Pregnancy Short Term Disability Denied What to Do?

Well, short term disability is common to use for maternity leave in smaller companies that do not offer actual maternity leave. So I get that, but if you've got 30 weeks of pregnancy left and you can't do your job, I'm not sure they are required to keep you on. I would also think that would be Long Term Disability, in which the requirements are stricter.

If your doctor's think you can't perform the work, then maybe see if the doctor's office can work with Cigna to see what can be done. Otherwise, I'm honestly not too sure. The good news is that you can go find another job that would allow you to sit at a computer or answer phones or something, thus not lifting anything at all.

This question really doesn't give anyone enough information. This sounds like a precautionary restriction since it was given to you well before ten weeks. I can think of a fair few issues that could cause you to have restrictions that early but you just don't say.

The thing is anyone can nag their OB into giving restrictions, Cigna only has to respect those that are medically necessary. If yours is not medically necessary there is no appeal process, you need to start looking for a desk job.

I hate to be an alarmist but you also need to realize that six months is well beyond the limits of FMLA which means they do not have to hold your job either.

My advice is look for another job because this one is going to be gone and I doubt your appeal will be successful. Perhaps if you give us more information we can be more helpful.
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To respond to Kay's it might be legal, it is legal. FMLA is the law that governs family leave. An employer is only required to hold a job for 3 months. After that an employer can hold your job but is not required by law. That three month leave, on a Federal level, is unpaid.

It isn't that you can't work, it's only that you can't lift more than 25 pounds. Your employer doesn't want the liability in the event of you having a pregnancy injury such as having a miscarriage or premature delivery where your health is compromised or the health of the baby is compromised [based on what your doctor wrote and/or based on company police].

They only have to provide you with a job that's equal in pay and status to the one you currently have if such a position exists and is in need of being filled. They are NOT required to create such a position. They are NOT required to simply remove some of your job requirements for your current job, meaning if your doctor has restricted you from lifting more than 25 lbs, then you're unable to do your entire job.

That does NOT mean you are disabled. Pregnancy is not a disability, and that's why Cigna denied a short term disability claim. You CAN work, you just can't work a job where you lift more than 25 lbs. And frankly they did the right thing in denying that claim. You're not going to win an appeal.

If you're used to lifting and doing all of your job requirements daily then I'm actually very surprised that all of a sudden your doctor would put you on a restriction like that unless you have an actual problem and have a high risk pregnancy. You really need to talk to your doctor and have them talk with the doctors at Cigna, and work things out with your employer. If that's not possible or you're unwilling, then it's time to find a new employer.

EDIT: When I had my first pregnancy I worked as a store manager for San Francisco Music Box Co. It required heavy lifting which I couldn't do, but I had help in that area. The main requirement was climbing ladders that reached the ceiling in order to put stock shipments away, rearrange stock shipments, and to obtain stock for customer purchases. The ladders were old and rickety with wheels on them. Per company policy I was not allowed on those ladders while pregnant. Therefore, I had to find another job. Climbing those ladders was part of the job no matter what the position was. I had no disability claim to make. Oh well. You're in the exact same position.

Your job cannot go against a Doctor's restriction. However, if your job really does require you to lift 40-50 lbs and that is stated in your formal job description, I am not sure that they have an obligation to provide you with work that meets your accomodations. It sounds like you have already applied for STD and been denied.

I do not know what your actual job is and in what industry so I cannot give insight there. While I understand that you did not ask to be put out of work, you DID come back to your employer and tell them that you can no longer perform the requirements of your job. Depending on what kind of job this is, they may not have any light duty work for you to do.

I think that you need to call the New Jersey State Labor Board to find out if your job could do that. They have to have some sort of jobs that would not require lifting, answering phones, doing paper work, sweeping up or cleaning, something to keep you working.

As for the claim on the insurance...I can't imagine that you could get any sort of disability for being pregnant since it's a choice...not saying you are to blame or anything like that, just that pregnancy is a normal thing and not a disability.

The labor board can tell you what the law says about this.

As a last resort their are state programs that can offer some assistance, I know they won't be near enough though. But at least you wouldn't be going hungry if you got food stamps to help with the grocery bills.

ETA

I agree that perhaps finding another job would be a good thing to consider. I can say that I know of several people who have been pregnant and left for maternity leave when they had the baby. When they called after their 6 weeks off some didn't have a job to go back to because they had to hire someone to take their place and they were doing a good job so they couldn't just fire them too.

One came back, had the infant in a child care setting but when she went to check the schedule for the next week's work she was on the night shift, 11pm-7am. She told them she had to work her regular days due to child care and none took babies during those nighttime hours. They said take it or leave it. They did not have to return her to the same job, shift, or anything. She chose to get pregnant and leave work. She tried to find child care and could not so she had to quit. Since "she" quit she could not draw any benefits due to being out of work.

Another friend got off to have her baby and they told her she could have her job back when she was ready. It was a call center open 24 hours per day. When she came back to check the schedule they too had put her on an evening schedule from 6pm-2am. No child care for her either.

So even if they worked with you the job you'd be coming back to might not be the one you left or even the shift you need or anything.

Finding another job that would be temporary until you deliver might be something that would work for the interim until you can seek full time employment.

When I was pregnant with my first I did a pretty heavy duty job myself that required a lot of lifting of huge glove boxes etc (like 50lbs). I just asked someone to help me during my pregnancy. Now I had to do a ton of driving, sitting, standing, walking etc, that part I had to do bc that was the job. But the lifting, they knew immediately I would not be doing. Can they assign you a helper? I would just go tell them that the claim was denied and ask what can be worked out so you can do the best job possible. At 7 months, I was assigned a person with me full time until I delivered, she was the person I was training to take my spot while I was out on maternity leave, I just never went back ;) I think they can work with you bc pregnancy is a short term situation and everyone knows some accommodation must be made on a very physical job. I would just talk it through with my boss and go from there and assure them that other than the lifting you are ready and able to work :) Wish you the best!

I would dispute the denial with Cigna. What is their reasoning? Contact Cigna and follow their disputing process. I think their issue may be the the doctor didn't say you couldn't work but your employer did.

Another thought would be since your doctor didn't take you out and your work is taking you out, can you apply for unemployment (on the premise that they are temporarily laying you off)?

Your HR department may be able to help you.

I can tell you that pregnancy has to be treated like any other medical condition/short term disability. They are only obligated to provide light duty for work-related injuries. For instance, if someone broke their arm or leg (in a non-work related injury) and couldn't perform their duties, were accommodations made for them to keep working (modified duty or alternative assignment)? If so, they have to do the same for pregnancies. If the answer is no, they are not obligated to do so for pregnancies (although some may).

Good luck.

ETA - I just read your SWH - if you had applied for Short Term Disability with our company, your claim would have been denied as well. Your doctor did not take you off work. He put restrictions on you. Thus you are not eligible for short term disability because you are not disabled. As for the restrictions with the company, I would have done the same thing - I can't accommodate those restrictions especially since it is not a work related injury. You are in a tough spot. Your doctor can include all of that but he has NOT taken you off work, thus not disabled. Until your doctor says "you are disabled and unable to work, your claim will be denied.
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FMLA is the federal governing act that covers this type of thing. Under FMLA if you have worked one year or 1250 hours, you are entitled to 12 weeks of unpaid leave (except in California). FMLA holds you job whil you are on leave. However, if you go over the 12 weeks, your job does not have to be held per FMLA.

In addition, your job does NOT have to make the accommodation if it is an undue burden to the company. For example, you are lifiting and that IS your job then having someone else doing that is someone doing your job. We do not accommodate for non-work related restrictions. I'm not going to buy that claim should something happen while the employee is on the job. We do make accommodations for workers compensation injuries because I have already bought the claim.

I would contact Cigna for a reason to the denial of the claim. I think the reason for the denial is that you can work because your doctor didn't take you off work. If that is the case, you are going to be stuck. If after a few weeks your pregnancy is progressing nicely, your doctor might be able to lift the restriction and allow you back to work.

No you are not eligible for unemployment. You are still empl;oyed. They haven't laid you off they just can't work with your lifting restriction.

Here is another wrinkle. If you quit to find another job, will you have insurance? Some companies will have a "waiting period" before you are eligible for benefits. You would need to go on COBRA to pay for the birth of your child. That will be very expensive. So, right now, that might not be an option for you and your family.

I really don't know the medical reason for your restrictions but if you can have them changed to allow more weight, you should be able to go back to work. Good luck.

That's because CIGNA is evil.

Dealt with them when my son was in Children's Hospital... We had to appeal EVERYTHING.

Hundreds of billing codes.

Ugh

3 step process. Weeks for each. Hundreds of thousands in debt when we HAD insurance.

One (goddess) of a CIGNA employee sat me down and explained while its not 'policy' to reject certain claims up front, it was encouraged... Because most people wouldn't resubmit & appeal.

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ALSO sometimes you get a goddess, sometimes you get a goblin. When you're 'working with' someone less than helpful, hang up. Call back. Keep doing so until you get someone with a brain.

I always appeal denied claims at least twice IF it is covererd. If it is not covered, there is no point.

What company and is it in NJ? Do you have a policy manual?
I would contact the state agency and double check.

Also, several say you probally won't have a job when you get back or they will reduce your hours or change your shift. If that happened to others, they got away with it and will do it to you too. Even if we don't think it is right, it might be legally ok.

Hi J.,
I think you need to appeal. Where do you work? Is there a human resources department? They should be able to help you. Can you transfer to another position in the company that doesn't interfere with your restrictions? If you cannot get disability pay, you could ask your company to lay you off so that you can collect unemployment. I'm not sure how long short term disability covers you, this may be the issue - if you need this coverage for 30 weeks, that may not be considered short term. Good luck.

Did they say why they are declining your benefits, you could follow up your claim with a letter from your doctor.