Short Term Disability Claim Denied for Pregnancy Leave

Since there is clearly an administrative oversight here, meaning you did sign up in time, you did not notice the withdrawal did not continue (a bit fishy to them I imagine)....can you offer to back pay the amount missed?

And yet another medical reason I am happy to live in Canada now....I have not met one, single pregnant mom, nor young family, slammed with exorbitant hospital bills and pre-natal care. It's FREE here. Plus 1 year of maternity leave. Yeah for common sense, and a system that actually honors mothers and infants.

I don't know what to tell you, but I want to say to the other mom's wondering why you think it's a disability, maternity leave is explicitly covered in my company's short term disablilty coverage, it's one of the reasons I was excited to take the job.

No offense Bug but anyone who has ever worked in insurance should be aware that STD use for 6 weeks of leave following vaginal delivery and 8 weeks for c-section is standard practice. It's how most employers who offer any kind of paid leave at all covered it.

To the OP, your initial enrollment should be all the proof that you need that *you* took the correct action. Their failure to maintain your enrollment is their issue, not yours. You may have to pay back the premiums that they failed to collect from your payroll but you should be covered. Additionally, I would find it odd that they would have a pre-existing condition clause on this that would extend to maternity. Your policy that was effective in January and you are looking to take your STD leave this year, while you are covered. For them to deny you your medical leave that is the result of childbirth would seem to me to be discrimination. If a male co-worker had back surgery this year for a condition that has been chronic, would his recovery from surgery also be not covered? Check the policy carefully and see what it says about this. Seems ridiculous to me but you never know.

In any case, you enrolled and your provider or payroll department messed up. Your HR department should be able to rectify this. This kind of thing happens frequently where I work (we are benefits administrators) and retroactive premiums and coverage are commonplace corrections.

ETA and to those who can't read a calendar...August 2012 is not even a year ago, never mind more than a year. That 3 months of premiums were missed by the payroll department or insurer does not entirely negate coverage.

Well here's the rub, you knew they didn't charge you and didn't bring it to their attention. I suppose if you were honest you would admit at some point you thought no biggie, I will sign up in December, save a few months. Even if that didn't happen you still had the ability to know you weren't paying for it and therefore weren't covered. No one's fault that you didn't notice or didn't report.

I had a problem with my insurance a few years ago. I brought it to our plan administrator after I reviewed my first EOB and discovered the deductible was incorrect. She dropped the ball. Then a few months later when I tore my ACL the wrong deductible was applied. Turns out one part of our health care provider had me as single, the other family. Here is the thing though, the only reason it was fixable was that we were paying the correct amount to them.

Granted my employer wouldn't have left me twisting in the wind because one of my coworkers didn't check into my complaint. Still you did not complain.

That you did not complain may mean you will not be covered.
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Okay seriously folks! Why ya jumping her butt about maternity not being a disability. If people want to pay for Aflec so their maternity leave is paid for get over it!

My employer pays for our short term major medical so if I were on maternity leave it would be paid for, why shouldn't someone be able to pay for it? Of course she needs to pay for it....

To those posters that say that Short Term Disability should not cover you for pregnancy--you are all wrong. I received Short Term Disability for 6 weeks for each of my 3 children. You cannot return to work for 4-6 weeks after giving birth (most docs will not sign off on it) and thus it is considered a "disability." Under some policies, if you have a C Section, you get 8 weeks. I don't know what you pay for Short Term Disability in relation to what you would receive for 6 weeks salary, to say if it is even worth it for you to fight (we get it free where we work). I don't know if you have a case. I think you would have to check with HR, and possible an attorney.

Doesn't matter that they failed to charge. It matters, that YOU failed to rectify. It's been a year. I've worked in insurance. There is no way they will retroactive back a year. They will tell you, that should have looked, because you should have. Why do you think you should receive benefits, that you have not paid for?

I'm curious as to why you want disability? Are you unable to work, or just don't want to? I'm not coming down on you, I just find it odd. I'm a bit confused, as to how you think you would even qualify for disability.

Were you a new employee signing up for benefits in August? I don't understand why you would sign up in August and then again in December. That question number one. Question number two would be it would be knowingly they withdrew the money because you authorized them to in September. They didn't for October, November and December. That is odd. You definitely need to address this with HR.

STD is used for pregnancy. The theory is that you are disabled during the 6 to 8 weeks. If you want additional time, and depending of the size of your company you could be eligible for FMLA which is not paid.

In our company, STD is paid by the employer. So there is no "signing up". It is also based on your length of service. For example, if you have been employed three years, you get one month at 100% pay, one month at 80% pay and one month at 60%. Then you are done.

Contact HR ASAP. Discuss it with them, don't yell and scream. I'm in HR and there is nothing worse than that.

You need to check your pay stub ALL THE TIME. While it was an oversite with payroll, you also contribute because you didn't check. I do feel like there is more to the story.

I don't know about short term disability being for the birth of a child. I wasn't aware that you could do that. However, I went into preterm labor at 24 weeks and had to go on full bedrest. I was paid STD for that until I was cleared to go back to work 6 weeks after giving birth. I was grateful for that.

I can't tell you what your rights are, but I think that you must continue to try to get HR to help you. Now that you know how important it is to check your paystubs, do that especially after the baby is born. We've had several people come here to ask how to get their babies on insurance when they've missed the 30 day period after the birth to include them on the insurance. I don't know how that ended up for them, but they should never let it happen in the first place. Check and then check again, since you know these people don't get their work done right. I'd get the names of whoever you talk to and the dates you talked to them as well. You don't want to have to wait for open enrollment for the baby.

Good luck with the STD issue...

ok well just FYI, at my job pregnancy (maternity leave) IS covered by short term disability (6 weeks) , then if medically you have to take longer off of work it goes to long term. just wanted to put that out there. with my job, it's something my company pays for, so i don't have to worry about "signing up" - i do have to agree, you are probably going to have a battle on your hands to get them to cover you though because of the mix up.

I've never heard of maternity leave being STD. I personally do not consider being pregnant and maternity leave as a disability.

That said, you didn't make the premium payments in 2012 and the insurance will most likely not go backwards.

You'll need to speak with HR. Keep your wits about you... don't be confrontational and just communicate with them. Who knows what they might do if you just ask.

ALL that said... Why on earth do you not check your paystub? Only you can make sure you are being paid correctly or having the correct adjustments made on your pay. If you knowingly did not make the premium payment, don't expect the coverage. Didn't you notice the amount of checks to be different? Why wouldn't that prompt you to look and see why your check was more or less than you expected?

Even though I own my company and run payroll, you bet I review my check when I run payroll. Not only am I double checking myself, I am also making sure I have enough deductions, etc for the IRS.

Good luck and start checking your check stubs and stay on top of your financial plan.

You should have noticed you were not being charged. No recourse. I did not think pregnancy was a disability anyway.

I have an insurance background. Basically, they will say, why did you wait MORE than a year to say something after only being charged for one month? Do you not pay attention to your check stub? Had you addressed it back in Oct 2012, it could have been fixed and you would have been covered. You can't let something like this go for that long then play ignorance like, what? I thought I had coverage! and expect them to pay you without collecting any premiums on it. Insurance is not something you want to skimp on or think lightly about. You can ask them to find out why you paid one month and then nothing after that. There is a 1% chance that if there is some error they may charge back premium for you. But in all my 26 years I have never heard it happening. I hope it works out for you. In the very least, you are signed up now. Good luck.

ETA: If it's Aflac, pregnancy is covered as long as you don't deliver within the first 10 months of the policy. Other carriers may be different or have it not covered at all.

It's probably wise to pay more attention to your paystubs in the future.
That way you'll notice errors/differences and be on top of what is going on.
If you signed up in Aug and they deducted correctly for it in once in Sept, what happened that the deduction/coverage did not continue?
That's what you should have found out immediately when it happened.
By the next pay period in late Sept you should have been on the war path getting that straightened out right then and there and then you would not have had to re-enroll in Dec for it to begin in Jan.
As it stands, it's unfortunate you became pregnant when not covered but you would have had that ironed out had you been paying attention.
The mess up in payroll was certainly not your fault but failing to notice any problems with it in a timely fashion WAS your fault.
I'm not sure you're going to be able to fix anything at this point but if you pay attention to your paystubs in the future and you will have learned a valuable lesson.

Well, my first thought is that if signed up in August it would be odd that it was effective already if you then also had open ennrollment in Decemeber (most employers have it once a year). Now, if you have proof you signed up in September then you may be able to push the issue with HR but would also owe the back premiums that weren't deducted.

My other thought is that if you are saying you didn't notice they weren't taking the premium because you are salaried and rarely look at your stub, since your pay check was different when they deducted the premium one time and not the next it would have prompted you to look at it....right?

You will definately have to reach out to HR (and keep trying until you get them).

Since you seem to work on a system that you have to pay into in order to take advantage of it... I have a feeling you're not going to be able to reap the benefits of maternity leave disability. Which is such a misnomer, considering maternity leave isn't a disability and neither is pregnancy.

Anyway. The system is really set up so that you're paying yourself. That didn't happen. I would see if you qualify for FMLA so that you can at least go back to your job even if the time you're out is unpaid.

When I had my kids, my employers had short term disability coverage for the time I was out. The first, I was out for 5 months, the others 6 and 8 weeks. When I sign up for benefits, I get a confirmation. In my current job, I get a statement that I can save to show what I did sign up for. And I do check my pay, especially with the new year, to make sure they are not taking out too much or the wrong things. Do you have anything showing that you did sign up. I would think your first check with the deduction should get them started.

Pregnancy is not a disability. If you were in danger of losing the baby unless you had strict bed rest for months, THAT's a disability. Or if you had the kind of morning sickness that put you in the hospital, that's disability. Giving birth is not a disability.

It's the INABILITY to work, not the desire not to.

You need to ask HR about the Family Leave Act, but unless you have a medical problem where you are incapable of working due to illness or injury, you don't qualify for disability coverage.

Maternity leave is not covered by disability I am pretty sure.

I'm having a hard time understanding why you think pregnancy is a disability.

My company has STD no matter what, however if I have the additional buy up I get more pay.. ie 90% vs 75%.

Maybe you are talking about something different? For me my maternity was considered STD.