Getting Long-Term Disability Benefits for Cancer

Cancers in early stages aren't likely to qualify for long-term disability insurance benefits.

Long-term disability (LTD) benefits are often available to workers who have been diagnosed with cancer, but not all LTD claims for cancer will be approved. Whether your claim will be approved depends on the severity of your illness and the specifics of your LTD policy.

While no cure for cancer has yet been developed, modern medicine has been remarkably effective at arresting the spread of certain cancers and limiting or eliminating their worst symptoms. Still, if you suffer from cancer and it prevents you from performing the material duties of your own occupation or any occupation in the economy (depending on how your policy defines disability), you will be eligible for long-term disability benefits.

The Stages of Cancer and Your Chance of Getting Benefits

Doctors often classify cancer into "stages" based on the size of the tumor and to what extent it has spread throughout the body. Stage 1 cancer involves an abnormal growth of cells that is confined to a single part of the body. Depending on the location, stage 1 cancers can sometimes be removed surgically. Successful LTD claims based solely on stage 1 cancer are exceedingly rare.

Cancers at stage 2 are growing but still localized or spread only to nearby lymph nodes. Stage 3 cancers usually have advanced to lymph nodes farther afield. LTD benefits may be available to those with stage 2 or 3 cancer, especially when accompanied by severe symptoms such as pain, weakness, fever, cough, headaches, nausea, and fatigue.

Cancers that metastasize (spread) beyond the regional lymph nodes into distant parts of the body are deemed stage 4. Stage 4 cancers are sometimes receptive to treatment, but more often they involve severe symptoms that easily form the basis for a successful LTD claim.

Disability Benefits Based on Treatment Side Effects

Treatment options for cancer patients vary significantly depending on where the cancer is located and how far it has spread. On one end of the spectrum, cancerous skin lesions can be removed through routine surgery requiring little or no time off from work. On the other end, lung cancer, which is the most deadly form of cancer, typically calls for chemotherapy and radiation. Other cancer treatments include gene therapy, proton therapy, laser treatments, and bone marrow transplants.

Chemotherapy, in particular, tends to cause side effects including nausea, fatigue, pain, compromised immune system, and digestive problems, any of which can prevent you from working. Radiation, which like chemotherapy destroys some healthy cells while targeting those that are cancerous, may be accompanied by persistent fatigue, skin irritation, or other symptoms that can limit work activities.

In many cases, the debilitating side effects of these treatments can give rise to a claim for short-term disability insurance payments, which replace a portion of your income for up to six months. Disability insurers generally approve short-term disability claims at a higher rate than those for long-term benefits.

These treatments can also cause long-lasting residual effects, called "late effects," that could form the basis of a long-term disability claim. Some common examples include heart problems, respiratory issues, nerve damage, muscle weakness, osteoporosis, and fatigue, among many others.

Proving Your Long-Term Disability Case

If you're applying for long-term disability benefits, expect your case to be closely scrutinized, even if your cancer has reached stage 2, 3, or 4. It's essential that your claim file contain all the medical evidence relevant to your disability. ERISA, the federal law governing most LTD plans, allows workers or their attorneys to request a free copy of the claim file from the plan administrator. Once you've obtained a copy of your file, make sure it contains your diagnostic tests (biopsies, bone scans, CT scans, x-rays, MRIs, ultrasounds) as well as the clinic notes from your treating provider and oncologist.

Statements from friends and family members regarding your day-to-day limitations, along with observations from co-workers about on-the-job difficulties, can also strengthen your case. Be sure to "stack the administrative record" with favorable evidence prior to the time your insurance company makes its final decision on your case. ERISA generally prevents claimants from presenting new evidence to a court on appeal if such evidence was not presented to your insurer.

Finally, it's a good idea to hire an attorney who specializes in disability law to handle your long-term disability case. An experienced disability lawyer will not only keep track of deadlines and communicate with the insurance company on your behalf, but he or she will also understand how to present your case in the most persuasive way possible. A lawyer can also work with your physicians to obtain helpful medical opinions and compelling objective evidence demonstrating that you're unable to work. Most disability attorneys provide a free consultation and collect a fee only if you win your case.

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