Navigating employment and finances after a cancer diagnosis can be enormously challenging for patients, particularly in the midst of treatment. As almost half of Americans receive health insurance through their employers, work and healthcare are closely intertwined for millions of individuals. According to Stephanie Fajuri, JD, Director of the Cancer Legal Resource Center (CLRC), patients should be aware of their legal rights to better navigate these difficult issues and relieve some of the burden on themselves and their families.
At the AONN+ 2019 Midyear Conference, Ms Fajuri armed the crowd of navigators with some basic legal knowledge to relay to their patients struggling with employment and finances after a cancer diagnosis.
Employment Rights and Responsibilities
The Americans with Disabilities Act (ADA) and Family and Medical Leave Act (FMLA) are federal laws that apply to every state. But Ms Fajuri noted that employment laws are only a baseline, and many employers can and do provide more benefits to employees than is required by law.
First of all, patients should know that disclosure of a cancer diagnosis is never required (and especially not in a job interview), but there are times when disclosure might be helpful or necessary. If a patient fails to request reasonable accommodations before her performance suffers, legal action cannot be taken against her employer for any repercussions that result from a lapse in performance.
Note that employers are only required to negotiate reasonable changes or adjustments; for example, a cashier could not ask to work from home but might reasonably ask for a stool to sit on behind the register.
The ADA prohibits discrimination at all stages of the employment process and applies to state/local government and employers with 15 or more employees. To be covered by protections of the ADA, a patient must have a “disability” as defined by the ADA, but must also be qualified to perform essential functions of the job. For example, it would not be considered discriminatory if someone with a background in law wasn’t hired for a job in nursing.
In addition to the ADA, there are also applicable state laws, many of which apply to smaller employers (fewer than 15 employees), and may have a broader definition of “disability.”
Another federal law that provides protection for workers is the FMLA. It provides 12 weeks of unpaid, job- and health benefit–protected leave for one’s own serious health condition, or to take care of a parent, spouse, or child. Ms Fajuri stressed the importance of making clear to patients that this protected leave is unpaid, but noted that it may also apply to some part-time employees.
Managing Medical Bills, Debt, and Income Replacement
“I haven’t talked to a single person dealing with cancer or a serious health condition who is not concerned about their finances,” she said.
Maintaining employment when possible can help patients to avoid (some) financial problems, but they should be vigilant about researching what their employers offer regarding paid or unpaid leave policies.
Awareness of eligibility for disability benefits (and timelines for applying) is crucial. “We have so many people who wait far too long to apply for benefits,” she noted.
Importantly, many patients are unaware that medical bills can actually be negotiated. “[At CLRC] we talk to people who set up a GoFundMe [a crowdfunding platform], or go into serious credit card debt because they’re putting medical bills on their credit cards or raising money for a bill they probably could have negotiated down.”
A number of long- and short-term income replacement programs are also available. If a patient is already sick, they will not likely be approved for private disability insurance, but Social Security Disability Insurance (SSDI; based on how much a person has paid into the system) and Supplemental Security Income (SSI; for individuals with very low income) may be options. Additionally, some states offer state disability insurance and paid family leave for caregivers.
Denials are very common, so if patients are applying for SSDI or SSI and get denied, encourage them to appeal, not reapply, she urged. If they submit a new application, they essentially go to the back of the line.
One practical tip she offers patients is to open their mail. “It seems so simple to tell patients to open their mail and review their bills, but in practice it’s a very daunting experience,” she said.
Encourage patients to be vigilant about opening mail, she stressed. “If they don’t, they might not know treatment was denied or the Social Security Administration is giving them 60 days to appeal their denial.”
Warn patients to be cautious of predatory lending, to be informed of their options, and to maximize their insurance coverage before looking into alternative sources of income.
Finally, encourage patients to prioritize their debts and expenses. Keep in mind that many facilities and medical providers will negotiate or set up a payment plan, but failing to pay rent or a mortgage will likely result in eviction, regardless of whether a patient has cancer. “There’s more wiggle room with a medical bill than with a mortgage,” she said. “Having a safe place to live should be prioritized.”
The CLRC is a national organization with a mission to provide information and resources on cancer-related legal issues to patients, survivors, caregivers, healthcare professionals, employers, and others coping with the disease.
Free information and assistance for patients and families nationwide can be found at www.clrcintake.org or by calling (866) THE-CLRC. Note: The CLRC does not provide direct legal advice; should individuals need these services, they should consult a lawyer.