Cancer and Disability Claims

Disability benefits are meant to provide a source of income during a time of need. Like, for example, when you are unable to work as a result of illness or injury.



Cancer patients may find that their claims for short-term or long-term disability benefits have been denied as a result of treatment being finished. The expectation is that you would have recovered and should be able to perform your job or any occupation.

This guide will cover:

• Complications/side effects of cancer treatments
• Why your STD or LTD claim might be denied
• What to do if your disability claim is denied
  

Complications/side effects of cancer treatments

It is quite common for benefits to be approved during the period of time that a person is undergoing treatment for cancer. This could include the date of surgery and prescribed recovery period, the timeframe for chemotherapy or radiation, and general recovery period for those treatments.

However, the path to recovery is different for everyone. It may take some people longer than others to recover from surgery, chemotherapy and/or radiation treatment. As well, there are many negative side effects as a result of surgery and cancer treatments.

These include:

• weight loss
• fatigue
• cognitive impairment
• depression
• anxiety
• lymphedema
• pain/numbness in the areas of radiation treatment
• digestive issues
• loss of bladder control

Your treatment may be completed and the expected recovery time from surgery may have past, but you may not be ready to return to work. You may have developed pain, fatigue, weakness and psychological symptoms as a result of your experience and your cancer treatment.

Reasons your disability claim might be denied

If your post-treatment symptoms are preventing you from performing your activities of daily living and regular routine, including working, you may need more time for recovery. This means that you may need to remain on long-term disability. However, your insurance company may disagree and may try to encourage you to return to work.

Here are some common reasons for STD and LTD denials for cancer claims:

Lack of supportive or objective medical evidence

Your oncologist may find your cancer to be in remission or find no evidence of metastasis on imaging/testing. Your insurance company can take this as a signal that your condition has stabilized and you should be able to return to work.

Still, many treatments cause long-term side effects and cancer patients might experience difficulties working in their occupation or in any occupation. For example, you may be required to be on hormone replacement therapy that has severe side effects. Or maybe you have developed cognitive difficulties and would therefore find it difficult to work in an office setting. It may also be unsafe to work with machinery/in a safety sensitive job. Also, fatigue may make it difficult to get through many of your essential duties.

You can perform the duties of your own occupation

If your insurer feels there are no proven medically supported restrictions or limitations, they may deny your claim on the basis that you should be able to return to your pre-cancer occupation.

If you worked at a desk job prior to the onset of your illness, the insurance company may not understand that side effects from treatment can impact your ability to perform duties that are done while seated.

You can participate in a graduated return to work plan

Your insurance company may assign a rehabilitation consultant to your claim to assist you with a return to work plan based on their assessment of your file. They may have requested a medical consultant review or asked your treating physicians about your restrictions and limitations.

Under a return to work plan, you would gradually build up the number of hours/days you work until you reach the same hours you previously worked.

However, you may be unable to participate in the return to work plan due to your symptoms. Your insurance company may not find that the medical evidence supports an inability to work, and it is their opinion you are not totally disabled and therefore able to gradually return to work.

You can participate in a work hardening/work conditioning program

A rehabilitation consultant may also be asked to arrange what is known as a work hardening program (or work conditioning program), as the insurance company believes that this may assist you in getting back to work.

A work conditioning program can involve working with an occupational therapist, physiotherapist and/or kinesiologist. The goal would be to increase your endurance and improve your physical and/or psychological position.

You may have difficulties completing the program; it may worsen your symptoms. It is important to provide medical evidence to the insurance company to show why you are not able to participate in the work plan, and your treatment provider should clearly outline the restrictions and limitations that affect your ability to participate.

You can perform the duties of an alternate occupation

If you have been on claim for some time and are nearing the change of definition date, or it is evident you will not be able to return to your previous employer, your insurer may request that a vocational specialist prepare what is called a Transferable Skills Analysis (TSA). This will help them see what your "transferable skills are”, if any. They are trying to determine if there are other jobs you may be able to perform that match up with your education, training and experience.

If a TSA identifies alternative occupations, your insurer may take the position that you should be able to work in one of these occupations. Therefore you no longer meet the test for totally disabled.

COVID-19 and cancer claims 

As a result of the COVID-19 pandemic, many cancer patients have had their surgeries delayed or have delayed their chemotherapy/radiation treatments.

As one of the reasons for denial can be due to not seeking the expected treatment for your condition, insurance companies might deny your claim on the basis of failure to seek appropriate treatment. However, you may also be experiencing increased anxiety or depression as a result of the pandemic, and fear of being immunocompromised and high risk.

What you can do if your claim is denied

If your short-term or long-term disability claim has been denied for any reason, do not delay in seeking legal advice to find out what your rights are. If you wish to start a court action, it is important to find out when your limitation date to sue your insurance company is.



Even if your claim is denied, you should still continue to seek treatment and medical attention (and follow medical advice) as you normally would. It is important that you always report your symptoms to your doctors/treatment providers so they can document them and refer you to any additional specialists.

One of the important elements of a disability claim is to show continuous disability, therefore documenting your symptoms and treatment is very important.

At Aaron Waxman & Associates, we understand that your recovery and health are important. We understand the importance of focusing on recovery. We offer a free, no obligation initial consultation where we can answer any questions you may have about your rights and your long-term disability benefits. There are no bad questions. There are no upfront legal fees. We only get paid, when you get paid.