Why Was My Maternity Benefit Claim for Miscarriage Denied?
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Miscarriage in July 2024 → Semester is April to September 2024.
SSS will check April 2023 to March 2024 for contributions. If you only have 2 contributions, claim will be denied.
How to solve:
If miscarriage has not happened yet, make sure you’re actively paying contributions.
If it already happened and you lacked contributions, you can’t retroactively fix it—focus on meeting requirements for future claims.
2. Late or No Maternity Notification to SSS
For employed members: Employer must notify SSS immediately after knowing about the pregnancy.
For self-employed/voluntary members: You must submit the maternity benefitⓘ. This step is required before childbirth, ?" title="Maternity Notification is the official process of informing SSS about a member's pregnancy in order to qualify for the maternity benefit. This step is required before childbirth, ?">maternity notificationⓘ yourself before the miscarriage or childbirth.
Possible cause:
Member only submitted documents during claim filingⓘ, not before.
How to solve:
Always file your maternity notification as soon as you confirm pregnancy, even if you later miscarry.
If missed, unfortunately SSS will not process the claim.
3. Lack of Medical Proof of Miscarriage
SSS requires specific documents such as:
confinement periodⓘ, and the member’s inability to work. For sickness benefits, thi?" title="A medical certificate is a formal document issued by a licensed physician stating the diagnosis, confinement period, and the member’s inability to work. For sickness benefits, thi?">Medical certificateⓘ from attending physician
Hospital or clinic records
Histopathology report (if applicable)
Possible cause:
Missing or incomplete medical documentsⓘ, or reports not signed by a licensed doctor.
How to solve:
Ask your doctor or hospital to issue a complete and signed report.
Ensure all medical records clearly indicate that it was a miscarriage and the date it occurred.
4. Miscarriage Not Covered Under SSS Rules
Illegal abortions and self-induced miscarriages are not covered.
SSS also doesn’t cover procedures without valid medical justification.
Possible cause:
Miscarriage happened in circumstances that are not legally or medically recognized.
How to solve:
If it falls under excluded cases, no remedy is possible. Focus on preparing for eligibility in future pregnancies.
5. Already Claimed Maternity Benefit in the Same Year
Only one maternity benefit per calendar year is allowed, whether for childbirth or miscarriage.
Example:
Claimed miscarriage in February → Cannot claim childbirth in August of the same year.
How to solve:
If the claim for the first event has not been processed yet, you may request to withdraw and claim for the second event instead.
What To Do If Your Claim Was Denied
Read the SSS Denial Letter Carefully
It will state the exact reason for denial.
Check If It’s Correctable
Missing documents? Submit them.
Employer forgot to notify? Ask for a late notification with justification (though approval is not guaranteed).
If It’s Not Fixable
Accept that some denials are final due to legal limits.
Focus on completing requirements for the next claim.
SSS denies miscarriage claims mostly due to lack of contributions, late notification, incomplete documents, non-covered cases, or double claiming in the same year.
Some issues can be fixed by submitting missing requirements; others are final and unappealable.
Always file maternity notification early, pay contributions regularly, and keep all medical proof.
FAQs
1. Can I appeal my denied miscarriage claim? Yes, but only if you can provide missing documents or correct errors. If the reason is legal limitation (like one claim per year), appeal won’t work.
2. How soon should I file my maternity notification? As soon as you confirm pregnancy—don’t wait until later.
3. Does SSS cover miscarriages at any pregnancy stage? Yes, as long as it is medically documented and within coverage rules.
4. Can I pay contributions after miscarriage to qualify? No, contributions must be made before the semester of contingencyⓘ.
5. If my employer forgot to notify SSS, can I still claim? You can try submitting a late notification with an explanation, but approval is not guaranteed.
