Short-Term Disability and Pregnancy: Understanding Your Rights and Benefits

Welcome to Season 5, Episode 25 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Short-Term Disability and Pregnancy: Understanding Your Rights and Benefits."

Pregnancy and Short-Term Disability don’t always go hand in hand - at least not the way they should. In today’s episode, disability law expert Nancy L. Cavey sheds light on a critical issue affecting millions of working women: the challenges of securing Short-Term Disability benefits during pregnancy. While pregnancy is often a time of excitement and change, it can also involve serious medical complications, extended leave, or postpartum recovery that makes returning to work impossible. That’s when Short-Term Disability insurance is meant to provide support - but the claims process is often anything but supportive. From unclear policy terms to denied claims and employer resistance, many women find themselves overwhelmed and underprotected at one of the most vulnerable times in their lives. Nancy breaks it all down - what pregnancy-related conditions qualify, how Short-Term Disability differs from long-term coverage, when to seek legal help, and how to fight back if your claim is denied. Whether you’re pregnant now, planning to be, or helping someone through the process, this episode offers clear, actionable guidance for navigating the system and securing the benefits you deserve. Let’s get started.

In this episode, we'll cover the following topics:

One - Understanding Short-Term Disability and Pregnancy

Two - Filing and Protecting Your Pregnancy-Related Disability Claim

Three - Knowing Your Rights and Seeking Support

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/


Resources Mentioned in This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mind

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals. 

Transcript

Nancy Cavey [00:00:00]:
 Foreign hey, I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to Winning Isn't Easy. Before we get started, I've got to give you a legal disclaimer. This podcast isn't legal advice. The Florida Bar association says I have to tell you that. And now that I've told you that this isn't legal advice, nothing will prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Now.
 
 Nancy Cavey [00:00:47]:
 Today we're going to dive into a topic that affects millions of working women, but it's often misunderstood, overlooked and mishandled by employers and and insurance companies alike. Pregnancy and Short Term Disability now for many, pregnancy is a joyful and transformative time, but it can also come with serious medical complications, doctored ordered bed rest, and a recovery period that makes returning to work right away impossible. And that's where short term disability insurance is supposed to step in to offer financial protection when you're temporarily unable to work due to pregnancy related conditions. But if you've ever tried to file a short term disability claim during pregnancy, you may already know it's not always smooth sailing. From confusing policy language and waiting periods to claims denial and employer pushback, the process can be overwhelming, especially when you're trying to focus on your health and your baby. In today's episode, I'm going to walk you through everything you need to know about pregnancy and short term disability. What qualifies? How is short term disability different than long term disability? When should you seek legal help? What happens if your claim is denied? So if you're pregnant or planning to become pregnant and wondering how to protect your paycheck, this episode is for you. So let's get going.
 
 Nancy Cavey [00:02:05]:
 I'm going to talk about 1 understanding short term disability and pregnancy, 2. Filing and protecting your pregnancy related disability claim 2 and 3 knowing your rights and seeking support. We're gonna take a quick break before we get into this episode.
 
 Speaker B [00:02:21]:
 Have you been robbed of your peace of mind by your disability insurance carrier? You owe it to yourself to get a copy of Robbed of youf Peace of Mind, which provides you with everything you need to know about the long term disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:02:39]:
 Foreign welcome back to Winning Isn't Easy Understanding Short Term Disability and Pregnancy. Let's start out by talking about what short term disability is and how it's different than long term disability. So short term disability STD provides partial income replacement when you're temporarily unable to work due to a non work related illness, injury or medical condition, including pregnancy. Generally, most short term disability policies or plans will exclude payment for workers comp type situations where you've been injured on the job or have an aggravation or acceleration of a condition as a result of workplace conditions. So let's distinguish that first from workers comp and then let's talk about short term disability. Now in the terms of short term disability, it can last for a few weeks or a few months depending on the terms of your policy. There are some employers who self fund short term disability, so they will actually pay it out of their own coffers, if you will, and they will self administer the short term disability and that's basically called self funded. Now there's another scenario where the employer will self fund the short term disability and will have a third party administrator administer the claim.
 
 Nancy Cavey [00:04:09]:
 And then of course there's a short term disability policy where the employer has offered to you a short term disability policy or plan. And in each of those instances you are going to see generally the same kinds of games that are played that we'll talk about in a minute. Now, what's long term disability? That's an extended income replacement for conditions that generally will last longer than the short term disability period. Generally, as I've said, in short term disability you will see the payment of benefits anywhere from three months to six months, though I've seen them as long as a year or once you complete your short term disability benefits and you're eligible for long term disability, the policy will have generally two different definitions of long term disability. One is an inability to do your own occupation and normally that's paid for one to two years. Then after that point in time, the definition of long term disability will switch from an inability to do your own occupation to an inability to do any occupation by virtue of your medical condition, your education and training. So potentially you can move through short term to long term disability. Now, in the context of pregnancy, most short term disabilities benefits will cover both pre delivery complications and post delivery recovery.
 
 Nancy Cavey [00:05:40]:
 But there is no uniform policy or plan and so each is different. You need to understand that there are some common benefits. But again, I would strongly suggest that if you're thinking about getting pregnant or you are pregnant beginning to have complications, that you get out that policy or plan so you understand what the benefits are that are going to be provided. So let's talk about common benefit periods. Normally they will pay short term disability benefits for six weeks after a vaginal birth, eight weeks following a C section. And generally they will offer additional time for complications or medically required benefits bed rest. Again, it just really depends on your policies, coverage terms, the waiting periods, exclusions, and especially if you're newly enrolled or recently become pregnant. Because we're going to talk about something that's known as the pre existing condition clause that is used to limit the payment or actually exclude the payment of benefits because of pregnancy.
 
 Nancy Cavey [00:06:49]:
 So who qualifies for short term disability and what conditions are covered? Pregnancy obviously is one of the most common reasons for filing a short term disability claim, but it's far from the only qualifying conditions. Now, short term disability policies will typically cover a range of temporary medical situations, including high risk pregnancy and complications like gestational diabetes or preeclampsia. I had those in my first pregnancy and was on physician ordered bed rest too. So those are common complications that you will see. But you also might have issues with recovery from childbirth, both C section and evaginally. You might also suffer from postpartum depression or anxiety. You also might have in a non pregnancy situation, medical conditions that result in you being disabled and unable to work because of an acute illness such as severe flu or pneumonia. You might have musculoskeletal injuries or pain limiting your abilities.
 
 Nancy Cavey [00:07:56]:
 You might have undergone surgery and are recovering from surgery. So those are sort of the waterfront of some of the conditions that can be the basis of a short term disability claim. Generally though, you have to be under the regular care of a licensed medical provider and provide documentation supporting your inability to work. Now, I alluded to the fact that most disability policies will have some policy limitations. And one of the things that you need to understand is the pre existing condition clause. And I have litigated this issue before in federal court. And so let me give you the rough story of of this particular client. She had become newly enrolled with her employer short term disability plan.
 
 Nancy Cavey [00:08:50]:
 And there was in this plan a look back period that says, look, literally if you become disabled as a result of a pre existing condition for which you received treatment before you became enrolled in this program, we're going to look back at your medical records and see whether you got treatment for this medical condition. And if so, we're most likely going to deny any complications or problems that you have under the pre existing condition clause because you're newly enrolled in this short term disability plan. Now, in this particular case, my client was pregnant at the time she enrolled in her employer's short term disability plan. And of course, if you look back, she got treatment for her pregnancy, but that wasn't the problem. Post delivery she had episodes of preeclampsia and also issues with hemorrhaging. Subsequently she had a stroke and the disability carrier said, oh look, this is all the result of the pregnancy and certainly the hemorrhaging was, but that wasn't the cause of the stroke. And as a result the carrier denied the claim. Ultimately the case ended up in the 11th Circuit and the judges took judicial notice of of strokes and what could cause strokes and basically said in terms of time, the onset of this stroke was not temporally or time related to the pregnancy.
 
 Nancy Cavey [00:10:39]:
 And yes, we understand she got treatment for the pregnancy. We understand that that was a pre existing condition, but that is not what caused the stroke in this particular case. So again, when you enroll in your short term disability plan or policy can impact the extent and nature of the coverage that you might have as a result of any complications for pregnancy or just the natural recovery period for pregnancy. Got it. Let's take a break. Filing and Protecting your pregnancy related Disability Claim welcome back to Winning Isn't Easy. Now, when you are filing a short term disability claim during pregnancy, there are some things you need to do that can really impact ultimately the payment of your claim. When you file a claim based on pregnancy, you need to be prepared to submit detailed medical documentation.
 
 Nancy Cavey [00:12:13]:
 This should include your expected due date, any medical restrictions, particularly with lifting limitations, traveling bed rest orders number three, any pregnancy related complications you might be having. So you might for example, have issues with gestational diabetes. Next, your anticipated time off from work. So those are the sort of the general things that you want to be discussing in the application. It will take several weeks for the insurance company or plan to process and approve a claim. So don't wait until the due date approaches. You want to get the paperwork in, I think at least four to six weeks before you expect to go on leave or earlier if your doctor anticipates complications. Now remember, some policies only provide benefits for postpartum recovery unless medical issues justify leave before birth.
 
 Nancy Cavey [00:13:07]:
 Others will require that you meet specific eligibility timelines related to when your policy began. Again, you got to get out that policy or plan and read it cover to cover. When should you contact a disability attorney? Now if your employer denies your right to take leave under the Family Medical Leave act, or if you're being discriminated against because you're pregnant, it might be time to talk with both an employment attorney and a disability insurance attorney. I don't do FMLA or employment Litigation. And I routinely refer these types of issues to my local employment attorney with whom I have a really great referral relationship. But you would want to consult a disability attorney. Also, if the carrier is denying your claim due to exclusions for pre existing conditions or policy timing issues, your insurer questions whether your doctor's restrictions are valid, you miss paperwork deadlines or are accused of non compliance with medical care. So what we disability attorneys can do is really to review the policy or the plan, review your medical records, and then review the denial letter or request for information that you're getting from the disability carrier or plan to understand what the limits are here.
 
 Nancy Cavey [00:14:30]:
 Limits in terms of what does the policy provide? What do you have to prove? What are they saying you haven't proven or provided? Are there any non compliance issues? Are there any pre existing condition issues? So obviously it's important that all of that be done to determine your legal rights and whether you have a valid appeal to challenge a wrongful denial or termination of benefits. Clearly, the involvement of an attorney can make a difference in the outcome of your claim and any necessary appeals. But what happens then if your claim is denied and how will the attorney assist? Well, if the claim is denied, you typically have the right to file what's called an internal appeal directly with the insurance company or plan. Now what I do is I assist my clients, as I said, in understanding why the claim was denied in the context of the policy or the plan. We identify gaps or weaknesses in the medical documentation and we prepare an appeal with additional evidence and legal arguments. Now, most insurers, companies in the short term disability world will be responding within 30 days. And again, it depends on the terms of the policy or the plan. But we also need to understand that an appeal has to be filed.
 
 Nancy Cavey [00:15:58]:
 If you don't file an appeal, you may not be able to litigate the case. Your attorney might suggest that a lawsuit be filed after an appeal just for the purposes of bringing them to the table to talk about resolving the case. Appealing the denial can be complex and I find that disability carriers can rely on vague policy language or incomplete medical records to create a reason to deny a claim, much as they did in the story that I told you about my pregnant client who after delivery had a stroke. So we developed a strategy to help overcome this denial. We weren't successful in federal court at the district level, but the case was taken to the 11th Circuit Court of Appeals because we felt strongly that the district court was wrong. And ultimately the federal the 11th Circuit Court of Appeals agreed with us. But we created a strategy that gave her ultimately the best chance of reversing that denial. And we were successful.
 
 Nancy Cavey [00:17:04]:
 Pregnancy cases can be very complicated and also complicated because of the language and limitations in the policy or plan. Got it. Let's take a break.
 
 Speaker B [00:17:14]:
 Are you a professional with questions about your individual disability policy? You need the Disability Insurance Claim Survival Guide for Professionals. This book gives you a comprehensive understanding of your disability policy with tips and to dos that will assist you in submitting a winning disability application. This is one you don't want to miss. For the next 24 hours, we're giving away free copies of the Disability Insurance Claim Survival Guide for Professionals. Order yours through today@disabilityclaimsforprofessionals.com.
 
 Nancy Cavey [00:18:15]:
 Welcome back to Winning Isn't Easy knowing your rights and seeking support so what are your rights under FMLA and short term disability? Now, as I've told you before, 1 I'm not giving legal advice and 2 I am not an employment attorney, but I want to try to give you sort of an overview, if you will, of the waterfront of FMLA and short term disability benefits. Now, most people are surprised to learn that FMLA and short term Disability are separate benefits. The FMLA Family Medical Leave act provides up to 12 weeks of unpaid job protected leave for qualifying medical and family reasons, including childbirth and recovery. Short Term Disability provides income replacement during that time, and the length of that really depends on the terms of your policy or plan. Now, the two can overlap. Clearly, you may be on FMLA unpaid while you're collecting short term disability. But I will tell you not every employee qualifies for FMLA and not every employer offers short term disability fmla. Your employer has to have a certain number of employees.
 
 Nancy Cavey [00:19:26]:
 You have to have worked for a certain period of time. Again, I'm not an expert in this, but you need to understand that problems can arise. Employers can try to reduce your leave or even deny it outright. You might be pressured to return to work early. You may not, and they may not understand how the FMLA and the short term disability benefits are coordinating. If you find yourself in those situations, you should be consulting with two lawyers. One is an employment lawyer who can answer your questions about FMLA and certainly a disability attorney such as myself who who can discuss with you your short term disability benefits, what needs to be done to win a claim, and the interaction between those two. If you have any questions about finding an employment lawyer, I would suggest that you talk to your disability lawyer who can make referrals or call your county or state bar association because they can give you recommendations.
 
 Nancy Cavey [00:20:28]:
 So what are the common pitfalls that will lead to denials and how should you avoid these? I will tell you that disability carriers and plans are looking for any reason to deny a claim, particularly those related to pregnancy. So what are some of the common pitfalls? 1. Missing critical claim deadlines 2. Submitting incomplete or inconsistent medical forms 3. Failing to clearly document your restrictions or complications. Next delivering before the end of the waiting period or the exclusion period. In other words, if there's a seven day waiting period and you have the baby in that seven days, you may not have met the waiting period unless you have complications or not attending follow up medical appointments. You can clearly understand that you need to be working closely with your OBGYN or other care provider to ensure that your medical records are documenting the nature of your problems, the treatment that you have gotten, the lack of response, their recommendations to address the complications, including bed rest or other limitations.
 
 Nancy Cavey [00:21:34]:
 And it's really important that your doctor is supporting your claim because your doctor is going to be asked to complete some forms called Attending Physician statement forms, APS forms. Those forms generally don't ask the right questions and I will assure you they don't ask the right questions in pregnancy complication cases. Now I'm also a Social Security disability attorney, so we Social Security attorneys have created some forms we call residual functional capacity forms. They're much more detailed and they ask the right questions. And I always use them as a supplement to my barista disability cases because they ask the right questions. And we do have some pregnancy related complication forms that that sometimes we can use as an adjunct. For example, we have a diabetes residual functional capacity form that sometimes can be used as a supplement to the APS form that the carrier is asking your doctor to complete because we want the information and problems to be clear. So you can see here that your physician is a really important partner in getting your disability benefits and you need to understand their interest and willingness to help you.
 
 Nancy Cavey [00:22:51]:
 So you can see that getting help early from both a legal and insurance expert and making sure that you and your doctor are on the same page can prevent costly mistakes. If you find yourself in this situation, you clearly need to understand your rights under the disability policy, the FMLA and any other applicable state laws. You need to be able to identify any coverage gaps or legal risks. You need to understand the timeframes in which your policy pays benefits. You might have to be dealing with a preexisting condition issue. You might have a rather long waiting period. Benefits might be limited. So you kind of need to understand that before you begin the process.
 
 Nancy Cavey [00:23:35]:
 And obviously the whole goal here is to build a strong claim or appeal with the right documentation and and have an advocate who understands the disability claims process. If you're pregnant and facing obstacles to getting short term disability benefits, you don't need to go it alone. Whether you're preparing to file a claim, you're dealing with questions about how the short term disability and the FMLA works together, or you're dealing with a denial a an experienced ERISA disability attorney, and with the assistance of an employment attorney, you can get all those questions answered so you can understand your options and protect your financial security. Knowledge is power, and understanding that policy, documenting your medical needs and knowing your rights can make all the difference for protecting your income and giving you peace of mind during one of life's significant transitions. If you have any questions again, you should be writing these questions down and consulting with your HR department, because sometimes they may be able to answer some of these questions. But if at the end of the day you don't get answers you think are right, or just get a bad feeling about what's going on, you owe it to yourself to make some calls to your state bar associations to get a referral to to an employment attorney or to contact a disability attorney such as myself. Got it? All right, thanks for tuning in to this week's episode of Winning Isn't Easy. If you found this episode helpful, please take a moment to like our page, leave a review, share it with your friends, and of course, subscribe to this podcast.
 
 Nancy Cavey [00:25:16]:
 Join us next week for another insightful discussion and episode of Winning Isn't Easy. Thanks for listening. Sam.