Many women have disability insurance coverage through their work that covers them when they become ill or develop a health condition that keeps them working. Some women wonder whether their long-term disability insurance coverage will apply to their maternity leave.
In some cases, the answer to that question is yes, though a long-term disability attorney can review your situation and provide tailored legal advice.
First, pregnancy itself is not a condition that should keep you from working. Most pregnant women can continue working.
Second, pregnancy is not a condition that invokes your long-term disability policy. If anything, pregnancy will involve short-term coverage that lasts for months instead of years.
Your maternity leave may become permanent if you suffer long-term complications during childbirth or your pregnancy. Then, your long-term coverage may cover your maternity leave.
Pregnancy Can Lead to Disability
Thankfully, most pregnancies unfold without issue for both the mother and the baby. Advances in medical care allow doctors to monitor for the emergence of anything that can lead to complications.
Still, roughly 8 percent of pregnant women experience complications that can endanger the child or the mother. While some of these complications arise from medical negligence, others emerge with little warning.
Pregnancy can lead to a disability that can qualify you for payment under your disability insurance policy. However, the insurance company may not see it that way. If your short or long-term disability benefits claim results in denial, you can fight the insurance company. Always hire an experienced ERISA attorney to vigorously represent you throughout the legal process.
Pregnancy Complications That Can Keep You From Working Again
Although it is rare, pregnancy can lead to long-term complications for the mother that may affect her ability to work.
For example, one of the most dangerous complications of pregnancy is preeclampsia, due to high blood pressure after the 20th week of pregnancy. Preeclampsia can lead to multi-organ failure and permanently impair the mother’s health.
Another dangerous condition is placental abruption, where the placenta detaches from the womb. Placental abruption can cause excessive bleeding, which can lead to death. The sudden loss of so much blood can cause brain damage or other long-term complications.
These conditions might lead to long-term disabilities that can qualify for benefits.
Pregnancy Complications Can Affect Your Ability to Do Your Job
A mother may recover from pregnancy complications at some point in the future. She may require quite a bit of time before she can resume the level of activity that she had before the pregnancy, including working.
If the mother had a job that required any type of physical labor or standing on her feet all day, pregnancy complications can make it impossible. The effects of excessive blood loss can cause brain damage that can keep a woman from performing any type of job.
Either way, a mother who has given birth can expect a lengthy absence from work after serious pregnancy complications. This health issue is why people buy disability insurance.
The primary reason why you may need long-term disability insurance coverage for pregnancy is if you have complications that can keep you from returning to work for an extended period or even at all. If you can prove that you meet the policy’s definition of disabled, you may qualify for benefits. The main questions are whether you can make that showing and how long you may miss work.
You may have purchased (or your employer may have provided you with) two types of disability insurance. Usually, you will file the first claim for short-term disability benefits because you do not know right off the bat whether you can work at all in the future.
Short-Term Disability for Pregnancy Benefits
Short-term disability benefits usually cover the first three to 12 months of your covered condition. The average short-term disability policy will provide benefits for six months. Some may last for as long as one year.
In normal pregnancies, you will return to work when your short-term benefits lapse. If you need time to recover from pregnancy complications, your short-term disability policy will usually cover them.
Short-term disability may cover 40 to 70 percent of your pre-illness earnings, subject to a certain cap. While these benefits do not completely replace your salary, they will go a long way toward helping you cover your expenses until you can return to work.
Long-term disability benefits apply to more serious conditions that keep you from recovering for the long term. Again, if the mother experiences some of the most serious complications from pregnancy, permanent health damage will change the mother’s life forever.
Long-Term Disability Benefits for Pregnancy Complications
Like short-term disability, long-term disability will cover a portion of your earnings, as set forth in your policy. Because the insurance company might need to pay you money for at least two years, they will be even more stringent about whether they will grant your claim. It does not matter that you have already proven that you merit short-term benefits. More expenditures mean a greater level of scrutiny.
The disability insurance company usually has little sympathy for your condition, no matter how profoundly your pregnancy affected you. They care about one thing – whether you meet your policy’s definition of disabled.
Your disability insurance claim will define disability that depends on your ability (or inability) to do your current job. Having to remain at home with your child will not come into consideration at all. Everything depends on your ability to work and do your job. If you cannot do the job that you did before the pregnancy complications, the insurance company may consider you disabled.
Things may change after 24 months when the insurance company tightens the policy’s definition of disabled. Then, you need to show that you cannot do any job to maintain your qualification for benefits. This is when the insurance company tries to throw many people off their roles, whether their arguments have merit or not.
Unless you fight them back with the help of an experienced lawyer, they will win.
Insurance companies have made outlandish determinations based solely on their own financial interests. They have been known to find that people with serious disabilities can still work to avoid paying benefits.
You Must Invest Time and Effort in Your Initial Claim
If you are filing for long-term disability benefits after pregnancy, you are likely dealing with significant complications that can include frequent pain and other impacts of a difficult delivery.
The insurance company will do everything that it can to dispute your symptoms and argue why you can work.
Therefore, you need to invest a great deal of time and attention in compiling your initial claim file seeking benefits.
You can hire an attorney to prepare the claim in the first place. This way, you can put your strongest case possible in the first place and somewhat lessen the chance that you may have to appeal in the first place.
A strong initial claim file should include:
- Objective test results, such as magnetic resonance imaging examinations, that show the existence of a disabling condition
- A statement from your treating physician that describes your symptoms
- Your medical records and history that evidence the treatment you have sought for your condition
- Statements from family and friends who observe you with frequency and know what you are going through
- An impact statement from yourself that describes what you are feeling
- Analysis from a vocational expert who is familiar with your condition and job duties and will testify that you are unable to work
An attorney can compile and document your initial file to make the most persuasive case to the insurance company. When the insurance company sees that you have hired a lawyer at the outset, they know you mean business. In some close cases where they may have otherwise denied your benefits, the insurance company might be more willing to give you the benefit of the doubt.
Appealing the Denial of Your Long-Term Disability Insurance Claim
Do not be surprised if the insurance company denies your initial claim. It seems they deny initial claims more often than not. This treatment is the same that you can expect from the Social Security Administration.
Anytime someone knows they can be on the hook for a large amount of payments, they take a very stringent view of what may qualify you for those payments.
In many cases, your long-term disability insurance comes from your job. Then, a federal law called ERISA governs how and when you may appeal.
Unfortunately, ERISA is not a claimant-friendly law. Even though ERISA should protect employee benefits and provide uniformity, the law has become a major benefit to insurance companies.
ERISA makes you appeal first to the insurance company. You have to spend the time to build the file for them to consider before they do the inevitable and deny your appeal. Essentially, you are asking the same company that denied your claim in the first place to admit that they were wrong.
Usually, it does not matter what additional information you give them. They will always reinforce their additional conclusion. That they reached when they initially denied your claim.
You will get your day in federal court, but the judge may have to show some deference to the initial insurance company decision. Nonetheless, the federal district court judge can and will overturn the insurance company’s decision if they make a mistake.
You need to build the evidence as part of the appeal file so the judge can see exactly what the insurance company did. The good news is that the judge has no incentive financially, and they will review your file objectively.
Nonetheless, you need an experienced lawyer to beat the insurance company at their own game. Otherwise, you might not bring a credible case against the insurance company in court.
You Do Not Have to Pay for a Lawyer Out of Your Own Pocket
The good news is that you do not have to pay for a lawyer’s services out of your own pocket – ever. When disability benefits are at issue, your attorney works for you on a contingency basis. You only pay if you receive a successful result in your case. Then, your attorney receives payment from the terms of any settlement agreement you reach.
Unfortunately, it may not be possible to even get the insurance company to pay you anything at all if you do not have legal help.
Many people may hesitate to hire a ERISA lawyer because they do not want to pay anything, even if it is not out of pocket. However, getting a lawyer is an absolute must, especially when the insurance company has already denied your initial claim. Otherwise, the insurance company may get away with a wrongful denial of your claim.
If you do not manage to obtain anything from the insurance company, your lawyer has then worked for you for free. In that way, when you can persuade a lawyer to even take your case, you already know that you have a fighting chance of beating the insurance company.
J. Price McNamara
Attorney
Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!
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