38 weeks pregnant and not approved for short term disabilty?????????

[PammyK]

I've worked in STD/LTD claims for 10 years and unfortunately, insurance companies are getting tougher and tougher on pregnancy claims. One company I worked for provided benefits from 4 weeks antepatum through 6 weeks postpartum, essentially without questions, provided the physician complete a statement of disability. Another one is much more strict and will not provide antepartum benefits unless there are medcally documented complications at the time you stop working. The bottom line for the ins. company is going to be what has changed in your medical condition from week 37 to 38 that you are now unable to do your job. Unless there is some medical or vocational information to document a change in your condition or functionality, then the insurance company will most likely stick to their position.

You've been given some good advice and here is some more that may help.

• Make sure your doctor knows what your job entails - specifically anything that required balance, etc. If your doctor thinks your job is a desk job, s/he may not see any reason for your to NOT continue working.
• Make sure the insurance company knows what your job entails - especially the physical requirements. Again, if they just have a job title they may not understand all that your job entails.
• Make sure you know what your physician is sending the insurance company. Make sure they are providing the medical evidence that the insurance company needs in order to approve your claim.
• If you have legitimate postpartum complications, be proactive in getting your physician to provide information to your disability insurance company. Otherwise, they'll get your delivery date, pay you through 6-weeks postpartum and close your file.
• Make sure that your benefits rep at work is aware of the situation and see if they can follow up with the insurer - especially if they cannot provide accmommodations for a less physically demanding job.
• Know you rights if your claim falls under ERISA regulations. You do have the right to appeal the decision.

Remember that the insurance company has to be responsible to its shareholders/partners. That means that unless they have medical evidence to support your claim (not just a note from the doctor saying "I don't think my patient can work") they have a responsibility to deny the claim. If they are audited and your claim was approved without such medical evidence, the person handling your claim could lose their job.

Most companies will approve benefits through 6 weeks postpartum unless there are complications. This is true for both ******l and cesarean deliveries in most cases.

From what you've said thus far, if fatigue is your only reason for stopping work then you may have a tough time. However, if you are having balance problems due to a change in your center of gravity and you have to climb ladders, that could work in your favor.

I know it stinks but thats the way things are these days. Best of luck to you.

 

[danicaw]

I am sorry you are having to deal with this.
There is enough going on you don't want the added stress.

I have to admit I am a bit jealous you get the option of STD. I am 33 weeks along and its not an option for me. As it turns out a few months ago hubby and I decided to try to make ends meet on just his income so I will be staying at home. But had we had that option we might have worked things out differently.
I am happy with our choice and am questioning my deal with work to stay unitl end of week 39. What was I thinking?

I hope things resolve quickly, so you can relax and get ready for you new arrival. Dealing with Insurance co. can be yucky.

Hang in there.

 

[Tinkbell]

My cousin controls traffic for the city. When she became too "big" to walk around and stand for 8 hours a day, they gladly found her work to do in the office. I hope that there is some way you can make it through this while getting paid. Every little penny counts when you have a newborn. Congrats on this joyful event.

 

[dzneprincess]

Thanks all. Reading everyone's POV has really helped me calm down I also called my case manager back, and she gave me a little hope. I have an OB appointment on Monday, and she stated if I am dilated or effaced any than that would help my case out. If not, well then back to work I go on Tuesday. I'll just do what I need to do. I guess they want me to have my baby in the central office

 

[mhopset]

Your ST Disability (I was going to put STD, but that didn't look to good )wouldn't be First UNUM would it? I know what youa re going through, not pregnancy related but ST disability related. I have Muscular Dystrophy and had to go on ST disability a few years ago. The lady from the insurance told me that "your disease is not considered disabiling until the very end of your life" I called my neurologist and he threw a fit. He called them directly and the next day she called me and said I was approved.

Just call your Doc. I am sure he/she will be able to send something to them so they will approve you.

Good luck

T.

 

[Gillian]

I'm sure that because of the nature of your job you'll have no problem getting the Dr to approve your disability. Your situation goes beyond tiredness, obviously!

One of the docs in a local ob practice won't give anyone approval for disability before the delivery. One poor woman at my office worked 2 weeks past her due date. She had a desk job, but always had to run around the floor & upstairs. It sure didn't look fun!

 

[Gillian]

Originally posted by jel0511
There is one thing that I want to note here. You're planning on taking 12 weeks after the birth, but it you take ANY time off before the baby is born, it counts towards your 12 weeks untitled under FMLA. So, if you really want these 2 weeks, paid or unpaid, you'll only be entitled to 10 weeks after delivery. Basically FMLA is cummulative and isn't for just after delivery, it's for both.

FMLA says that your employer MAY choose to count other medical leave against your 12 weeks. Most of my friends employers (in NJ) allow you to start FMLA time AFTER disability ends.

My DH gets 2 weeks off paid for the birth/adoption of a child. The moms get the same thing. They don't have to take it right away, it is separate from any ST disability and from family leave.

 

[ducklite]

Originally posted by AirForceRocks
The military (the Air Force at least) gives six weeks for maternity leave, not two.

Hmmm...I recall a woman being deployed to active duty two weeks after delivery during the past few years--it was all over the news around here.

Anne

 

[AirForceRocks]

Originally posted by ducklite
Hmmm...I recall a woman being deployed to active duty two weeks after delivery during the past few years--it was all over the news around here.

Anne

Sorry, I've never heard of such a thing - there was a very brief time early in my career when the Air Force cut back to 4 weeks, but it didn't last long, and was soon back at 6 weeks. I've never heard of anyone only having 2 weeks. Two months perhaps, but not two weeks.

 

[AirForceRocks]

Using the "I'm tired because I'm pregnant" line sets the women's equality movement back about 30 years.

I agree 100%!

 

[JohnTBap]

Oh boy. Not what you need right now, is it? I hope that you get this straightened out soon. {{{HUGS}}}

 

[NHAnn]

PammyK: Well said! As an HR/benefits professional, I'm glad you typed it all out, it was what I was going to say

 

[tigercat]

Here in Ontario women get a year off with partial pay and your job is there for you. My dd is looking to get pregnant and is looking forward to the year off with the baby. My dh just had a baby who wasn't due to the end of the month but had decided to start her maternity leave a month before the birth and then take 11 months off. She delivered 2 weeks early so I guess she will have a longer time with the baby. She really didn't have a stressful job and didn't have to do any hard work at all so I wasn't sure why she would want to take the time off before. When my dd had her 1st she was overdue and still working. She worked at a store with me and people would ask her when she was due and it was always fun to see their faces when she would tell them she was overdue by a week. It must be really difficult only being able to take such a short time off from work.
tigercat

 

[Mishetta]

Being that I was a Maintenance Adminstrator for the phone company (many moons ago), I can respect your position working in the Central Office. Many a times I had to call to have sticks put up in the C.O. for testing purposes! Honestly, I don't know how you get down each tight aisle way being pregnant!!

Would you qualify to go on "light duty" if your STD is denied? At least this way you wouldn't have to climb the ladders.

Let me know....my Godchild's father is the Union President of our local phone company. Maybe he can offer me some advice to pass on to you.

Lots of luck to you & baby!

 

[jfulcer]

Originally posted by dzneprincess
But there will be nothing for me to be able to do. I just think it is silly, that either way I would have gotten paid (were the benefits approved), but now I have to go and be in the way for 8 hours.

If your employer wants you to sit there for 8 hours and do nothing, then it's their choice. You can DIS for those 8 hours.

I can't imagine that they are going to just want 'nobody' to do your job for 6 weeks - it sounds as if what you do is a needed service. Maybe they are going to want you to cross-train someone for this? I would have thought they would have done this before you got to 38 weeks....