Cancer And Long-Term Disability

The impact of a cancer diagnosis extends beyond just the medical implications; it can have far-reaching consequences on a person’s ability to work and maintain financial stability. In this blog post, we will delve into the complex intersection of cancer and long-term disability insurance claims, exploring the challenges individuals may encounter and the available resources to help navigate this difficult terrain. From understanding the process of applying for disability benefits to exploring options if a claim is denied, we aim to provide valuable insights and guidance to those grappling with these issues.

Understanding Cancer and Long-Term Disability

Cancer is a condition characterized by uncontrolled cell growth that can invade and spread to other body parts. There are numerous types of cancer, each with its characteristics and treatment approaches. While some cancers have a high survival rate, others can be more aggressive and challenging to manage.

Disabling Symptoms of Cancer

Cancer symptoms can vary depending on the type and stage of the disease. Signs to watch for include feeling tired, lumps or thickened areas under the skin, weight fluctuations, skin changes like yellowing, darkening, redness, sores that don’t heal, or changes in moles. Keep an eye out for shifts in bowel or bladder habits, lingering cough or breathing difficulties, trouble swallowing, hoarseness, ongoing indigestion, discomfort after eating, unexplained muscle or joint pain, persistent fevers or night sweats, and unexpected bleeding or bruising.

In some cases, cancer can lead to physical limitations that impact an individual’s ability to perform daily tasks. In addition to physical symptoms, cancer can also take a toll on the emotional well-being of individuals. Coping with the diagnosis and uncertainty of cancer can be overwhelming and lead to anxiety, depression, and post-traumatic stress.

If your symptoms and limitations prevent you from working, you may be eligible for long-term disability benefits.

Side Effects of Cancer Treatments

Cancer treatments such as chemotherapy and radiation therapy can cause significant side effects that may also contribute to a claimant’s inability to work. Your experience with chemotherapy and radiation depends on your overall health and the specific types of drugs or treatments you’re getting. Whether you’re receiving a mix of treatments also plays a role.

You might experience some of these side effects or none at all. Your oncologist, the cancer specialist handling your treatment, is your best source for explaining the side effects to expect based on your health and treatment plan. However, typical side effects can include:

• Fatigue,
• Hair loss,
• Skin changes,
• Neuropathy,
• Nausea, vomiting, and diarrhea,
• Loss of appetite or difficulty eating,
• Bladder issues,
• Cognitive impairment, and
• Emotional distress.

Side effects usually go away within a few months after you finish treatment. However, some side effects may not appear until months or years later. In certain situations, side effects could be permanent. Make sure to talk to your oncologist about what to expect.

How to Get Approved for Long-Term Disability Benefits for Cancer

When seeking long-term disability benefits for cancer, you must apply for disability benefits by submitting an application and any other required claim forms. Often, your employer and attending physician must also complete specific forms.  We recommend that our clients submit a custom residual functional capacity form in addition to the required forms.

RELATED POST: How to Apply for Long-Term Disability

Your insurance provider will also require detailed documentation of your medical condition and its impact on your ability to work. This includes medical records, treatment history, and statements from healthcare providers. It is essential to adhere to all deadlines and requirements the insurance provider sets to avoid delays in processing your claim.

Medical and Vocational Evidence

Strong medical evidence is vital in substantiating your disability claim. Ensure your medical records clearly outline the diagnosis, treatment plan, and prognosis for your cancer. Providing objective medical evidence, such as test results and physician assessments, can strengthen your case and demonstrate the severity of your condition.

In addition to medical documentation, vocational evidence can support your claim by illustrating how your cancer diagnosis has affected your ability to perform job-related tasks. Vocational experts can offer insights into the limitations imposed by your condition and how they impact your capacity to work.

Tell the Story of Your Cancer Disability

Crafting a compelling narrative that conveys the impact of your cancer disability is essential. Clearly articulating how your symptoms prevent you from engaging in substantial gainful activity is critical to demonstrating your eligibility for long-term disability benefits. Personal statements detailing your daily challenges due to your condition can provide valuable context to support your claim.

How a Disability Attorney Can Help with Your Claim

A disability attorney can provide invaluable assistance, especially when a long-term disability claim is denied.  They understand the legal framework surrounding disability claims and can craft a compelling appeal to challenge the decision. Their expertise ensures that your appeal is structured correctly and submitted within deadlines.

At Ortiz Law Firm, we obtain all the documents the insurance company used to decide your claim and review the reasons for the denial. We analyze your medical records to understand your diagnosis and assess how your condition affects your ability to work. We also gather additional information to support your claim and build arguments to challenge their decision.

We submit an appeal that summarizes the key medical diagnoses and how those conditions impair work capacity. But we also make legal arguments in the appeal, pointing out legal errors in the LTD insurance company’s decision-making process.

Once the appeal is submitted, we will communicate with the insurance company on your behalf throughout the appeal review process. If the insurer obtains additional evidence during the appeal review process, we can assist you in responding. We can also help you file a lawsuit against the insurance company if your appeal is denied.

Cancer and Long-Term Disability Case Study

Let’s review one individual’s journey through the long-term disability appeal process to illustrate better how we could help with your claim.

Background

“James” was a 55-year-old sales manager at Republic National Distributing Company. James had worked for the company for six years and had a history of exceeding expectations and going the extra mile. However, there were noticeable (and understandable) changes in his performance once he was diagnosed with cancer and began taking daily chemotherapy pills, which came with side effects including diarrhea, nausea, cognitive impairment, and fatigue:

• Several days a week, he would struggle to get out of bed and get ready for work, which would cause him to be late.
• He began to miss important meetings and conference calls with sales staff.
• His time management and organizational skills had decreased dramatically.
• He experienced an inability to concentrate and was struggling to process information for his sales reports, and he couldn’t keep up with the fast-paced sales environment.
• Daily tasks became more and more difficult as the day continued, and there were many days that James had to go home early.

Fortunately, James had enrolled in the company’s group benefits plan, which included short-term and long-term disability insurance coverage with New York Life Group Benefit Solutions (NYL GBS). He received short-term disability benefits for six months, but his long-term disability claim was denied.

Understanding the Reasons for Denial

The denial letter shed some light on how NYL GBS reached its conclusion:

• Clerical Errors: It appeared that James’ oncologist had inadvertently noted that he had not experienced significant side effects from his medications in several of his most recent visit notes. James knew this was a simple clerical error, but it supported NYL GBS’s decision to deny his claim for long-term disability benefits.
• Relevant Medical Evidence Was Missing from the File: James also noticed that the claims examiner did not have all the pertinent medical records. He had been referred to a specialist for evaluation of his cognitive impairments, and he had reported this treatment to NYL GBS. Still, the claims examiner never received (or possibly never requested) the visit notes from this evaluation. James filed his claim for long-term disability benefits in large part due to his cognitive impairments resulting from his chemotherapy and the fatigue that impairs his ability to concentrate. Without this evidence, NYL GBS could not see the whole picture.
• A Consulting Physician Determined the Claimant Could Work: There was also the consulting physician’s report. NYL GBS had the medical records on file reviewed by a consulting physician. The consulting physician attempted to contact the claimant’s providers but was unsuccessful. Ultimately, the consulting physician determined that “the data lacks any objective findings substantiating the presence of global impairment in functioning and cognitive abilities.” The consulting physician never examined – or even spoke with – the claimant, yet they heavily influenced the decision to close the claim.

The denial letter included instructions to appeal the decision, but James did not feel up to the task. He was worried that he would be unable to prepare an appeal within the required time frame, and even if he did, he feared it would not be enough. He needed an experienced team to help him fight for his benefits, so he contacted Ortiz Law Firm the next day and shared his story with our team.

Our Appeal Process

Having handled long-term disability claims since 2005, attorney Nick Ortiz has developed a comprehensive strategy for preparing and submitting a long-term disability appeal:

1. The first step is to notify the insurance carrier that the claimant has hired an attorney and request a copy of the complete claim file and disability insurance policy so we can review the information used to decide the claim. With this information, we can gather additional evidence to challenge the decision.
2. The next step is to prepare custom forms for the claimant’s treating physicians to fill out. These questionnaires are designed to make the process quick and easy for the physician while providing valuable evidence to dispute a denial.
3. We also request copies of all the claimant’s office treatment notes and diagnostic test results. In this case, that included the cognitive impairment evaluation not in the file when the decision to deny James’ claim was made. We may obtain additional testing through a functional capacity evaluation or neuropsychological assessment if necessary.
4. We work with the claimant to prepare a sworn statement as a notarized affidavit. The affidavit details daily activities for 24 hours and specifies symptoms and limitations. Medical records don’t always accurately depict a condition’s impact on a claimant’s life, so the affidavit allows the claimant to speak about how their conditions affect their daily lives. We may also get statements from your family, friends, and colleagues supporting your disability.
5. Once we have gathered all the supporting medical evidence, the next step is to prepare the claimant’s appeal letter, which includes a detailed legal analysis and a summary of the medical evidence.
6. The fight doesn’t stop once the appeal is submitted. In most cases, the insurance carrier will obtain the opinions of other medical or vocational experts, usually through a medical file review, independent medical exam, or vocational assessment.  The insurer may also conduct surveillance of the claimant. We also assist our clients in responding to any new evidence developed during the appeal review that could hurt their case.

FREE RESOURCE: Appeal a Long-Term Disability Denial with our LTD Appeal Guide

Why We Need to “Stack the Record” on Appeal

Some long-term disability claimants think that all they need to do to appeal a denial is write a brief letter asking the insurance company to take a second look at the file, but that is not true: one of the key points to remember when preparing and filing an appeal is that you must gather medical records and other documentation to “stack the administrative record” or “pack the claim file” with favorable evidence.

Suppose all available appeals are denied, and you must file a lawsuit. In that case, the judge will only be able to consider the evidence in your claim file when the insurance company decides to deny benefits. The judge will not consider any new medical evidence generated since the appeal, newly written statements, or any testimony from you or your doctors at a trial. It will be as if the judge has “blinders” and will only consider the evidence available to the claim’s associate when they deny your claim.

Again – that is why it is essential to provide as much supporting information as possible (doctor’s reports, letters from employers, letters from friends and family, etc.) during the administrative appeal review process. And if your policy only allows you to file one appeal, then you only have one chance to get it right. Most long-term disability claimants are shocked to learn that they cannot testify in court or introduce new evidence once a lawsuit has been filed against the insurance carrier.

Our Results

Thankfully, there was no need to file a lawsuit against New York Life. With the help of our appeal, NYL GBS determined the previous decision to deny James’ claim should be overturned, and his claim was approved.

Call Ortiz Law Firm for a Free Disability Case Review

If your claim has been denied, don’t wait to seek help. You only have a limited time to appeal a denial. While the future may seem uncertain, remember that hope and resilience can carry you through tough times. With the right mindset and support, you can successfully navigate the challenges of the long-term disability appeal process.

Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. Led by disability attorney Nick Ortiz, our team is ready to fight for you. If your long-term disability insurance company has wrongfully denied or terminated your claim, contact us today at (888) 321-8131 to learn how we can help you get the benefits you deserve.

FAQ: Cancer and Long-Term Disability