Having a baby while receiving disability benefits is NOT a good idea for LTD. While most STD claims provide for maternity leave, it is expected that insured women will return to work after 6 weeks maternity leave. Disability insurers often will NOT take the position that pregnancy during LTD is a payable claim. Prudential has been particularly known to toss mothers off claim if they have a baby while on LTD.
Insurance companies question pregnancy during LTD for several reasons. First, insureds are expected to do everything they can to regain their health and return to the workplace. Deliberately getting pregnant, or not, according to insurers, is not taking the necessary steps toward restoration of health and return to work. Insurers don’t want to pay for mothers to stay home and take care of their infants. Benefits are disability income replacement, not day care.
Second, insurers make the argument that taking care of a newborn, infant or toddler is a lot of work and is equivalent to at least “light functional work capacity.” Are they wrong about that? I had two children and I can definitely say that taking care of infants and active toddlers is tiring, physically exhaustive, and demanding. And, it probably IS the equivalent of “light work capacity.” Although some women on LTD seeking to keep their benefits try to say they hire nannies to help them, the argument generally doesn’t work to keep them on claim.
Third, providing medical restrictions and limitations having to do with any level of pain, clinical depression, etc. in order to be eligible for LTD is inconsistentwith continuous child care. “How can an insured claim both back pain severe enough to preclude working, AND at the same time be taking care of a newborn or infant? Or, report frequent medical consultations, hospital visits and tests while breast feeding, or caring for a toddler. These are questions insurance companies will want to know, usually by conducting surveillance where work capacity with a young child strapped to your back or chest will be demonstrated.
Personally, I take no side to whether or not female insureds should have babies while disabled. I offer no value judgments one way or the other. But, it is my responsibility as a Consultant to be truthful about how insurance companies’ reactions to caring for young children while reporting no work capacity will affect future payment of claims. Insurers DON’T LIKE IT, and depending on the claims handler the claim will be red flagged and potentially denied.
Fertility treatments and deliberately trying to get pregnant while on claim is another issue insurers frown upon. Working with a surrogate is also a red flag because mothers are brining upon themselves more work and strenuous physical capacity at a time when they should be focusing on regaining health for returning to work.
Again, while I have no opinion on this issue personally, I do report that disability benefits are at great risk when female insureds have children while receiving benefits. Women should be aware of the risks going into a pregnancy while on disability.
