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When is cancer considered a long-term disability?

On Behalf of | Dec 12, 2022 | Erisa

Cancer is one of the most common health conditions and a leading cause of death in the United States. However, if you are diagnosed with cancer, a long-term disability (LTD) claim will depend on the terms outlined in your employer’s policy and the severity of your illness. Many plans offer benefits to employees with cancer, but insurance companies routinely deny claims.

Claims based on the stages of cancer

Receiving a cancer diagnosis is frightening, even if it’s detected early. Doctors typically classify the degree that cancer has spread through the body into “stages:”

  • Stage 1 cancers are generally located in a confined body area and are often removed surgically.
  • Stage 2 cancers are typically still growing but are confined to a relatively small area or have spread to lymph nodes nearby.
  • Stage 3 cancers usually spread to lymph nodes located further away.
  • Stage 4 cancers can be terminal, but many may still be treatable. Here, cancer has generally spread beyond localized lymph nodes to distant parts of the body.

LTD approvals for Stage 1 are rare. Some policies offer benefits for Stage 2 or 3 cancers when severe symptoms prohibit someone from doing their job. Individuals are more likely to have a successful disability claim for a Stage 4 diagnosis, but denials still occur.

Can I make a claim based on treatment side effects?

Everyone’s cancer diagnosis and treatment are unique. So is the ability to handle treatment. Radiation and chemotherapy can be debilitating, leaving people unable to work. But in many cases, the side effects may last for only a few weeks or months.

But these treatments can also result in long-lasting conditions, called “late effects,” which are the basis for many long-term disability claims. Some cancer treatments can lead to heart problems, excessive fatigue, breathing problems, nerve damage and other conditions.

Comprehensive medical information is crucial

Under the federal Employment Retirement Income Security Act of 1974 (ERISA), your employer must provide a free copy of their LTD plan. Once it’s determined that it classifies your cancer diagnosis as a disability, it’s vital to submit all medical evidence related to your condition. It’s advisable to work with a lawyer specializing in ERISA law during this process, ideally before submitting your claim.

Experienced attorneys know what information needs to be included, as well as the tactics insurance companies use to deny claims. Receiving a cancer diagnosis is devastating, especially if you cannot work and draw a paycheck. Having a knowledgeable ERISA lawyer help with this complicated process can bring peace of mind.