Denying Short Term disability

[BluRose]

What is the name of your state? Texas

My daughter is currently pregnant and due in the next few weeks. Her doctor placed her on bed rest for the remainder of her pregnancy. She went to file for her short term disability that she pays for and the company told her she wasn't eligible as she had an emergency room visit for the pregnancy the day before she became eligible for benefits. So its a pre-existing condition. The problem is she has documentation from when she was hired in May that stated she was eligible for short term 30 days after hiring. So that would have made her eligible in early June. She has a screen shot of her employment portal showing the original eligibility date in June. While she was on the phone with the HR people the date literally changed to August 1st. Now her HR department, their benefits company, and her boss are all dodging her calls. Should she contact an atty first or start with the workforce commission? Thanks in advance!

 

[cbg]

While the ACA eliminated pre-existing for health insurance plans, it did not do so for disability plans. An STD plan may still legally impose a pre-ex clause.

You're confusing being eligible to enroll in a plan with having any condition covered unconditionally, and there is a difference . Being eligible for a plan does not mean the plan is required to pay for everything. Excluding a specific condition is not the same as saying she is not eligible for the plan.

If she had come down with pneumonia or broken her leg, that would not have been considered a pre-ex condition and it would have been covered. She WAS and IS eligible for coverage - just not for a pre-existing condition.

 

[PayrollHRGuy]

While she was on the phone with the HR people the date literally changed to August 1st.

This is not good but it isn't going to help her get STD.

 

[BluRose]

Thank you for your responses. She began paying for the short term disability when she hired on in early May so with the documentation she has stating benefits kick in 30 days after employment, how do they now get to claim it's a preexisting condition? Thanks again for the information. It is helpful.

 

[cbg]

Because the benefit is not solely for pregnancy.

 

[LdiJ]

Thank you for your responses. She began paying for the short term disability when she hired on in early May so with the documentation she has stating benefits kick in 30 days after employment, how do they now get to claim it's a preexisting condition? Thanks again for the information. It is helpful.

When, exactly, did she get pregnant?

 

[PayrollHRGuy]

When, exactly, did she get pregnant?

It isn't the pregnancy itself that is the disability. It is the complication that is the disability and it started before she was covered by the STD.

 

[LdiJ]

It isn't the pregnancy itself that is the disability. It is the complication that is the disability and it started before she was covered by the STD.

How do you know that it started before she was covered? The pregnancy caused the disability and the OP hasn't said when the pregnancy started. We can assume that it was before the date she was eligible, but we don't actually know. There is also some question as to when her eligibility started.

 

[cbg]

Actually we do know.

as she had an emergency room visit for the pregnancy the day before she became eligible for benefits.

 

[PayrollHRGuy]

How do you know that it started before she was covered? The pregnancy caused the disability and the OP hasn't said when the pregnancy started. We can assume that it was before the date she was eligible, but we don't actually know. There is also some question as to when her eligibility started.

Reading is fundamental.

My daughter is currently pregnant and due in the next few weeks.

she had an emergency room visit for the pregnancy the day before she became eligible for benefits.

 

[Zigner]

Reading is fundamental.

I agree - in fact, I just read cbg's post from 3:30 yesterday that said the same thing.

(Pot/kettle. Glass houses/stones. Etc.)

 

[PayrollHRGuy]

I agree - in fact, I just read cbg's post from 3:30 yesterday that said the same thing.

(Pot/kettle. Glass houses/stones. Etc.)

I saw her post. I was showing LdiJ how we "Actually do know."

As well as responding to a post that quoted me.

 

[LdiJ]

Actually we do know.

Yes but there seems to be some dispute about when she became eligible.

 

[cbg]

Only if you don't understand how disability insurance works. You can be eligible for the policy (which apparently she is) without being eligible for a specific condition (which is apparently the case.)

You do remember that I do this for a living, right?

 

[LdiJ]

Only if you don't understand how disability insurance works. You can be eligible for the policy (which apparently she is) without being eligible for a specific condition (which is apparently the case.)

You do remember that I do this for a living, right?

Yes, of course I do.