What medical reasons qualify for short-term disability benefits during pregnancy?

How does the coverage work for maternity leave after childbirth?

Can you extend claim payments in case postpartum depression delays your return to work?

You have come to the right place if you are asking any of these questions. The answers depend on where and when you obtained the coverage, and why your doctor wants you to stop working or extend your leave.

Learn what the insurance companies look for when processing a claim. Enjoy wage replacement benefits while resting at home before your due date, while bonding with your baby, or dealing with your emotions.

Short-Term Disability Pregnancy Medical Reasons

There is no list of valid medical reasons for short-term disability during pregnancy leave. The condition must meet the definition of a covered sickness as defined in your policy. In addition, exclusions may apply and you must complete your claim form properly.

High Risk

A high-risk pregnancy is not a valid medical reason for short-term disability benefits. The term is simply too broad and non-specific to meet the qualifying condition standard.

A high-risk pregnancy means you have one or more issues that raise the odds of preterm delivery or other problems. A woman may be high-risk if she has high blood pressure, diabetes, depression, or another health disorder.

The doctor’s note on the claim form must reference a covered sickness. Covered sicknesses mean an illness, infection, disease or any other abnormal physical condition that prevents you from performing the duties of your full-time occupation.

Bed Rest

A doctor ordered bed rest during pregnancy is also not a valid medical reason for short-term disability benefits. Bed rest is a prescription that your physician might give to treat an underlying health issue. Your doctor’s note on the claim form must reference the covered sickness that forces you to relax at home.

Below are examples of medical conditions that a doctor could include on the claim form. These could be valid reasons for a woman with a high-risk pregnancy prescribed bed rest. Keep in mind that the issuing insurance company makes the final decision.

  • Anemia must be severe with clear deficiencies of iron, folate, or vitamin B12
  • Carpal tunnel syndrome must impede the performance of your primary job duties
  • Exhaustion by itself does not meet the standard
  • Ectopic pregnancy often requires home recovery
  • Gestational diabetes rarely interferes with job duties
  • Lower back pain can impede lifting or standing for long periods
  • Sciatica also impedes sitting or standing for long periods.
  • Miscarriage may require recovery at home
  • Dilation and curettage (D&C) has a very short recovery period
  • Morning sickness must be very severe (Hyperemesis Gravidarum)
  • Preterm labor may be eligible after satisfying the elimination period

Short-Term Disability Maternity Leave

This is how short-term disability works for maternity leave while you are recovering from childbirth. Even when mom and baby are both perfectly healthy, the mother needs time to recover from her routine labor and delivery.

Many couples plan when they want to have a baby. This allows women to time their purchase and win a hefty benefit for a scheduled, normal medical event. Insurance companies know this happens. Therefore, they limit coverage for normal childbirth to certain policy types.

Voluntary Plans

Group and voluntary short-term disability obtained through employment cover maternity leave after normal childbirth. The insurance companies often lose a great deal of money when women file claims for something they plan to happen.

Therefore, they limit these popular benefits to groups so they can pool risks.

  • Vaginal Delivery: 6-weeks minus the elimination period
  • Cesarean Section: 8-weeks less the elimination period

Individual Policies

Individual short-term disability obtained outside your employer does not work at all for maternity leave after normal labor and delivery. Policies that you purchase privately do not allow the insurance company to pool risks with a large group.

However, having individual coverage still has great value – even without the surefire payout for a planned medical event. You could enjoy wage replacement benefits for any of these uncertain but common conditions.

  • Covered accidents and illnesses
  • Pregnancy complication before birth
  • Medical complications after birth

Short-Term Disability Postpartum Extensions

Extending short-term disability due to postpartum problems may be possible. However, the insurance companies are far more likely to approve claims for physical (somatic) post-delivery issues than they are for emotional problems. Read your policy contract carefully.

A mother’s plans to quit or not return to work should not affect any postpartum extension request. The carrier’s pay claims based solely on a person’s ability to return to the job. Intentions or plans do not matter.

Postpartum Depression

Postpartum depression and short-term disability is a complicated issue. Some women will be able to extend benefits, while others may not, and the length of time could vary as well.

Postpartum depression does not qualify under every short-term disability policy type.

  • Group and state plans cover mental health issues more frequently
  • Individual policies rarely cover issues such as anxiety and depression

Women diagnosed with postpartum depression will have different extension lengths

After Birth Disorders

Several after birth medical disorders may qualify you to extend your short-term disability benefits. Having a baby is a high-risk activity. Things do not always go the way you envision. You may be injured during delivery, develop an infection, or other serious postpartum health issues.

The main disorders that might affect you after a vaginal delivery include fissures, infections, and postpartum hemorrhage. The leading somatic risk factors include:

  • A baby weighing more than 9 pounds
  • Use of forceps or vacuum
  • Repair of large episiotomy tear

A delivery via C-section is a relatively safe surgical procedure but entails a higher risk of complications as it is far more invasive. The most common disorders associated with this surgery are blood clots in your legs or lungs, anesthesia-related nausea, and bowel movement problems (ileus).

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