Cancer ERISA Disability Claims

Welcome to Season 3, Episode 18 of Winning Isn't Easy, the podcast that delves into the complexities of disability insurance claims. In this episode, we shine a spotlight on a crucial topic: "Cancer ERISA Disability Claims."

Join us as we explore the unique challenges and intricacies of disability claims related to cancer under ERISA. Cancer can have a profound impact on an individual's life and ability to work, making it essential to understand the complexities of navigating the claims process.

Our host, Nancy Cavey, a seasoned disability attorney, shares her expertise in handling cancer disability ERISA claims. Nancy will provide valuable insights and strategies for effectively advocating for your rights as a cancer claimant and securing the disability benefits you deserve.

Throughout the episode, we'll discuss the medical evidence required to support a cancer disability claim, common issues faced during the claims process, and the importance of accurate and comprehensive medical records.

Whether you're personally dealing with a cancer disability claim, or seeking to deepen your understanding of this topic, this episode offers valuable information to help you navigate the complexities of cancer disability ERISA claims.

Tune in to empower yourself to fight for the disability benefits you need during this challenging time.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.   

Transcript

Nationwide Disability Attorney Nancy L. Cavey: 0:11

Hey, I'm Nancy Cavey , national ERISA and I d i , disability attorney. Welcome to Winning Isn't Easy . Before we get started, I've gotta give you a legal disclaimer. This podcast is not legal advice. The Florida Bar Association says I have to say it. So I've said it. Nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to do to get the disability benefits you deserve as quickly as you can get those benefits. So off we go with this episode. Now, today I'm gonna be discussing a few different types of cancer , uh, and how these , uh, cancers can impact the disability claims process. I'm gonna cover a number of topics. I'm gonna first talk about prostate cancer and what a disability insurance carrier is looking for in your medical records. I'm also gonna talk about leukemia and your long-term disability insurance claim. And lastly, I'm gonna talk about Toby Keith's stomach cancer diagnosis and what it can teach you about your social security disability, stomach claim, and your L t D claim. Now, before we do all of that, but I'm gonna take a quick break.

Speaker 2: 1:37

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Nationwide Disability Attorney Nancy L. Cavey: 1:58

Welcome back to Winning Isn't Easy. Let's talk about prostate cancer and what a disability care might be looking for in your medical records. Prostate cancer can be deadly when men ignore potential warning signs, and unfortunately, prostate cancer can develop so slowly that the symptoms typically aren't , uh, present until the cancer has progressed and reached an advanced stage. If you have any of the following symptoms, you should be seeing a urologist for further evaluation. Now, these , uh, symptoms are generally five in nature , uh, and the , um, cancer association has suggested that frequent urination pain while urinating, frequent urination , uh, in terms of blood in the urine , uh, painful , uh, erectile dysfunction and blood in the semen are all , uh, some of the five common symptoms that you'll see with prostate cancer. So when the disability carrier gets your , um, medical records in your claim, they're gonna be looking , uh, first at the diagnosis, you've got the burden to prove that you have , uh, prostate cancer. And the second thing they're gonna be doing is looking for the objective basis of the diagnosis. And that means that they're gonna be looking for prostate-specific antigen test results, a digital rectal examination and a biopsy. They're also gonna be looking for the symptoms that we just talked about. They're gonna be looking for treatment. And under the terms of your disability policy, you have a obligation to get treatment, and they wanna see that you've gotten treatment and they're gonna wanna know the response to treatment. And as part of that, they will expect that you have either discussed with your doctor or undergone hormonal therapy options, including the surgical re uh, removal of your testicles. Uh , they wanna see a discussion about medications to suppress , to suppress. Uh , androgens and androgens are the male hormones that help prostate cancer cell , uh, cells grow , um, and they wanna see that you have gotten androgen suppression treatment that's normally short term and temporary in nature is not designed to cure the , the cancer , um, in particular cases that you might have had surgery. So the carrier's gonna wanna see the , uh, operative report , uh, to see the nature of the surgery that you underwent, be it , uh, the surgery or radiation treatment, or a combination of both. Now, radiation treatment can cause significant side effects and that can impact your ability to work in addition to the secondary problems associated with prostate cancer. So ultimately, the court , the carrier rather, is gonna wanna see restrictions and limitations. Uh, they want your doctor who have addressed not only the symptoms that we've talked about, but how those symptoms impact your ability to do the material and substantial duties of your occupation. They wanna see the side effects of the treatment and how those side effects might impact your ability to function. So for example, if you have problems with frequent urination that interferes with the ability to do a sedentary job or travel, that could mean you can't do the material unsubstantial duties of your occupation. If you have difficulty in pain while urinating, that can impact your ability to sit, stand, walk, or even concentrate. And as embarrassing as these things are, these are things that should be noted in your medical records. Got it. Now you know what should be in your medical records. Let's take a break. Welcome back to Winning Isn't Easy Leukemia and your long-term disability insurance Claim. Leukemia is a cancer of the blood and the blood-forming cells in your bone marrow. It's estimated that there are 60,000 people who will be diagnosed with leukemia on an annual basis. There's a five year survival rate for leukemia , uh, and that's generally about 65 , uh, to 66% of people who live. But it wasn't that high when my o was diagnosed with leukemia. Um, w what is also important in a claim are the risk factors. Now leukemia is the 11th common cancer in the United States. And from 2015 to 2019, an average of 18 men out of a hundred thousand were diagnosed with leukemia. Women have an average of 11 out of 100 cases, so males are more likely than females to be diagnosed with , uh, leukemia. Leukemia will start when the d N A inside bone marrow cells , uh, become abnormal. That's gonna result in the development of more abnormal cells. And there have been risk , risk factors associated with the development of leukemia. In addition to , um, the sex, and this can include smoking, benzene exposure, radiation exposure, family history , uh, and of course a history of chemotherapy. My father was a smoker and he, during World War II as a combat pilot, was exposed to aviation fuels, either of which may have caused or contributed to his leukemia. Uh, and of course, he had the symptoms of , uh, leukemia, and that included unexplained , uh, fevers, night sweats, chills , uh, and unintentional weight loss. Uh, he also had tremendous fatigue. Um, the carrier will wanna see those symptoms and they'll also wanna see , uh, medication trials. Clinical trials have shown that some patients with chronic myeloid leukemia will have an increase in musculoskeletal pain after treatment with a number of , um, uh, treatment forms. And that pain can be intense. That can be the basis of a disability claim. Now, ultimately, the disability carrier is going to be , uh, asking , uh, what treatment you've gotten and whether you're actually getting now pain management treatment that's appropriate , uh, based on the level of your pain. So what does the disability carrier do with all of this information? In an ERISA disability claim, they are first going to look at the diagnosis, the symptoms, your doctor's opinion regarding restrictions and limitations. They're gonna wanna see that you've gotten appropriate medical treatment by a specialist. They can't make you get invasive treatment. But I'll tell you, I've seen many cases where the disability carrier will question not only the nature of the treatment, the frequency of the treatment, and why this treatment is more, isn't more aggressive in view of the nature of the , uh, policy holders complaints. Uh, they'll play all of that off, and of course, they on the other hand, will ignore the side effects of treatment. As I've said, I think the side effects in and of themselves can be the basis of a disability claim. If your doctor recommends pain management as opposed to reduc reintroduction of t K s treatment, your doctor should explain in the medical records why you're getting the treatment. You're getting your response to that , uh, treatment, including the pain management treatment, and any further potential problems or complications that you might have with the re reduction of the, the tk uh, uh, treatments. Because most disability policies require that you get appropriate treatment , uh, again, you should be seeing a pain management doctor in addition to your oncologist because the disability carrier is going to expect that , um, that you are getting both. And both doctors are needs to document , uh, the nature of your pain. Um, where is it located, particularly , uh, bony pain. Uh, document your response to pain management and to treatment , uh, and, and explain why you have restrictions and limitations. They also need to be prepared to address why your treatment shouldn't be more intensive. You can see particularly in a leukemia , a leukemia case. It takes teamwork to get the disability benefits you deserve. You should be working closely with your doctor in documenting your medical records , uh, and making sure that you have established all of the things that the disability carrier wants to see, an objective basis of the diagnosis, a history of your symptoms, how those symptoms disable you. Um , the treatment that you're getting, the side effects of medication, and the nature of , uh, any complications you have such as pain issues or , or other side effects of the medication. All of that needs to be combined, if you will, but well explained. So you just can't skip one. It's important that all of that information be provided and in a detailed manner if we're going to get or you're gonna get the disability benefits you deserve as a result of leukemia. The good news is that my dad did get his disability benefits. The bad news is that he didn't live the five-year life expectancy. Got it. Let's take a break.

Speaker 2: 11:25

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Nationwide Disability Attorney Nancy L. Cavey: 12:01

Welcome back to Winning Isn't Easy . What Toby Keith's Stomach cancer diagnosis can teach you about your social security and ERISA long-term disability claim. Now, country star Toby Keith has more than 40 top 10 hits and there are over 30 songs that he's done that have gone to number one on the charts. His fame and fortune hasn't prevented him from being diagnosed with stomach cancer. Now, Keith has undergone surgery and radiation treatment. He's optimistic about his recovery and we wish him the best, but I think there's some lessons that you can learn from his unfortunate diagnosis. Now, his diagnosis first has prompted I think a much needed discussion about the symptoms, diagnosis and treatment of stomach cancer. Uh, and I am, you know, if there's any silver lining, that's what it is. But you need to understand that stomach cancer, which is known as gastric cancer, is the sixth most common cancer and is the third most common cause of cancer related deaths in the United States. There's nothing to , uh, take lightly and it's estimated there are going to be over 26,000 new cases , um, on an annual basis. And the average death rate, unfortunately is 11,000 , uh, people per year. Now, you might be eligible for your social security disability or long-term disability benefits, or both if you're diagnosed with stomach cancer. Let's talk a little bit about the anatomy of the stomach because I think it's important and impacts these claims. There are five parts to the stomach. There's the proximal stomach , which consists of the cardiac that's the closest to your esophagus. The fundus, which is the body or the main part of the stomach. There's the distal part of the stomach, and that's where the food, you know, mixes with the gastric juice like a blender. And then there's the pyros , which acts as a valve to control the , uh, stomach emptying into the small intestine. The wall of the stomach , uh, is made up of three layers. Now, gastric cancer will normally thetic carrier is rather administration is going to be looking at your medical records. They're gonna look at the diagnosis and the location of cancer and the type of cancer that you have. They're gonna look at the symptoms of gastric cancer. And in the early stages, that can include just indigestion and stomach discomfort or a bloated feeling after eating, there could be mild nauseousness, there could be loss of appetite and heartburn. And it's not just somebody's cooking. Unfortunately, most patients have symptoms of advanced stage disease by the time they see a physician. Now in my practice, when I have a person who is coming to me with advanced stage cancer, they will normally have blood in the stools, vomiting, weight loss for unknown reasons, stomach pain, jaundice , uh, uh, and problems with their kidneys problems, swelling. It's important that your medical records document your symptoms and how those symptoms impact your ability to function. But in those situations, what's also important, I think, is the basis of the diagnosis. When you have a biopsy, you biopsy is going to be staged. And that's important because you most likely are going to be filing a claim for both Social Security disability and a risk and disability benefits. Under the Social Security statute, there is a program called the Compassion Allowance Program for a number of medical conditions, including cancers, including stomach cancers, and whether or not you qualify for that compassion allowance, which will fast track your claim depends on the staging , uh, report. So it is important that your medical records are documenting the diagnosis and the staging or of, of your stomach cancer because that can help expedite not only the Social Security disability , uh, benefits, but I have found that it can expedite the disability carrier's analysis and determination of your , uh, claim. Now the disability carrier and, and is gonna expect that you've undergone surgical resection. Uh, and in the later stages of the case, they're also gonna expect that you've had a resection with chemotherapy. They're gonna expect that you've had radiation therapy, targeted therapy with monoclonal antibodies , uh, or , uh, inhibitors, immunotherapy, or a combination of all of that. The social administration is gonna expect that you would've gotten treatment of that nature too. And both in the Social Security claim and in the ERISA disability claim, the side effects of the treatment are crucial to be developed because those side effects can be just as disabling as the cancer itself. So the Social Security Administration and the disability carrier is going to want to see , um, that you have side effects. Um , those side effects can , um, include , uh, things like obviously , uh, fatigue. Uh, they can cause problems with , um, with pain. They can cause problems , uh, with your stomach in terms of the ability to eat or process , uh, food, that sort of thing. Those side effects should be documented in the medical records. What are they, how long do they last? How do they impact your ability to function? So your records wanna document not only the diagnosis, the staging , uh, the symptoms, what the side effects of medication. That's crucial , uh, and should be well developed and documented in your medical records because we want to obviously try to, to get you to , um, uh, meet the , um, social Security Disability Compassion Allowance program so that your benefits are fast tracked. And I have found, as I've said, that disability carriers, particularly based on the staging, will fast track a stomach cancer or risk of disability claim. All of this is important because they also have to understand that most disability policies or plans will require that you apply for Social Security disability benefits because they have the right to reduce your long-term disability benefits by whatever you or your dependents might get in your Social Security disability claim. They will act as if you're getting those Social security benefits, if even if you haven't applied. So there is this interaction , uh, and it's important that you understand how the Social Security Administration looks at claims. The I is a disability carrier looks at claims and the interaction between these two types of benefits. I hope that you have enjoyed this week's episode of Winning Isn't Easy. Please like our page, leave a review, subscribe and share it with your family or friends. I look forward to talking with you in our next episode of Winning Isn't Easy. Thanks.