When I am asked questions like this I feel the need to clarify disability policies in general. Private disability is not solely “impairment directed”, but a determination that one’s medical condition prevents him/her from returning to work.
The presumption by claimants and, on occasion their physicians, that private disability is only medically based is entirely wrong. There are two criteria that must be met in the definition of disability: 1) that a medical impairment exists severe enough to warrant restrictions and limitations, and 2) that the restrictions and limitations are severe enough to prevent one from working. Unless insureds and claimants “connect the dots” between medical condition and inability to work, there is no disability claim.
Therefore, to answer the question specifically is, yes, Unum could cover depression after the birth of a baby if the condition is severe enough to prevent returning to work after the normal 6 weeks of maternity leave.
The above discussion applies to ALL impairments. I keep seeing questions such as, “Does Unum cover irritable bowel syndrome?”, or, “Does MetLife cover fibromyalgia? etc. And again, the answer is that insurers cover any impairment with medical restrictions and limitations that prevents one from working. Both criteria must be met in order to meet the definition of disability in all private and group policies.
Claimants should also keep in mind that a diagnosis does NOT equal disability. Just because your physician has diagnosed you with a medical condition requiring treatment does not necessarily mean you can’t continue working. Many employees continue working with various medical conditions until there are unable to work at the standard required by their employers. Private disability is always determined when medical restrictions and limitations diagnosed by a qualified physician prevent you from working. (Remembering, of course, that insurers themselves determine who meets the definition of disability in the policy and who doesn’t.)
What do I do if I am abused by my employer as a disabled employee?
Employment abuse should be immediately reported to your state Human Rights Commission and EEOC. Then, retain a good employment attorney to discuss any future actions you may have against your employer.
Why do I keep getting paperwork and letters from Unum even if they don’t really say anything new?
Unum’s management wants to know that your claim isn’t part of the claims handler’s backlog. In addition, management requires your claim to be “touched” (reviewed) frequently so that there are no opportunities lost to deny the claim. It’s very interesting, MetLife, Aetna, and CIGNA do not send out enough status letters while Unum sends them out even when they don’t need to. These patterns of practice indicate to me Unum may still be micromanaging the claims process and forcing its claims personnel to set frequent flups. Go figure.
I’m devastated. My company says I can’t get benefits because my claim is pre-existing. What do I do now?
With the exception of catastrophic and sudden disability, pre-existing condition denials should never happen. New employees who are eligible, and are then covered under the employer’s Group STD/LTD Plan should obtain copies of the Certificate Booklet and read it. In the Plan, it will describe under what conditions a claim would be considered pre-existing. Although there are many versions of pre-existing condition provisions, the most common is the 3/12 provision.
The 3/12 pre-existing condition provision states that claims filed within 12 months of the Effective Date of Coverage (EDOC), will have a three-month look-back to determine if the claimant took prescribed medications, or was treated for the same claimed medical condition(s). Claimants treated for the same medical condition during the 3 month look-back are not eligible for benefits.
Claimants date of hire: August 1, 2014
Effective Date of LTD Plan: October 1, 2014
Date of Disability: December 1, 2014.
Claimant’s date of disability is within 12 months of the Effective Date of Coverage, therefore, the three-month look-back period is May, June and July 2014, If the insured was treated for the claimed disability, and/or took prescribed medications for the same disability, the claim is determined to be pre-existing and will not be paid.
In order to be eligible for benefits under the employer’s Plan claimants must remain at work at least 12 months from the Effective Date of Coverage. Knowing this in advance, claimants could remain at work as long as possible in order to receive benefits under the Plan. Pre-existing condition denials are very difficult to contest since claimants are either treated during the look-back period or they are not. Unlike other claims decisions, pre-existing conditions are not a matter of opinion, but a matter of mathematics in calculating the look-back period.
A true case in point: A single mother of three was newly hired in August 2014 and immediately became effective (covered) under her employer’s group Plans. Due to severe depression and anxiety her doctor recommended she go out on disability in October. Ms. S. has a prior history of depression and anxiety and will not be paid benefits under her employer’s LTD Plan because she was treated and took medications during the three-month look-back.
Her options are: 1) return to work with her employer and wait until after August 2015 to file a claim assuming she is still having difficulty; 2) Ms. S. is not eligible for FMLA because she has not worked for her employer for 12 months or 1,250 hours; therefore her employer can terminate employment if she does not return to work; 3) After employment termination, Ms. S. can file for unemployment, but may not receive it if the employer challenges the claim; 4) File for SSDI and wait to see if SSA approves her claim.
I think we can all admit that Ms. S. is in a terrible situation with limited options. Pre-existing condition situations can also become complicated when there are “continuity of coverage” provisions in the group Plans.
Nevertheless, many pre-existing condition denials need not happen if claimants obtained copies of their Plan and knew in advance what to expect.