A Detailed Guide on How to Apply for Pregnancy Disability - Shegerian Law

Welcoming a child into your life is one of the most exciting experiences life has to offer.  However, it can also be stressful when problems arise during, before, or after birth, especially for women building their careers. Pregnancy complications aren’t uncommon—approximately 8% of pregnancies result in medical conditions that can harm the mother or baby if left untreated.

Being physically and mentally capable of working 100 percent of the time during pregnancy is challenging. If you’re experiencing pregnancy-related difficulties, it’s important to use the benefits your employer and the government provide to focus on recovery without worrying about work or salary.

Understanding the basics of disability benefits is the first step to getting them. If you want to learn more, this article tackles everything about disability for pregnancy, from the benefits you can receive to the steps in filing claims if you’re met with difficulty from your employer when trying to use these benefits.

What is Pregnancy Disability?

Pregnancy disability benefits are provided to women with maternal disabilities caused by pregnancy or childbirth.

Unfortunately, the Americans with Disabilities Act (ADA) does not consider pregnancy a disability, along with common symptoms like fatigue and morning sickness. However, complications that prevent a return to everyday life can qualify as a disability on a case-to-case basis. Some conditions may include the following:

The fact that pregnancy disability falls under the ADA means qualified women are eligible for benefits, including leaves and Social Security Disability Insurance (SSDI). The Family Medical Leave Act (FMLA) also provides up to 12 weeks of unpaid leave for birth, childcare, and family care reasons.

Employees wishing to take maternity leave should provide their employers with reasonable notice of their need for the leave. A substantial notice provided by the employee should have the following 

  • The time the leave is anticipated to be taken
  • The expected duration of the leave 
  • The necessary facts and documentation needed to make the employer aware of the reason the employee is taking the leave

These benefits guarantee your and your child’s physical, mental, and financial well-being during and after pregnancy. With that in mind, one of the most popular benefits you can enjoy is disability insurance.

Short-Term vs. Long-Term Pregnancy Disability Insurance

Disability insurance replaces a portion of your income if you cannot immediately return to work due to pregnancy or birth complications. The coverage depends on what the policy considers a disability, often excluding pregnancy. Check your policy to see if it qualifies pregnancy as a disability.

There are two types of disability insurance: short-term and long-term. Depending on your choice, the insurance may cover anywhere from three months after your disablement to your retirement.

Short-term disability insurance

This policy replaces your weekly or monthly income and lasts up to a year, usually covering cancers, mental health conditions, extensive injuries, and pregnancy. You can file claims from this insurance type to recover from pregnancy and birth trauma.

The elimination period, or the time after disablement before you start receiving payouts, may range from seven to 30 days. Moreover, short-term disability insurance usually covers 50%–70% of your salary, while some offer stepped payouts. 

Long-term disability insurance

This type of insurance replaces your income for longer than the short-term, mostly lasting from two years after disablement until retirement. It doesn’t usually qualify for normal pregnancies but may cover resulting complications during high risk pregnancy.

Like its short-term counterpart, long-term disability insurance covers around 60% of your income. The elimination period often takes 90 days, so employees typically claim short-term benefits to support them while waiting for long-term payouts. Moreover, the benefits depend on how the insurance company defines your disability based on the following criteria:

  1. Own-occupation disability – You cannot work at your regular job but may work at another that can accommodate your disability.
  2. Any-occupation disability – You can’t work any job at all.

How to Qualify for Pregnancy Disability

As mentioned, pregnancies may result in complications that aren’t always qualified for disability claims. Your condition is usually only accepted if you can’t perform your work duties because of it. Here’s a list of qualifying pregnancy-related factors to help determine if you’re entitled to disability benefits.

  • Doctor-ordered bed rest
  • Childbirth complications
  • Recovery from childbirth
  • Prenatal visits
  • Prenatal care
  • Severe morning sickness

How to File a Claim for Pregnancy Disability

Learning how to apply for pregnancy disability and file claims is essential if you want to maximize the benefits. The process is straightforward, but it is recommended to consult a qualified disability attorney if you are unsure if your employer has provided you with necessary accommodations for your pregnancy disability. 

Step 1. Review your documents

The ADA only considers pregnancy and resulting complications as disabilities on a case-to-case basis, which could mean your disability insurance might not completely cover them.

To determine your eligibility, refer to your policy and understand what pregnancy-related problems qualify. You can also consult with a disability insurance lawyer, who can help you understand the procedure better. Otherwise, you might miss opportunities to get pregnancy disability.

Step 2. Collect evidence

Insurance companies are infamously evasive with claims. Now that you’ve determined your disability qualifies for benefits, it’s time to compile everything that can support your claims. Your evidence may include the following:

  • Medical records
  • Insurance policy
  • Proof of insurance
  • Statement from your employer
  • Written statements from your healthcare provider

Managing documents is often challenging when you’re disabled. Luckily, a lawyer can collect and process them if you can’t do so yourself.

Step 3. File a claim

At this stage, you’d usually have to fill out forms, undergo an interview, and deliberate with a claims adjuster. The adjuster’s job is to make your claim as quick and cheap for the company as possible, so anticipate that the deliberation could dismay you. Having an attorney on your side can increase your claim strength.

Step 4. File an appeal if needed

It is common for the insurance company to deny your claim regardless of the evidence to back you up. Fortunately, you can appeal your case. You’ll have to fill out appropriate forms and request the appeals council to reconsider.

Appeals are complex, so having a lawyer to represent you is essential

Other Benefits

Below are other benefits you can enjoy from filing disability claims due to pregnancy.

State Disability Insurance

State Disability Insurance (SDI) is a state-mandated policy that replaces your income after disablement. You may be eligible in cases of:

  • Illness
  • Injury
  • Pregnancy
  • Childbirth

California, Hawaii, New Jersey, New York, and Rhode Island are the only states that mandate employers to include SDIs in company group insurance plans. Other states allow SDIs at the discretion of the enterprise.

Paid Family Leave

Paid Family Leave (PFL) provides leave benefits to employees who need time off work to attend to family matters. You may be eligible for PFL when you have to:

  • Care for an ill family member
  • Care for a newborn child
  • Participate in a qualifying event in place of a military-deployed family member

Note that most states provide unpaid family leave per the FMLA. Meanwhile, those that grant PFL to supplement the law are California, Colorado, Connecticut, Delaware, Massachusetts, Maryland, New Jersey, New York, Oregon, Rhode Island, and Washington.

Temporary Disability Insurance

If you suffer from non-work-related illness, injury, or disability and need a short time off work, you may be eligible for Temporary Disability Insurance (TDI). It provides debilitated employees cash benefits to help with their recovery.

However, some states require a minimum salary to qualify for TDI, while others provide a short time limit after disablement to file claims. Contact your state’s disability insurance representative for TDI information specific to your location.

Disclaimer: None of the aforementioned information should be construed as legal advice. Likewise, contacting us via our website does not constitute an attorney-client relationship. Please consult with a competent and qualified attorney to discuss your specific situation before taking action on your own.

Leveraging the Benefits that You Deserve

Now you understand the benefits available to you during pregnancy and childbirth. However, to get the assistance you need, you should be informed about your eligibility.

Moreover, staying up to date with the latest disability insurance news can protect you from exploitative employers who refuse to let you recover from pregnancy-related illnesses. If you believe that your employer has denied your rights , contact a pregnancy discrimination lawyer about your disability rights.

Get in touch with our expert attorneys at Shegerian & Associates for assistance with disability insurance benefits, appeals, and other legal matters. Our extensive knowledge of federal and state insurance laws can give you an advantage when applying for benefits claims when you’re on the road to recovery.

Manuela Varela

Relations Manager

Manuela Varela has been with Shegerian & Associates since August 2022. She is responsible for outreach and marketing on behalf of the firm and manages relationships between firms and referring attorneys. She is also responsible for developing business opportunities and affiliations. Manuela graduated from Loyola Marymount University with a degree in Economics and Political Science.