Can I File a Disability Claim for Pregnancy? Part II
As explained in our previous post, some disability insurance policies indicate that they won’t pay benefits due to pregnancy or childbirth, but that they will cover a disability due to complications for pregnancy only.
Here are some examples of how various disability insurers have defined complications of pregnancy. In reviewing, keep in mind that insurance companies regularly change their policies over time and your policy may not necessarily contain the same definitions, even if it was issued by one of the below companies.
METLIFE POLICY
Complications of Pregnancy means:
- Physical conditions which are distinct from pregnancy, but which are caused by pregnancy or adversely affected by pregnancy, and which require medical treatment, prior or subsequent to the termination of pregnancy, such as acute nephritis, nephritis, cardiac decompensation, missed abortion, disease of the endocrine, hemopoietic, nervous or vascular systems, and similar medical and surgical conditions of comparable severity;
- Hyperemesis gravidarum and pre-eclampsia requiring Hospital confinement, placenta praevia, ectopic pregnancy which is terminated and spontaneous termination of pregnancy which occurs during a period of gestation in which a viable birth is not possible.
It does not include false labor, occasional spotting, Physician prescribed rest during the period of pregnancy, morning sickness and similar conditions associated with the management of a difficult pregnancy not constituting a classifiable distinct complication of pregnancy.
Other policies are less exacting when it comes to defining complications, for example:
NORTHWESTERN MUTUAL POLICY
Complications are physical conditions physicians consider distinct from pregnancy even though caused or worsened by pregnancy. For purposes of this policy, a non-elective caesarian birth is a complication of pregnancy. Examples of conditions that are not complications include false labor, fatigue, and morning sickness.
Some policies will also include exclusions specific to the policyholder, if the policyholder already has a history of complications related to pregnancy prior to applying for the disability policy.
Additionally, some conditions, including musculoskeletal issues (common with dentists) and mental health issues like depression, can be made worse during pregnancy and lead to longer recovery times. This may be relevant to a long-term disability claim, but ultimately depends on the language and limitations in the policy in question.
Once case example is that of Sprenkle v. Hartford[1]. In this instance, during her pregnancy, Sprenkle’s doctor indicated that she could not work due to complications of pregnancy—primarily due to complications from a previous pregnancy, but also current anxiety and weight loss. Despite the support of her doctor, Hartford denied Sprenkle’s claim, indicating that there was no evidence that she was unable to perform her occupation, and argued that her doctor was basing his recommendations on a previous pregnancy versus current limitations. The Court found that Hartford’s assessments were “simply not accurate” and determined that they had abused their discretion in denying Sprenkle’s claim.
Although Sprenkle’s policy even expressly provided for disabilities caused by pregnancy but the companies still held that she was not totally and continuously disabled, despite her doctor’s findings to the contrary. In pregnancy cases like this, strong medical support can be key to getting a claim to go through.
Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your insurer is not evaluating your claim under the proper standard, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.
[1] Sprenkle v. Hartford Life Ins. Co., 84 F. Supp. 2d 751, 756 (N.D.W. Va. 2000).
