Maternity Leave And Disability Insurance Benefits

Pregnancy itself is a wonderful and miraculous thing, and should never be considered a disability, but that doesn’t mean that there aren’t certain complications that can’t arise during the process. There are plenty of real-world scenarios where pregnancies have led to the mother ending up permanently disabled or out of work for a long period. There are also plenty of scenarios or complications that have arisen from the pregnancy itself. Just say you and the hubby are looking to start a family. You get pregnant, but during that pregnancy discover that something is wrong. Something that prevents you from going back to work. How do you balance all this new information with your insurance provider and employer? Does this mean that you’ll still be covered? All excellent questions! Expecting mothers from around the world find themselves asking these very questions and similar ones every day.

Unfortunately, it doesn’t matter if it was the pregnancy or the disability that came first, your biggest concern like most mothers is whether or not the insurance company is going to want to pay for our maternity leave or disability. Throw into the mix that most insurance companies have the mindset that if you can care for a newborn child then you should be more than well enough to be back at work full-time or at the very least, part-time.

Whatever situation you are currently facing or fear that you might be facing in the future, the prospects can look bleak, grim, and scary. If you are going to be the sole provider for this new life it is only going to add to your worries and concerns. This is why it is imperative to understand everything you can about some of the most common cares and concerns in the industry. That’s exactly what you are going to learn from this guide.

 

How Are Maternity Leave And Sick Leave Different?

Before you delve deep into the world of common concerns surrounding pregnancy and the workplace, you need to completely understand the differences between maternity leave and sick leave. You’ve likely heard of both from your employer. You might have even been offered both when your illness came about. The most important thing to know is that both of these leaves are excused absences from the workplace. However, the reasoning behind the absences will vary.

For instance, sick leave means that you need to be absent from work due to an illness or disability. Either one renders you unable to perform your daily duties in the office or the field. Additionally, while you are under sick leave, you might be able to apply for and obtain various disability insurance benefits. For instance, when on sick leave, you might be able to apply for and obtain short-term disability, long-term disability, or EI sickness from the government.

Maternity leave, on the other hand, is something else entirely. As the names suggest, it is an excused absence from work that allows you to care for and raise your newborn child during those first crucial months after giving birth. It also gives you the time that you need to recover from the process, although most women could physically and mentally go back to work the very next day after giving birth. This is not to say that this is an ideal scenario or something that should be suggested. It is just to say that it is entirely possible, but should never be expected, even if you have already arranged alternative care. Both you and your child need time to properly recover from this wondrous experience.

Just keep in mind that there might also be further distinctions between the two. This really could come down to the employer, your location, and the insurance provider. Nonetheless, pregnancy leave is considered the time before the baby is born, while maternity or parental leave is considered the time after the baby is born. Take Ontario, for example. In this area, it is required by law for the employer to gift the mother a maximum of 17 weeks of unpaid time off work before the baby is born. And, this is not to even mention the 63 weeks that you are gifted for maternity leave after the baby is born. This is a total of 80 weeks paid leave.

 

What If One Gets Pregnant On Sick Leave Due To Disability?

It is entirely possible to already be on sick leave from your employer and get pregnant. Just because you are on sick leave doesn’t mean that you can’t be sexually active. There is no law against it, and this is a more common scenario than one might imagine. In fact, it is so common that a lot of insurance providers have become worried that the parent will try to extend the sick leave to stay at home and care for the child, rather than return to work when the disability ends. It is understandable that they would be concerned, as they likely do not want to become a substitute parental leave payment plan. The mother should make the move from sick leave to parental leave. Regardless, this is how the mother should approach a situation like this.

First, she’ll want to visit a doctor to not only have the pregnancy confirmed, but to determine exactly how the pregnancy is going to affect the current medical condition. Will it exacerbate it? Could it actually help the medical condition? Whatever the potential outcome is, the mother should specifically mention this to the care provider that is currently on sick leave. And, the sick leave is by no means related to the pregnancy. Therefore, the disability claims in this situation are independent of that of the pregnancy. If the mother can get a letter written by the doctor with his agreeing medical opinion, she’ll be well on her way to getting the entire situation cleared up.

Once the mother has the letter in her possession, she’ll want to inform the insurance provider, whether it be EI or an independent insurance company. She’ll want to let them know of the current status of the pregnancy and how it might affect the disability. In these situations, if you are already receiving EI sickness benefits, you might be able to get them switched over to EI maternity benefits. If the mother in this scenario is receiving short-term disability benefits then it is possible that the provider will have to extend the benefits and continue paying out. If this is the case then the provider will likely require constant updates the entire time they are paying out benefits, which is to be expected.

It is more than likely that there are already going to be rules established in your existing plan covering taking maternity leave while on a disability claim. It is even entirely possible that the insurance company will try to force you to apply for federal maternity benefits. They’ll do this because it will legally allow them to reduce their payments to you by the amount that you will likely receive from the other source. Another thing you’ll want to keep in mind is that you are going to be highly scrutinized if your sick leave extends beyond the birth of your child. The providers will want to know how you are able to care for a newborn but can’t return to work. 

 

What If One Becomes Disabled While On Maternity Leave?

Here is another highly potential situation. You’re on maternity or parent leave with all intentions of returning back to work as soon as you can, but you learn that you just developed a medical condition that now renders you disabled. Disabled to the point where you can’t return back to work. It is possible that this disability could have risen because of pregnancy or childbirth. It is also possible that the disability was completely independent and had nothing to do with the pregnancy or childbirth. Whatever the situation is, you are likely most concerned with whether or not the provider will cover your disability benefits since this is something that technically happened when you were away from work.

It is completely understandable to be concerned here because if you go back over your long-term requirements, you’ll see that they clearly state that you must be actively working and become disabled in order to receive benefits. Luckily, you’ll be pleased to know that most disability plans have been altered or written to offer continuance of long-term disability coverage for individuals that are on approved maternity or parental leave.

However, there is one major problem in this scenario. That problem is that insurance providers won’t want to become a parental leave plan, simply meaning they won’t want to pay out benefits, and this is why it will be more than crucial for you to approach the situation by legally proving that you are unable to work. Insurance companies oftentimes make the assumption that the disability ends once the pregnancy is over.

This is possible sometimes, but not always the case. There are even instances where the medical condition extends after the pregnancy or new ones arise. Take postpartum depression, for example. It is only natural for Canadian mothers that find themselves in this situation to be concerned, given that the provider has already tried to whisk away the benefits once before. So, what is one to do? Do they inform Service Canada and their employer? Do they make an insurance claim and immediately switch from EI maternity to sick leave? The thing you’ll have to do is consult your physician. You’ll want him to look at the disability and determine whether or not it is related to the pregnancy.

If it is, in fact, the pregnancy that caused the condition, the doctor will have to clearly diagnose and explain why such a complication is keeping you from returning to work. Is it something that will end when the child is born? Will it possibly continue past birth, get worse, or cause new conditions to arise? These are all things that your doctor will have to determine and explain. However, just because your doctor has clearly described your condition it doesn’t necessarily mean that the exhaustive work is done.

Nope, now it will be your responsibility to learn, follow, and adhere to the disability rules set forth by your provider. These are rules and regulations that can most oftentimes be found in employee handbooks or manuals. While perusing through the handbook, you’ll likely come across a clause stating that disability cannot be paid out for “pregnancy.” In this scenario, the term “pregnancy” could mean anything from miscarriage to childbirth, or abortion. What this simply means is that these things would all be considered complications of pregnancy, but also part of the pregnancy itself. That means if disabilities do arise because of these conditions, they wouldn’t be covered under certain policies. Once again, all of this will be determined by the specific policy that you are currently covered under. Be sure to check yours and see how they deal with these situations.

 

Is It Possible To Collect EI Sickness And EI Maternity Benefits Simultaneously?

It is always more than important to collect what is owed to you when it is owed to you. However, to do so, one must know exactly what is owed to them. That being said, there are also situations when you shouldn’t wait to receive benefits one after another. Instead, you should apply for both of them as soon as you are aware of the fact that you apply for both of them. The thing that you need to know is that EI offers both regular and special benefits. Sickness, maternity, and parental benefits will all fall under the special classification.

This means that anyone that applies is capable of receiving both EI sickness and another special benefit at the same time. This could potentially include maternity and parental leave. The typical laws state that you can only receive 50 weeks of benefit in a 52-week benefit period. However, if you combine both sickness and maternity, it increases the coverage to 102 weeks. Just be sure to be as prepared as possible for any possible situation. You can do this by reviewing pertinent documentation revolving around the applications for each benefit that you are applying independently. Simply put, know what’s required of you so you can immediately start applying for benefits. The sooner you apply, the faster you’ll receive coverage.

 

Can You Get Fired While Maternity Or Sick Leave?

If you work under a union, you might not have to worry about this section because most unionized workplaces will offer basic protections against being fired while on maternity or sick leave. Some unionized workplaces will even go further above and beyond to protect employees. Of course, this is only something that you’ll know and discover if you consult your union rep. This is likely something that you’ll want to do immediately if you fear that you might be fired while on maternity or sick leave. All that being said, if you do not have the backing of a unionized workplace things might play out a bit differently for you.

Whatever the situation is, all employees need to be aware of the fact that they have protections under the human rights act and employment standards laws of their province. These are oftentimes referred to as Employment Standards Acts. Employment Standards Acts usually clearly outline the rules for all types of approved leaves. They’ll determine who has the right to take maternity and sick leave, how long the leave can be for, and if the individual is granted a reinstatement at their current position upon returning to work.

Just take the Ontario Employment Standards Act, for example. Section 53 of this act states: Upon the conclusion of an employee’s leave under this Part, the employer shall reinstate the employee to the position the employee most recently held with the employer, if it still exists, or to a comparable position if it does not.

What this basically means is that in Ontario it is illegal for any employer to terminate an employee just because they took maternity or sick leave. However, this does not mean that they cannot terminate the employee if the position goes away while they are on leave. If there are also other legitimate reasons for the firing that are unrelated to the maternity or sick leave then they can go ahead and fire the employee. It really comes down to a matter of if the termination is a direct result of the leave. If the termination is a direct result of the leave then the employer is in the right.

Unfortunately, you’d be surprised to learn just how many Canadian employers uncover issues with a person’s employment while they are on leave. This is usually because there is someone new doing the job. And, these new individuals sometimes reveal holes and gaps that weren’t as noticeable when the original individual was in the position. The new employee might be more organized or more efficient. They might even be the one that discovers the mistake made by the previous employee of the position.

 

How Is Insurance Costs Covered When On Leave?

When people go on maternity or sick leave they often have so much on their minds that they forget about keeping up with their insurance coverage. Of course, this wasn’t a problem when you were employed and receiving a paycheck. Everything came directly out of the check and was likely already cut out. Unfortunately, that might not be the case now and could majorly complicate things. At the end of the day, it really comes down to the specific insurance provider and employer. Some employers will go ahead and cover the entirety of your insurance costs while you are on leave, while others might force you to pay a portion to keep the plans in place.

If you aren’t aware of this and don’t plan for it in your budget while you are off it can cause major complications. When this happens, people usually don’t even know what’s going on until they discover that they are no longer going to receive benefits because their plans aren’t being paid. It really comes down to a matter of not being prepared and not knowing who to ask. This is something that you’ll want to avoid at all costs. If you are on maternity leave or sick leave, you’ll likely have enough on your plate. The last thing you want to have to worry about is whether or not you’re going to be provided adequate coverage. Speak with the Human Resources Department ahead of time to figure out how your employer handles these situations.

You’ll also want to look into any retirement and pension plans as well. If you are going to be out for months at a time, you do not want to miss out on months of payments. This might not sound like a lot, but it really could add up in the end.

 

Avoid Setting Off Red Flags

When you look at it from the insurance provider’s point of view, it really is easy to see how it might look like someone is abusing the system. They are off work all this time receiving benefits while taking care of their child. Now, all of a sudden they develop this disability that prevents them from returning back to work, yet they still get to continue receiving a paycheck and additional benefits. Overlapping disability and pregnancy alone can seem suspicious enough if the medical documentation is lacking. Whatever the situation is, this is something that you’ll want to try to avoid at all costs.

You don’t want to raise any potential red flags and run the risk of losing your benefits. One of the best ways to do this is by remaining in constant contact with your physician. Have them be as clear as possible and document everything about the type of treatment that you are receiving and the medical conditions that you are being treated for. It just won’t be enough for the provider to send a simple form saying that you are pregnant.

No, they need to be specific about how pregnancy might bring about specific disabilities. How the pregnancy did bring about specific disabilities and why it caused these to arise. They need to be able to show how such conditions limit your ability to do your job and live your everyday life. However, above all else, the most difficult thing will be trying to prove how you are able to care for your child without being able to return to work.

 

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