It is not uncommon for employers to provide employees with the option of cancelling coverage for long term disability benefits when they go on maternity leave. While it might seem like a financial relief not to have to pay premiums for benefits while off on maternity leave, failing to pay those premiums comes with several risks.
Many women experience pregnancy and childbirth without complication, however for some women, pregnancy and childbirth can wreak havoc on their physical and mental health. Patent and latent medical conditions, which may be triggered or aggravated by pregnancy, can significantly complicate pregnancy and post-pregnancy recovery.
Although certain pregnancy complications may be limited to the gestational period such as high blood pressure, gestational diabetes, cholestasis of pregnancy and anemia, other health issues might continue post-delivery. Postpartum depression, Post Traumatic Stress Disorder (PTSD) from a traumatic birth experience, back pain related to or exacerbated by pregnancy, thyroid issues, deep vein thrombosis, urinary and cardiac issues are some of the post-pregnancy conditions that we have seen in our disability law practice.
Can I apply for long-term disability (LTD) benefits while I am on maternity leave?
The answer to this will depend on the specific wording in your insurance plan/policy. Some plans/policies specifically address maternity leave, others specifically exclude a disability claim during maternity leave. If you have stopped paying premiums for long-term disability benefits however, you may not have the coverage in place to make a claim whether your policy/plan covers it or not.
While pregnancy and childbirth themselves are not disabilities, the physical and mental complications that occur as a result of pregnancy and childbirth could be covered under your insurance plan/policy.
What happens if I stop paying premiums for long term disability benefits coverage?
If you stop paying premiums for your long term disability benefits during maternity leave (or any other leave of absence), this results in a break in your insurance coverage. This could potentially have implications for you if you return to work after your maternity leave and become unable to work shortly thereafter due to your medical issues.
What happens if I return to work after maternity leave but find I am unable to work shortly thereafter?
If you do not continue paying premiums for long term disability benefits coverage during maternity leave and find that you are unable to continue working within a short period of time after you return to work, your claim might be denied based on a pre-existing condition exclusion clause.
What is a pre-existing condition exclusion clause?
Pre-existing condition exclusion clauses give insurance companies a basis to deny long-term disability claims for conditions a person had or received treatment for prior to the date their insurance coverage came into effect.
In other words, if you stopped paying premiums for long-term disability (LTD) benefits during your maternity leave and then restarted premium payments when you returned to work, your effective date of insurance would be changed to the date that you returned to work after your maternity leave. If you submit a claim for disability benefits shortly after you return to work, the insurer could deny your claim on the basis that any disabling condition you had or you sought treatment for during your maternity leave would be excluded under the pre-existing condition exclusion clause in your policy/plan.
More specifically, any treatment or medication that you received in the 90 days (this time period might differ from policy to policy) before you returned to work and your insurance became effective again, might be used by the insurer to trigger a denial of your disability benefits claim based on the pre-existing condition exclusion clause.
Do all insurance companies use this model?
Although there has been a more recent move by some Canadian insurers to stop the process of triggering a new pre-existing condition period when an employee re-enrols in the benefits plan/policy after their maternity leave ends, this has not been implemented by most leading insurers. It is our hope that more insurers will move towards eliminating this practice given the inequities associated with this model.
What should I do if my employer offers me the option of continuing premium payments while I am on maternity leave?
Our advice – if your employer offers you the ability to continue paying long term disability premiums during a maternity leave, you should do so!
If you are in the unfortunate position of returning to work after a maternity leave and find that your effective date of insurance has been reset to the date you returned to work, triggering a pre-existing condition clause exclusion, contact MK Disability Lawyers LLP. We are a female-led law firm with an exclusive focus on long-term disability insurance law. We can help you navigate this challenge.
The lawyers at MK Disability Lawyers LLP have over 50 years of cumulative experience handling insurance disability claims including many claims where insurers have denied benefits on the basis of the pre-existing condition exclusion clause. Contact us at firstname.lastname@example.org or (647) 697-4600 for a complimentary initial consultation.
The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor-client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, contact a lawyer specializing in disability law.