Before your pregnancy, carefully plan for all financial eventualities.
Hopefully, you have a disability insurance policy to cover some of your lost income if you need to take time off work. However, the insurance company can get in the way of some of the best-laid plans.
You must closely follow all the procedures outlined in your policy. Plan and research early in the process so no surprises arise. A lawyer can interpret and explain your policy and the disability process.
You can fight back when the insurance company wrongfully denies your claim or refuses to pay you all the benefits you deserve. When you hire an experienced short-term disability insurance attorney, the insurance company cannot hide behind questionable interpretations of the language of your policy or refuse to follow it altogether. Then, you can take the insurance company to court.
The last thing you should worry about when you are expecting a child is fighting with your disability insurance provider. An experienced disability claims lawyer can handle this process and advise you on what benefits you might receive based on your condition and circumstances.
Consultations with disability attorneys are free, so never wait to discuss your options for financial support with a trusted legal professional near you.
Disability Insurance Can Provide Payment During Maternity Leave
Some employers provide their employees with paid maternity leave, while others do not pay employees when they take off work to deliver and bond with a baby.
Without any additional help, the expectant mother may financially struggle while she takes time off work to have her baby.
Many employers provide a complete package of employee benefits, and among these benefits are often long and short-term disability coverage. These policies replace your income when you cannot work due to a disability.
The coverage pays you a percentage of your pre-disability earnings, helping you cover your bills until you can return to work or indefinitely. Disability insurance coverage will pay you between 40 and 70 percent of your pre-disability earnings, depending on the specific policy.
Pregnancy Can Qualify as a Disability Under Your Policy
The good news for you is that many insurance policies consider pregnancy a disability, so you might receive disability benefits for a set period.
- In most cases, your benefits will begin two weeks before the date you are due to deliver, and they will continue for six weeks after delivery.
- If you delivered your baby through a cesarean section, you can receive eight additional weeks of coverage after the delivery date.
The length of coverage depends on your plan, so check the exact language to understand your benefits. A disability attorney can review your policy language and advise you on what to expect regarding the duration of benefits.
Steps to Prepare Your Short-Term Disability Claim When Pregnant
To receive short-term disability insurance benefits, you need to have your claim approved by the insurance company, but unfortunately, this coverage is not automatic. Disability insurance companies operate in such a way that you have to provide lengthy documentation for approval.
Here is what you should do to prepare your short-term disability claim for the insurance company’s approval:
- Look at the exact language of your policy to determine whether you qualify for coverage and the extent of any exclusions.
- Verify the procedure you must follow to file the claim and any deadlines.
- Notify your employer that you intend to file a claim, and they may provide you with the necessary forms.
- Gather the medical documentation that shows your condition, including your expected due date.
- Document any required testing and information if you experience complications.
- Submit your claim to the insurance company, keeping a copy for your records.
- Follow up with the insurance company if you have not heard about the disposition of your claim.
Always discuss your claim with your human resources department at work because they can explain the claims submission process to you.
If you anticipate a problematic claim, hire an attorney to help with the claims process. If you need to take more time off from work due to pregnancy complications, you may fall within one of the exclusions in the policy, and you may need to fight.
The Language of Your Policy Controls Your Eligibility for Benefits
The language of your individual policy will determine how the insurance company treats your pregnancy. Your short-term disability coverage may specifically address pregnancy. Otherwise, pregnancy can fall under the existing language regarding general disability in your policy.
If the policy excludes pregnancy, your insurer may deny your claim. A good lawyer, however, might find other ways to obtain coverage. For example, if your policy excludes pregnancy, it might not exclude high blood pressure, nausea, bleeding, or other symptoms of difficult deliveries.
Always hire a disability claims attorney if the insurance company denies your claim, as you may face a fight with the insurance company in the appeals process.
Your Pregnancy Claim Can Fall Into an Exclusion
If you believe your insurer wrongfully denied your claim due to an inaccurate exclusion, consult a short-term disability lawyer immediately. They can review the denial reasons and advise whether you should appeal the decision.
Your Pregnancy Can Be a Pre-Existing Condition
Insurance companies will not cover a condition you already had when the insurance policy took effect and may treat pregnancy as a pre-existing condition.
If you were pregnant when your coverage started, you can expect a denial of the claim if it contains a pre-existing coverage exclusion. It does not matter whether the insurance company asked you about the condition when you applied for the policy.
If you purchase short-term disability coverage on your own, buy the policy at least 12 months before you intend to use it. The best time to plan is before you get pregnant so you have the benefits you need when the time comes. Your family planning should include a timeline for applying for benefits.
Pregnancy Complications Can Mean You Need More Benefits
Another potential area of disagreement with the insurance company is when you are experiencing complications related to your pregnancy. You may need to stop working and go on bed rest.
For example, you can develop gestational diabetes or high blood pressure and have to remain off your feet. Still, the insurance company may claim that you are not suffering from a disability within the language of your policy.
If this occurs, discuss your options for appeals and seeking benefits with your disability lawyer.
You May Not Return to Work When You Expected
You may also have difficulty getting benefits if you are experiencing complications after childbirth. Generally, the insurance company will cover six to eight weeks of pregnancy-related short-term disability benefits, depending on your delivery type.
However, you may need more time when you have a physical job, such as one that requires you to stand on your feet all day.
The terms of your short-term disability policy may allow you to receive coverage for up to 24 months after giving birth. The insurance company certainly does not want to pay you any more than it already is.
If you seek to extend your benefits by months or more, you can expect a challenge from the insurance company. If you need to seek benefits for anything longer than the standard period, hire an attorney to assist with your claim.
The Insurance Company May Question Everything About Your Medical Condition
You must convince the insurance company of the extent and severity of your medical condition if you seek benefits for longer than usual. You must have a persuasive medical file that shows the insurance company why you are not yet ready to return to the job that you previously did. Most short-term policies consider you disabled when you cannot do your job, as opposed to an inability to work in general.
They may question your need for bed rest, even though it is what your doctor recommended.
Their own “independent doctor” may believe that you can still work, and the insurance company does not have to pay you extra benefits beyond what is already in your policy.
The insurance company may think expectant mothers make easier targets because they have other things going on and may hesitate to fight. Accordingly, hire a lawyer to stand up for your rights.
You Can Appeal Any Adverse Decision About Your Benefits
If the insurance company denied your disability claim, hire a lawyer immediately to appeal any denial of coverage.
The process that you must follow depends on how you obtained your short-term coverage:
- If your disability policy came through your job, you must file your appeal according to a federal law called ERISA. First, you need to appeal directly to the insurance company. Once they deny your claim (and they more than likely will), you must file an administrative appeal with the insurance company before you can appeal to federal court, where an objective judge will determine whether the insurance company made the right decision.
- If you purchased your own short-term disability insurance policy, you can file a lawsuit directly against the insurance company in state court. The insurance policy is a contract between you and the insurance company, and you will allege that they breached the contract.
Never start the appeal process alone, as how you handle the initial appeal can hugely affect your options if the insurance company upholds the denial. Appealing disability denials requires getting everything right in a complex process, especially if your employer provided the policy. The right disability lawyer can make all the difference in the outcome of your claim.
How a Disability Insurance Attorney Can Help Your Case
Always hire a lawyer to fight the insurance company after it denies your benefits because you will have trouble getting a fair outcome if you handle it independently.
If the insurance company denies your claim, a disability insurance attorney can:
- Review the language of your policy and let you know what you can expect
- Prepare the claim for you to submit to the insurance company
- Review any denied claims to understand the basis for the insurance company’s decision
- File the appeal, either with the insurance company or in court
- Negotiate any potential settlement with the insurance company
Your attorney can add value to your case, putting you in a better position to receive benefits. They will fight on your behalf when the insurance company keeps you from getting what you deserve under the language of your policy.
You Do Not Have to Pay Out of Pocket for a Disability Insurance Attorney
It does not cost you anything to hire an ERISA attorney out of your pocket. Your attorney only receives payment if you win your case by getting a settlement or a favorable decision in court.
If you do not win your case, you do not need to pay your attorney for their time.
If the insurance company gives you a hard time, you must approach it with an attorney. Otherwise, you can end up empty-handed when you need disability benefits.
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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