Hello,

My wife is 30 weeks pregnant right now and has STD insurance (14 day elim.). She did not receive a policy when she signed up, only a brochure (somewhat detailed), a copy of application, and some privacy paperwork. Pregnancy was the main reason she took out the policy as she knew we would be trying in the next couple years and she told the agent this as well. According to her meeting with the agent and also after looking at the brochure, she understood that pregnancy would fall under full (6 mos.) or partial disability (3 mos.) as there was no mention from the agent or the information of any stipulations noting different benefit period lengths for pregnancy. When she recently asked for a claim form, it states that pregnancy ben. period is only 6 weeks AND they subtract the elimination period from that time. I assume this means she will only receive 4 weeks of STD payments. Am I correct and is this an example of misrepresentation by the agent? Do we have cause that they have not provided a policy? (in other words an offer to be agreed upon)

We have paid a decent sum to take this insurance out and are miffed that this may be the case.

Also, does Indiana have the same law that states that an employer can force repayment of ins. premiums if an employee quits within 30 days of returning from leave? If so, if she returns for more than 30 days do they lose the ability to do so?

Thank you so much, sorry for the long message,

Is this STD policy provided by her employer, or an independent one that she took out on her own?

FEDERAL law states that if an employee on FMLA does not return for 30 days, the employer can require the repayment of insurance premiums. That is written right into the FMLA statute. Last I looked, Indiana was still part of the US and therefore subject to that law.

Thanks for the quick response.

The policy is not from her employer(she pays all the premiums), though the employer asked for this agent to come to the work place to offer these and other benefits.

Also cbg, last I looked I wasn't a labor lawyer, nor did I have a copy of FMLA law laying around, nor did I know the 30 days was a part of that law and not a state law. Guess I could do without the sarcasm/condescension, but I do really appreciate your help.

Thank you very much.

Is the STD plan part of AFLAC, by any chance?

Actually it is Colonial Life and Accident Insurance Company. Is there a problem with AFLAC?

No, there's no problem with AFLAC, I've just occasionally had AFLAC reps who I felt were, shall we say, exaggerating.

When your wife applied, did she specify what she was looking for? "I want a plan that will cover x number of weeks". The thing is that with individual plans, it's pretty much up to you to tell the agent what you're looking for.

Taken out of context, I can't tell if you're reading the benefit correctly or not. The fact that you never received a policy may be in your favor, since at least in my state you have a 10-day period when you can review the policy and if it isn't what you want, turn it back in with no penalty.

I would suggest confirming the benefit with the agent and if you're reading it right, ask the IN state insurance commission if there is such a law in your state and if so, what rights you have in this situation.

Thank you for your input. I believe that in my state the same law applies in regards to the ten day look back. I actually work in insurance and have been shocked by how many examples there are of people being misled or exaggerated to.

I figured I was going to end up having to call the agent, but wanted a more learned opinion as to our options in the situation before I did.

I would love to return the policy, but unfortunately we're stuck with what we have and we need whatever we can get.

If you come up with any other info or options, please let me know.

Thanks again, especially for your expediency.

Also, I failed to mention, that the premiums are taken out of her company paycheck, so I don't know if that has any bearing on the company's responsibility. Thanks!

The company has no responsibility to see that the benefit is what your wife and the agent agreed to.

I didn't think so. Thanks.

Ther might be a maximum period that the policy would cover but it would be almost unheard of for any STD policy to cover someone beyond the period of time when they are medically incapacitated. Unless there are some major complications, your wife isn't going to be medically incapacitated for more than 6 weeks. I'm not sure why you would think the waiting period wouldn't apply here as well. Were you actually told there was no waiting period for maternity? Did you read the brochure you were given? Did you request the full policy from the insurer?

Thank you for replying Elle. We have read the brochure (including the fine print) and it gives zero information as to the benefit period, elim. period, benefits of the policy toward pregnancy. It only talks about partial and full disability and the elim. period for these two aspects. No mention of an elimination period for the pregnancy.

Now this is our first pregnancy, and not having dealt with it before we did not know that 6 weeks would be the maximum amount she would be considered disabled, we thought that if FMLA gives 12 weeks and partial disability is 12 they would be the same. Seemed logical. I (being in the insurance bus.) feel that this is where it is the agent's responsibility and job to explain the difference between pregnancy and full/partial disability especially since my wife explained to him that this was the primary purpose behind the policy.

He misled and withheld information vital to the purchase of the product. If we had known there would be only a 4 week benefit, we would have looked at other companies or removed the elim. period.

Thank you.

I'm really not sure why you thought it was the insurance agent who should have explained that the time your wife was off for bonding purposes wouldn't be covered under a policy that is intended to cover medical inabilty to work. What time her employer gives her off has nothing to do with the insurer and they have no knowledge or control over this. You knew there was a waiting period, and I've never seen a policy that did not have one, so it isn't clear why you thought giving birth was exempt from this. I'm sure womewhere out there is a policy that will cover from day 1, but you'd pay through the nose for it. Being in the insurance business I'm sure you realize while you can write a policy that says just about anything, it costs to do so and there are standard features which are just about a given for any type of insurance. A waiting period in a disability policy is one of those. You are also not going to find a policy that will pay benefits while you stay home to bond with the baby. No disability policy at any cost is going to pay someone when they aren't medically disabled.

The insurer would not know her eligibilty for FMLA, nor whether she would take all 12 weeks (not all do) or even longer. Disability benefits are not contingent on employment. Even if she opted not to return, the STD policy should still cover. The two are not related and the insurer would have no idea how long she would be off work as many employer's have non-FMLA leave policies. The only information the insurer would have is medical. They would only know when she was medically unable to work.

I understand all of that. The issue is that when someone takes out a policy to cover something, in this case pregnancy, it is the agent's responsibility to let the client know what the product will cover. If I'm afraid I might die in a plane crash and so take out a life insurance policy to cover myself if this happens, the agent better let me know how the policy covers me if I die in a plane crash. The average lay person does not know 6 weeks is the prescribed disability given for pregnancy, at least we did not know.

Under your arguments, the only job an insurance agent has is knowing how to fill out paperwork, and it's the clients job to know and understand the laws. This is not the case. An agent's job is to inform and do what is best for the client. And while this policy still may be good for us and so he can sleep at night, it is not the best, nor exactly what we wanted and so he failed to do his job in my estimation. I see this happen in my own office and drives me nuts.

In a nutshell, it comes down to the fact that we were unaware that 6 weeks is the prescribed disablility for pregnancy because that's what we wanted and I feel he should have made us aware of that. Because he did not, I have a wife that is upset because she hoped she would be able to take off 10-12 weeks and now this may not be an option. Insurance is supposed to solve problems, not cause anxiety. He failed at his job.

Sorry but the fact that you didn't realize or know that the typical maternity case is 6 weeks is more the fault of your doctor, not the insurance agent. When you buy a disability policy or any kind of insurance, it covers a variety of situations, not just one. She could have been in a car accident or gotten ill or suffered some sort of medical incapacity due to any variety of other reasons so the fact that the insurance agent didn't predict that you would use it for maternity alone and that you would assume it would cover her for as long as her employer was willing or required to give her leave. Unless she asked about this specifically, I'm not seeing anything the agent failed to do.


I understand it is frustrating but it isn't the agent's fault here. It just isn't. Not anymore than your car being vandalized and finding out the auto policy doesn't cover that, or hurting yourself sky diving and finding that the health insurance policy excludes accidents sustained in pursuit of risky behaviors. Agents just can't make sure you understand every possible contingency up front. If your wife has been unfortunate enough to endure a complicated pregnancy or recovery, it would have covered longer than 6 weeks. In that case the agent would have been remiss in telling you it would only cover 4.

In my FIRST post, I said that she told the agent that she was getting this policy FOR PREGNANCY. He failed to mention that the policy covered pregnancy for only 6 weeks (4 with the elim. period) and 8 with a Csection. He dropped the ball, he was remiss in telling us that. In all of your examples the covered person had not asked for the policy for a specific reason (vandalism, sky diving etc.) while in my example given earlier the person did. (dying in a plane accident) Are you an agent that uses this method in your own practice?

You haven't mentioned when you or your wife asked how long the benefit would cover. As Elle indicated (and no, she is not an insurance agent) it is fairly common knowledge that pregnancy is only covered for the time that the woman is MEDICALLY unable to work and not for bonding time. He wasn't to know that you were among the few who didn't know that.

He withheld pertinent information, end of story, whether it's known by 90% of people or not, it needs to be said to everyone that takes a STD for that reason. And I've never said he did it purposely, he just didn't do a good job.

I personally put every policy in my client's hands and go over it with them, I expect the same thing for my wife or any person out there.

Whatever you say.

Not to get involved in an ongoing argument ;) but, your wife would be deemed medically unable to work for whatever length of time her doctor says she would be. GENERALLY that is 6 or 8 weeks depending on type of birth, but if there are complications or other reasons that the doctor deems she is unable to work then disability coverage should still apply. For me, I was off for longer after my second child because he split my pelvis during delivery - believe me I don't recommend this as a way to get additional disability coverage, but understand it is what the doctor certifies.