Breast Cancer and Long-term Disability Claims

As many of you may know, October is Breast Cancer Awareness Month.

This blog post will discuss:

• What is breast cancer
• The impact of breast cancer
• What some treatment complications and side effects are
• Why a long-term disability claim might be denied for breast cancer
• What to do if your disability claim has been denied

What is breast cancer?

There are different types of breast cancer. Ductal carcinoma is when breast cancer starts in the cells that line the ducts and lobular carcinoma which starts in the cells of lobules. Both these types of cancer can be  either "in situ" which means they do not metastasize or they can be invasive. Less common types of breast cancer include inflammatory breast cancer, Paget disease and triple negative breast cancer.

The impact of breast cancer

The Statistics

• Breast cancer affects 1 in 8 Canadian women
• Men can also be diagnosed with breast cancer
• The most recent statistics from 2022 estimate that 28,600 women and 270 men in Canada will receive a breast cancer diagnosis and almost 5,500 women and 55 men will die from this form of cancer
• Breast cancer is the second leading cause of cancer deaths in Canadian women and it is expected to remain one of the four most diagnosed types of cancer

The Canadian Breast Cancer Foundation also tells us that...

• 1 in 4 cancers diagnosed in Canadian women are breast cancer
• Women aged 50 to 69 years of age are the age group most at risk for the development of breast cancer (51% of breast cancer diagnoses)
• 17% of breast cancer diagnoses will be in women under the age of 50, with 13% occurring in women aged 40 to 49
• The 5-year survival rate for breast cancer in Canada is 89%
• Since 1987, breast cancer mortality rates have decreased by 44%

Treatment side effects/complications

Complications from cancer treatments unfortunately do occur, and your insurance company may not understand the extent of your limitations resulting from post-cancer difficulties. Sometimes, after undergoing chemotherapy and radiation therapy, cancer patients develop chemotherapy induced neuropathic pain, lymphedema, fibromyalgia and psychological conditions such as anxiety and depression.

Side effects and complications from breast cancer treatment, can include...

• Lymphedema (swelling/discomfort in the arm that has persisted more than 6-12 weeks after surgery)
• Edema (swelling), particularly near the breast area
• Numbness, tenderness or skin sensitivity as a result of surgery or radiation
• Fibrosis (thickening/scarring of connective tissue)
• Pain and aching (also referred to as myalgias), that can start after surgery, chemotherapy or hormone therapy
• Bone loss which increases the risk for osteoporosis and risk of fractures
• Increased risk for heart problems as a result of radiation therapy, chemotherapy and targeted therapies
• Ongoing fatigue, from both the physical and emotional effects of treatment
• “Brain fog”- essentially mental fatigue, where you experience difficulties focusing, concentrating, forgetfulness because of treatment and stress
• Sleep disturbances/insomnia related to stress or as a side effect of treatment

Breast cancer and long-term disability claims: Why would my claim be denied?

When someone makes a claim for long-term disability benefits as a result of a breast cancer diagnosis, the length of disability might extend beyond the duration of treatment.

You may have received benefits for the period you are receiving chemotherapy and radiation and recovering from surgeries but denied further benefits past that period.

Reasons why your insurance company may terminate your claim after treatment has finished could include:

• Your own occupation is sedentary, and you should have the ability to work in a sedentary position
• You appear to have the ability to work in an alternative sedentary occupation (if your own occupation was a physical labour job)
• You completed a rehabilitation program organized by your insurance company to prepare you for a return to work, therefore you should have the ability to work
• You participated in a functional capacity evaluation which demonstrated your ability to work or did not reveal limitations or restrictions preventing you from returning to some form of work
• No objective medical evidence is found in your doctors’ records or on testing
• You have not had a recurrence of cancer and your symptoms are subjective (in the opinion of the insurance company)
• Your cancer is in remission and you have a good prognosis (i.e. it has not metastasized)
• No medical limitations or restrictions have been identified by the insurance company's medical consultant
  

What can I do if my claim is denied?

You might receive a denial letter telling you that your insurance company feels there is a lack of medical evidence to account for your inability work.

But what happens when your oncologist tells you that you are in remission though you feel you are not able to return to work due to your ongoing pain, fatigue or other complications?

The reality may be that your treating physician(s) have advised you to remain off work and agree that you are unable to work.

You may be on the road to remission, but you could be struggling with pain, anxiety, depression and be on various medications to help you cope with your symptoms. Your medications (i.e. hormone replacement therapy) could be causing severe side effects. You may not have findings on diagnostic imaging but that does not mean you do not have symptoms that affect your day to day functioning.

It is important to demonstrate to your insurance company that you do have limitations and restrictions because of pain, anxiety, depression, brain fog, fibromyalgia or other symptoms you may be experiencing.

By continuing to see your treating physicians and reporting your symptoms, you will have documented how your symptoms affect your day to day activities and your ability to work. Showing that you consistently attend doctor’s appointments, participate in prescribed treatment and take medications as directed is also important as you need to demonstrate that you are actively seeking treatment and are under the care of a physician.

if your claim has been denied for any reason, do not hesitate to seek the advice of a disability lawyer. An experienced lawyer can help you to understand why your claim was denied and what your legal options are and advise you of any limitation periods. It is always important to know your rights as an insured person.