Collecting LTD Benefits for Cancer and Slow Recovery

There are many forms of cancer and no one is immune from developing this disease, regardless of age or circumstances. Cancer results in many challenges for sufferers and their families, including emotional, physical and financial challenges, and cancer often strikes Canadians who are the essential breadwinners in their household. In such a case, the sufferer and their family often experience a reduction or loss of income, either temporarily or long-term, which causes additional stress during an already very trying time.

The American Cancer Society describes cancer as “a group of diseases that can cause almost any sign or symptom”. The signs or symptoms of cancer depend on where in the body the cancer is located (the type of cancer), how large it is, and how much the organs and/or tissues are affected by the cancer. Cancer that has metastasized (spread) may result in symptoms in other parts of the body. Also, as cancer grows, it can push on nearby blood vessels, organs and nerves, and this pressure can be responsible for some of the cancer symptoms.

Cancer symptoms and side-effects

Because there are many forms of cancer and the potential effects of the disease and treatment are varied, cancer symptoms vary greatly between individuals and many bodily functions may be affected, including thinking and behaviour. The American Cancer Society reports that the following are among the most common symptoms of cancer:

  • Unexplained weight loss
  • Fever
  • Extreme fatigue
  • Pain
  • Changes in the skin

Certain cancers may also have these symptoms:

  • Changes in bowel or bladder function (most common in colon, bladder and prostrate cancer)
  • Sores that fail to heal (particularly in skin cancer and oral cancer)
  • Unusual discharge or bleeding (occurs in many forms of cancer, including breast cancer, and cancer of the lung, colon, rectal, cervix or bladder)
  • A lump or thickening in the breast or another part of the body (mostly in breast or testicle cancer)
  • Indigestion or difficulty swallowing (as in cancer of the esophagus, throat or stomach)
  • Recent skin change, particularly in a mole or wart (can be a sign of melanoma)
  • Hoarseness or a nagging cough (may indicate lung cancer or cancer of the larynx or thyroid)

In addition to the symptoms directly associated with cancer, cancer treatments, such as chemotherapy, may have debilitating side-effects for a cancer patient, that greatly impact their ability to function at any level. The American Cancer Society lists the following possible side-effects of cancer treatment:

  • Cognitive changes, which include:
    • Anxiety or fear
    • Confusion, difficulty thinking and behaviour changes
    • Depression or sadness
    • Chemo brain (i.e. mental cloudiness)
  • Problems with eating or appetite
  • Dehydration
  • Falling
  • Extreme tiredness
  • Weakness
  • Sleep disturbances
  • Pain
  • Changes in bladder and bowel function
  • Hair loss
  • Leg Cramps
  • Infections
  • Low blood counts
  • Nausea and vomiting
  • Shortness of Breath
  • Lymphedema (i.e. a buildup of lymph fluid which causes swelling, usually in the arms or legs)
  • Dry mouth, bleeding in the mouth, and mouth sores
  • Seizures
  • Sexual and fertility side effects
  • Peripheral neuropathy (damage to the nerves controlling sensation and movement in the arms and legs, sometimes caused by chemotherapy)
  • Skin problems, including dry or itchy skin, pressures sores and scars
  • Sweating

Cancer survivors should monitor for unexpected symptoms that may occur after treatment, which are not necessarily directly related to cancer but may be associated with treatment or recovery (according to Cancer and Work). Patients should seek medical advice if they experience unexpected symptoms or side-effects, including those named above. Other symptoms that may appear after treatment and may be cause for concern are: visual or hearing impairments, diminished communication skills, mobility impairments, and changes in physical appearance, including nails and skin.

It is not uncommon for people who undergo cancer treatment to experience changes in their cognitive abilities. These symptoms may be elevated during and after chemotherapy, but stress can also be a causal factor. Changes to cognitive abilities may include:

  • Difficulty concentrating, focusing and multi-tasking
  • Reduced ability to learn new information
  • Problems remembering
  • Difficulty speaking or writing

A cancer diagnosis is certainly a significant stressor for cancer patients and the increase in stress alone can have a substantial negative affect on the patient’s health and their ability to function. As a result, in addition to anxiety and depression, cancer survivors may experience symptoms arising from unmanaged stress, such as an elevated blood pressure or heart rate, decreased digestion, or muscle tension and an increase in stress hormones which may result in impairment in immune function.

Clearly, cancer patients often experience debilitating symptoms that have a substantial impact on their ability to function and work, both on a cognitive and physical level. Of course, cancer and cancer treatments affect every person differently over the short and long-term. And, the severity and variation in symptoms and the nature of the recovery process will directly affect the type of work a cancer sufferer will be able to perform, if any. Some workplace environments may be able to accommodate symptoms for some cancer survivors, but workplace accommodations may not be possible for some jobs and in any case, not all employers are willing to make such accommodations.

Long-term disability benefits for cancer patients

Canadians who have long-term disability (LTD) coverage may be eligible for income replacement benefits while they are suffering symptoms, undergoing treatment for cancer and during slow recovery while the patient’s doctors advise that they are unable to work. During the first two years after becoming disabled, a claimant is eligible for LTD benefits when their cancer symptoms prevent them from performing the required tasks of their current job. After two years, eligibility requires that the claimant’s disability prevents them from being able to perform any occupation for which they are reasonably suited, by way of education, training or experience.

If a cancer patient has short-term disability coverage under their disability plan, depending on the time frame for receiving these benefits, they may be able to rely on their short-term disability benefits during the period of their surgery, chemotherapy or radiation treatment and even into their recovery period. Although the period for short-term disability coverage varies from plan to plan, many disability plans, particularly employer-provided group plans, provide short-term disability coverage for the first 120 days. After this period, the claimant may be eligible for long-term disability coverage, if they meet the eligibility requirements.

Once a person’s claim for disability benefits arising from a cancer diagnosis is approved, the insurance company generally requests regular updates on the claimant’s treatment, prognosis and recovery, from their doctors. As long as the claimant’s doctors provide the opinion that the person is unable to perform the essential tasks of their work, the claimant should be eligible to receive LTD benefits.

The end goal during the recovery period is for the claimant to return to their own job, either with accommodations or without. A case worker or insurance representative for the LTD insurance provider will typically be involved in gathering information during the recovery period to help assess whether the claimant is able to perform their job, and this information will also be used to determine, after two years, whether the person is able to perform any job for which they are reasonably qualified.

(As per Cancer and Work), some of the questions and issues that claimant’s doctors may be asked to provide information and updates for, include:

  • The ability to perform day-to-day activities
  • Planned treatments
  • Specific occupational/work requirements for the patient
  • Workplace issues that may cause the patient stress or difficulties, such as poor performance prior to the person’s cancer diagnosis or the lack of support in the workplace
  • Whether the patient and employer are open to a modified work environment while on disability
  • Whether specific supports in the workplace may be helpful

Note that there is one circumstance that may preclude access to LTD benefits for a cancer sufferer – that is, if their LTD plan excludes coverage for a pre-existing condition and the claimant sought medical care for cancer during the excluded period. Specifically, many long-term disability plans state that persons are not eligible for benefits for a particular illness or injury if they sought medical advice or treatment for the condition in the year prior to their enrollment in a new disability insurance plan.

Tragically, in addition to the burden of dealing with this debilitating physical illness, cancer victims sometimes have a legitimate claim for LTD benefits denied by their disability benefits insurance provider. Denial of disability benefits may occur for a number of reasons, such as when there was insufficient medical documentation to show why symptoms prevent you from performing the essential tasks of your job. Once a claim has been denied, the insurance company has made a decision on your case and unfortunately, they are unlikely to change their ruling during their internal appeals process. For this reason, the most effective course of action is to seek representation from a knowledgeable and experienced disability claims lawyer.

At Kotak Personal Injury Law, our team is experienced in representing clients in insurance disputes for denied long-term disability claims. Call our office today to discuss your case and find out how we can resolve your claim favourably and as quickly as possible.