Does my high-risk classification or bed rest prescription qualify as a valid medical reason for a short-term disability during pregnancy?
How does the coverage work while recovering after childbirth? Can you extend maternity leave if postpartum depression delays your return to work?
Getting your doctor to put you on disability is only half the equation. More importantly, you need the insurance company or government agency to approve the claim.
Learn what claims underwriters look for to avoid denials and unnecessary delays. Enjoy wage replacement benefits while resting at home before your due date, bonding with your baby, or dealing with your emotions.
Reasons While Pregnant
Follow the golden rule when learning how to successfully file claims for short-term disability pregnancy benefits before the birth of your baby. You do not want to miss out on valuable paycheck protection should you need early maternity leave.
Your doctor can put you on disability during pregnancy only if you already have coverage, eliminating perhaps 60% of the women reading this article.
- Government assistance for pregnant mothers might benefit most women without coverage at work or through their state.
- Only nine eight require short-term disability benefits: California, Connecticut, Hawaii, Massachusetts, New Jersey, New York, Rhode Island, and Washington.
- Buying a new policy while pregnant will not help because pre-existing condition exclusions mean you cannot file a claim for twelve months.
High-Risk
A high-risk pregnancy could qualify for short-term disability benefits. Your Perinatologist must document the exact medical reason you cannot perform the duties of your full-time job to justify the early maternity leave.
A high-risk pregnancy means that one or more factors jeopardize the mom’s health or her baby and might include one or more of these issues.
- Age extremes of the mother: younger than 17 or older than 35
- Severely underweight or overweight before conception
- Carrying multiple babies (twins or triplets)
- Poor lifestyle choices: smoking, alcohol, or drug use
- Previous history of severe pregnancy complications
The qualifying medical conditions do not include any of these factors. Therefore, the claim form should specify a different diagnosis, such as Carpal Tunnel Syndrome, severe morning sickness (Hyperemesis Gravidarum), lower back pain, Sciatica, etc.
Bed Rest
You can get short-term disability benefits for bed rest during a high-risk pregnancy, provided you focus on valid medical reasons rather than the prescription from a gynecologist.
The insurance company may deny benefits if your claim lists bed rest without an accompanying valid medical reason. Bed rest is a treatment, not a health problem!
Therefore, when filing a claim for early maternity leave, have your obstetrician list the exact diagnosis driving the bed rest prescription, which might include one of the following.
- High blood pressure (Pre-eclampsia or Toxemia)
- Premature rupture of fetal membranes
- Incompetent cervix or cervical effacement
- Infections caused by sexually transmitted diseases
- Vaginal bleeding and severe cramping
- Rhesus (Rh) sensitization
Miscarriage
Short-term disability should cover a miscarriage (spontaneous abortion) when a high-risk pregnancy ends before twenty weeks. The baby dies in the uterus before it can survive outside the womb.
Many women cannot work for a brief period after having a miscarriage because of grief and their physical condition, bringing up two contrasts to keep in mind when filing a claim.
- Elective surgeries such as Dilation and Curettage (D&C) needed after miscarriage to clear the uterine lining are medically necessary and covered.
- Grieving the death of family members, including the loss of an unborn baby via miscarriage, is an uncovered mental health issue.
Reasons for Maternity Leave
The qualifying medical reasons for a short-term disability during maternity leave are not as simple as you think. The place where you obtain coverage profoundly impacts the benefits you can claim while recovering from labor and delivery.
Individual Policies
Individual insurance policies bought outside the workplace do not cover maternity leave while you recover from childbirth. The issuing companies in this market protect their interests by excluding this coveted benefit for many plans.
The companies design the policies to cover unplanned and unexpected injuries and illnesses that prevent you from working – not those you intend to happen.
However, individual coverage still has great value—even without the surefire payout. You could enjoy wage replacement benefits for these uncertain but common conditions.
- Covered accidents and illnesses
- Pregnancy complications before birth
- Medical complications after delivery
Group Programs
Group short-term disability does cover maternity leave while you recover from labor and delivery. The issuing organizations in this market protect their interest by pooling risks with many other people paying premiums.
When included, the maternity leave benefits work as follows after meeting the elimination period. Women with approved claims from before their delivery have already satisfied this requirement.
- Vaginal delivery: six weeks
- C-section birth: eight weeks
Extending Maternity Leave
Many women want to know how to extend short-term disability after the delivery of their newborn baby. Therefore, learning the rules for when postpartum disorders qualify as valid medical reasons can help elongate your maternity leave benefits.
Postpartum Depression
Women can sometimes extend short-term disability after delivery when their program deems postpartum depression a qualifying reason. Postpartum depression is a mood disorder rather than a medical condition, limiting where you turn to elongate maternity leave benefits.
- Short-term disability rarely covers mood disorders, including postpartum depression, except through state programs and employer-paid group policies.
- Social Security Disability Insurance (SSDI) could extend your maternity leave, provided the postpartum depression prevents you from working for at least twelve months.
Postpartum Medical Disorders
Women are more likely to extend short-term disability after delivery when a postpartum medical disorder makes it impossible to return to work. It is easier to elongate maternity leave benefits when a mom experiences a qualifying medical reason: birth injury or related complication.
Postpartum medical problems that might qualify include these conditions.
- Blood clots in legs or lungs (thrombotic pulmonary embolism)
- Bowel movement problems (ileus)
- Post-surgical infections after C-section or episiotomy tears
- Heavy bleeding (hemorrhage)
- Fetal material in the bloodstream (amniotic fluid embolism)
