When an expectant mother takes off from work to deliver her child, she may forgo income, depending on the employer’s policy. Worse, sometimes a difficult labor or delivery can leave a mother physically or psychologically wounded and unable to return to work. Short-term disability insurance can provide a portion of the missing income for a certain amount of time (but not necessarily the entire maternity leave). If you suffered permanent, incapacitating injuries from the birth of your child, you may need benefits from your long-term disability insurance policy. In some circumstances, the disability insurance company will try to make life more complicated. When that happens, you can hire an experienced disability insurance lawyer to stand up for your rights under your policy. Do not allow the insurance company to get away with not giving you what you legally deserve.
Expectant Mothers Can Take Leave from Work in Many Cases
Expectant mothers have the legal right to take up to 12 weeks off from work under the Family and Medical Leave Act (FMLA). However, the employer does not have a legal obligation to pay the employee while they are on leave - they just need to hold the employer’s job for when they return from break.
FMLA applies if:
- You work for a company with more than 50 employees who live within 75 miles of their workplace
- You have worked for your organization for at least 12 months and at least 1,250 hours during the previous year
- You requested the leave at least 30 days before you took it
Federal Law Prohibits Discrimination Against Pregnant Women
Another federal law, the Pregnancy Discrimination Act, requires all employers to treat pregnancy the same as any other short-term medical condition for which they will allow the employee to miss work. State law may also offer additional protections when taking time off for maternity leave. They can require the employer to provide protections for expectant mothers when they take time off from work and return to the job.Paid Maternity Leave Is Not Always an Employee Benefit
Some employers will offer paid maternity leave as a benefit for employers, while others do not. In tight labor markets, companies compete for workers by providing the most generous benefits package. Unemployment is currently low, and employers have recently struggled to find enough workers. Accordingly, many employers have expanded their benefits and offered paid maternity leave for employees. If you work for an employer that does not give paid maternity leave, your family can struggle financially when your family needs the money.Some States Have Programs That Offer Paid Maternity Leave
Some states have programs that provide paid maternity leave for expectant mothers. The list of these states is expanding as legislators realize the benefits of caring for families. Large states like Texas and Illinois are not on this list, but their legislatures are considering bills to provide for 12 weeks of paid maternity leave. However, these bills have not yet passed, and the prospects for future coverage are unclear. In states without paid maternity leave, expectant mothers will need to rely on other ways to stay financially afloat when they cannot work.You Should Always Carry Disability Coverage
It makes financial sense to have a short-term disability policy to cover a portion of your income when you cannot work. Maternity leave should be something that entitles you to short-term disability benefits since pregnancy is a condition that keeps you from working, and you must be home to care for a newborn after they are born. Even employers who do not offer fully-paid maternity leave may provide workers with some means of paying their bills when they cannot work. One common employee benefit that companies will provide is short-term disability insurance. Some employers even offer long-term disability benefits. For many, this is a standard employee benefit. However, no law requires employers to provide this benefit - it is of their own volition. If your company offers the policy, federal ERISA law will govern the policy. While intended to protect employee benefits, ERISA is not necessarily employee-friendly.If Disability Insurance Is Not an Employee Benefit, You Can Buy Your Own
If your employer does not offer you short-term disability insurance, it is always a good idea to purchase it on your own. You never know when you will need the coverage. The premiums are a sound investment on behalf of your family, and you will have peace of mind when you need to miss work. When you purchase short-term disability insurance privately, ERISA does not apply. Instead, your state laws will govern benefits under your insurance policy. Short-term disability benefits will pay you a portion of your income when you cannot work. The amount that you get depends on the terms of your policy. Some policies will pay you as low as 40 percent of your pre-disability income (those policies will generally have lower premiums), while others can cover as much as 100 percent of your income. Policies may differ with regard to how long they will pay you. Many short-term disability policies will begin to pay you benefits two weeks before your baby’s due date. The benefits will continue until six weeks after your baby is born. You should check the terms of your policy because it may be different. You may lack coverage for the entire time you can take off from work under the FMLA, making some of your leave unpaid.How Insurance Companies May Deny Your Claim for Maternity Disability
There is generally one way that insurance companies will deny claims for disability benefits for expectant mothers. Short-term disability insurance policies do not cover pre-existing conditions. The policy itself will define a pre-existing condition. If you were pregnant when that employer hired you, the policy may not cover you. The same thing goes if the employer took out the policy from the insurance company while you were already pregnant. Some insurance companies will exclude pregnancy as a pre-existing condition for a certain period of time after the policy takes effect. Some companies will exclude coverage for 12 months after the policy takes effect. Other companies may deny benefits if the baby is born nine or ten months after the policy started because it is a pre-existing condition. Sometimes, insurers might deny completely valid claims for maternity disability benefits. The company might present a reason that is pretextual or based on inaccurate or incomplete information. Other companies might delay a decision for so long that it causes unnecessary financial stress. Whether you believe a denial is valid or not, you should seek a review by an experienced disability attorney. They can identify whether you have grounds to appeal the denial and help you handle the process. You never want to handle the appeals process alone, as one small error can hurt your chances of success.Other Issues that Can Complicate Your Disability Benefits
Other potential issues can relate to pregnancy and short-term disability benefits:- You may need to take time off from work if you have a difficult pregnancy and have work restrictions. The doctor may order you to be on bed rest, making you unable to work. The insurance company may deny your claim, arguing that it does not fall into the definition of disability under the policy.
- Some women may take time off work when they are undergoing fertility treatments. Insurance companies have denied these claims, forcing the employee to fight in court.
You Need a Lawyer to Fight a Complex Disability Coverage Claim
While you may think that covering pregnancy under the terms of a short-term disability insurance policy should be straightforward, insurance companies often find a way to deny claims. They may think that you will simply go away rather than take the time to fight them in court. The insurance company knows that ERISA is friendly to them, and you have the burden of proof to show that you deserve benefits. In any type of case under ERISA (where you cannot sue the insurance company itself for bad faith), you should expect anything and everything. Insurance companies may not push the envelope when you purchase your policy because state laws regarding bad faith apply. If you want to have a child, purchase a policy well before you need it. Then, you can feel more confident knowing you will have maternity benefits when needed. If not, you may give the insurance company an opening to deny you benefits. You may also want an attorney to review your disability insurance policies for fine print the insurer can use to deny you benefits. You want to know that you are on solid legal ground when you file the claim in the first place.You Can File an Appeal After a Denial of Your Benefits Claim
You can file an appeal if you believe you have wrongfully received a denial of benefits. The procedures you must follow depend on who pays for the insurance policy.- If the policy was an employee benefit, ERISA will provide the appeal procedures. You will need to appeal to the insurance company first, and they will review your case. The insurance company usually has another division that did not review your initial claim, which handles the appeal. If and when the insurance company denies the appeal (let’s face it - the result of an internal appeal is almost always a denial), you will take your case to the federal district court. The judge will review the file from the initial appeal to determine whether the insurance company made an error.
- If you purchased the policy, principles of contract law will govern your appeal since ERISA applies only to employee benefits. You can directly sue the insurance company for breach of contract without going through the appeals process first. You can sue in state or federal court. The judge will not have to give any deference to the insurance company’s determination in deciding whether you deserve benefits.
Contact a Disability Benefits Attorney if You Have Problems With Maternal Disability Claims
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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