Employment Issues

Some want to keep working during cancer treatment if possible. This might be to keep the income and health insurance coverage. Some go back to work after treatment. Others work part-time or work from home for a while. Still others decide to find a new type of work or don’t work at all.

Your decisions about work are likely to be based on your type and stage of cancer. Treatment side effects should be considered. Some treatments require a stay in the hospital. You are the best one to decide what’s right for your situation.

Think About Your Employment Options

• Whether you want to keep working during cancer treatment.
• Whether you need to tell your employer about the cancer diagnosis.
• How to talk with your employer about your needs if you will need to make changes to continue to work.

Continuing to Work

Cancer and treatment may or may not affect your ability to work. Telling your employer about the cancer diagnosis is a personal choice. If your ability to do your job will not be affected, you might decide not to tell your employer right away. On the other hand, there may be certain things that can be done to make it easier for you to continue to work if you tell your employer.

If you decide to tell your employer about your cancer, write down what you want to say. Review it with loved ones and friends. Get their feedback beforehand. Practice what you want to say until you feel comfortable. Provide only as much information as you want to.

Steps to Take to Continue Working

Telling your employer: When you talk with your employer, try to find a solution that works for everyone, and show him or her that you feel confident about working. Provide the following information:

• How long you will be able to continue working.
• Whether you will be able to continue to do all of your job duties.
• If you need to take time off from work for treatment and when you are likely to be able to return to work.

Changes at work: Some patients can work during treatment only if the employer allows changes in job duties (accommodations). Ask your health care provider’s advice before talking to your employer about making changes at work. Your provider may be able to write a note explaining what changes are needed, such as altering a work schedule, doing different job duties for a while or working from home for a time

Talk with your human resources director and your supervisor about your needs. Any job changes will have to be approved by your employer.

If You Are Unable to Work

Talk with your employer about your health situation if you will not be able to work for a while. Discuss your desire to return to the company when your health improves. Ask your human resources director to explain all of the benefits that will be available if you cannot work such as:

• Short-term disability income insurance.
• Long-term disability income insurance.
• Dental and vision insurance.
• Long-term care insurance.

Steps to Take to Stop Working

• Make a budget to decrease your expenses.
• Assess your current and anticipated medical expenses.
• Review your current insurance policies and see what you can do to maintain your coverage.
• Talk with your human resources coordinator about employer-sponsored benefits.
• Keep a journal of your contacts and steps taken, as well as copies of paperwork and applications.
• Talk with others with cancer who have had to stop working.
• Find out about your disability benefits.
• Ask your health care team to help you with your application for disability benefits.
• Check eligibility benefits through Social Security Administration (SSA).

Be certain that you know how to keep your job and benefits while you are not working. Find out how much you will have to pay to continue your insurance coverage. If you are leaving your job, ask about COBRA benefits. These benefits continue insurance coverage for a period after you leave a job. It is very important to know about COBRA application and payment deadlines. Be certain that you request and submit the paperwork and payments on time. If you are late, you will lose the opportunity to keep your benefits.

Ask Your Employer About COBRA Benefits

• What are my current benefits and insurance coverage?
• Will my COBRA benefits continue insurance coverage for a period after I leave my job?
• How much do COBRA benefits cost?
• What are the COBRA sign-up and payment due dates?

Look into applying for Americans with Disabilities Act (ADA). The ADA applies to employers with 15 or more employees as well as to those who work for state and local governments. If you are able to perform the duties of your job, an employer cannot treat you unfairly (or discriminate). In fact, the employer may need to allow some changes to help you do the job, such as light-duty work, flexible hours or leave time.

State employees cannot sue their employer for money. However, they may be able to sue the state to get their job back. They may also have additional protection under their own state laws. If cancer, treatment or side effects keep you from being able to do your job, learn more about the ADA.

The Family and Medical Leave Act (FMLA) can help those affected by cancer. This law applies to employers with 50 or more employees. An employee must have worked for the company for at least one year (1,250 hours) to take leave under the FMLA.

Under this law, an employee can take a certain number of weeks of unpaid medical leave in a year for a serious medical condition. FMLA can also be used to care for a seriously ill spouse, parent or child. You will not be paid wages when you take FMLA leave. However, your job and benefits remain protected. If the employer pays for the health insurance, that will continue while the employee is on FMLA leave. You will also need to continue to pay your portion of the cost for these benefits.

Some states also have FMLA laws that protect people with cancer. These laws may apply to employers with fewer than 15 employees. Find out about the laws in your state.

Other Federal Protection Laws

• Employee Retirement Income Security Act (ERISA): This law protects employees who use the rights provided by a benefit plan such as health insurance.
• Consolidated Omnibus Budget Reconciliation Act (COBRA): This law allows certain employees to continue their health insurance coverage after leaving a job. The employee must take over payment of premiums. Coverage is allowed for a certain length of time.
• Health Insurance Portability and Accountability Act (HIPAA): This law limits how an insurance company can refuse to cover health conditions that started before the policy took effect. It also protects the privacy of patients.
• Rehabilitation Act of 1973, as amended (Federal Rehabilitation Act): This law provides many ADA protections to employees of the federal government. It also covers those who work for employers who receive money from the federal government.

Learn about federal protection laws and get answers to your questions from these agencies:

• Social Security Administration.
• Department of Justice, Disability Rights Section.
• Equal Employment Opportunity Commission.
• Department of Labor.

Federal law requires that employers make decisions fairly. This means decisions regarding employees should be based on the ability of a person to perform the duties required by a job. Discrimination happens when employment decisions are based on other factors such as: race, age, gender, physical ability or religion.

Sometimes discrimination is due to fears and ideas about cancer that are not based on facts. You may have to help educate your employer about your situation and what to expect, and address your employer’s concerns.

Your employer’s concerns:

• Uncertainty about what you can or cannot do.
• Concerns about time away from work for cancer treatment and other health care.
• Fear that insurance costs will go up for the employer.
• Uncertainty about whether you will be able to continue to perform your job duties.
• Worry that you might decide not to come back to work after treatment.

Legal Rights During a Job Search

Some cancer survivors may no longer be able to do the same or different work for their employer. It may become necessary to look for a new employer. There can be advantages to going to work for a new employer. For example, you may find a job with a better schedule or lighter workload. A new employer might also offer a good group health insurance plan that covers your pre-existing cancer condition. Be sure to review the plan closely.

People who have had cancer do not have to talk about health conditions when applying for a new job. On the other hand, if you have a disability, a reasonable modification might make it possible to do the job. In this case, there will be a need to discuss the reason the adjustment would be helpful. For example, if you cannot carry heavy items, the employer may agree to let you use a cart to carry the items.

• Employers cannot ask about a medical condition. However, they can ask if you’re able to perform all of the required (or essential) duties of the job. For example, an employer may ask that employees be able to lift a certain number of pounds a certain number of times each hour.
• Employers can ask new employees to take a medical exam if a job offer is based on passing the exam. If this is required of one person, it must also be required of everyone else applying for that position. The employer cannot take back the job offer if the exam is passed.

Resolving Employment Problems

There are laws that can protect you from being treated unfairly by employers. The Equal Employment Opportunity Commission (EEOC) enforces these laws. Employers are often willing to make changes to help people with disabilities. However, sometimes it may not be possible to reach an agreement with an employer. Then you must decide what action to take. Some people may want to go to another job and not fight with the employer. Others may seek legal action. Each survivor must decide what is best for his or her situation.

Livestrong partners with the Patient Advocate Foundation to help patients and their insurers, employers and creditors resolve insurance and job retention issues.