaid leave. However, you might be surprised to discover that your short-term disability policy will cut off your benefits after a period if you had a “normal” labor and delivery. Typically, there is a six-week limit for vaginal births and an eight-week limit for c-sections.
However, just because your delivery was routine, it does not mean that your disability will not extend beyond that time period. If you are struggling with postpartum depression or anxiety, or have other health conditions that prevent you from working, you might be eligible for short-term benefits beyond this limit. However, be prepared for a fight—the adjuster will likely try to claim that you are capable of working and deny your request for continued benefits.
Elimination Periods Might Cut Into Your Short-Term Benefit Payments
In addition to limiting your eligibility for short-term disability benefits after routine labor and delivery, your policy’s elimination periods might further erode your disability benefit payments. Elimination periods are often compared to a deductible—even if you are eligible for benefits, the insurance company will not issue a payment until this waiting period has expired.
Suppose your short-term disability policy has a two-week elimination period and limits most c-section-related claims to eight weeks of benefits. Your baby is breech, so your OB-GYN schedules a caesarean section. Everything goes smoothly, and you and your baby soon head home from the hospital.
How many weeks of benefits will you actually receive? Let’s do the math:
Eight weeks of disability leave – two week elimination period = Six weeks of benefits
This is because most maternity leave benefit caps include the elimination period—which means there’s an automatic reduction in your benefits. If your policy has a very significant elimination period, your short-term disability benefits might be negligible after a routine, uncomplicated labor and delivery.
Pregnancy Complications Can Be a Pre-Existing Condition
If you have a history of pregnancy complications or fertility problems, the disability insurance company might argue that future difficulties are due to a pre-existing condition. For employer-sponsored disability insurance plans, there is typically a “look-back” period. With these policies, if you experienced pregnancy complications during the year before you enrolled, they might be a pre-existing condition.
If you have an individual or voluntary disability insurance policy, review it carefully. Sometimes, underwriters will exclude pregnancy complications if you have a history of preeclampsia, gestational diabetes, or stillbirth.
Postpartum Depression Claims Might Be Capped at Two Years of LTD Benefits
Roughly 15% of women experience postpartum depression (PPD) and anxiety after giving birth. PPD is more than the “baby blues.” The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines PPD as an episode of of major depressive disorder, bipolar I, or bipolar II disorder that develops within four weeks of giving birth.
If PPD is left untreated, it can last for years—and more than 25% of women do not report being screened for the disorder.
If you develop chronic depression or a mood disorder after labor and delivery, your long-term disability insurance policy might limit you to two years of benefits. Many LTD policies include a limitation for “self-reported” and mental health conditions, capping benefits to a maximum of two years.
However, this limitation should not apply if you have other physical disabilities, either due to your pregnancy or other health conditions. If you have questions about your long-term disability insurance coverage or eligibility for benefits, consult with an experienced attorney right away.
Bryant Legal Group: Chicago’s Trusted Disability Insurance Firm
At Bryant Legal Group, our practice focuses on disability insurance law. We have a long history of standing up to disability insurance companies, helping disabled professionals get the benefits they deserve. We have recovered millions in benefits for our clients, and we can help you understand your disability insurance options during and after pregnancy.
Trends in Pregnancy and Childbirth Complications in the U.S. (2020, June 17). Blue Cross Blue Shield. Retrieved from https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/HoA_Maternal_Health.pdf
Vliegen, N., Casalin, S., Luyten, P. The Course of Postpartum Depression, Harvard Review of Psychiatry: January/February 2014 – Volume 22 – Issue 1 – p 1-22. doi: 10.1097/HRP.0000000000000013
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.