Long-term disability due to cancer is a disease requiring specific and detailed documentation due to the wide range of origination and stages of the disease, as well as cure and recession rates. Specifics outlined in the disability insurance policy may increase or limit the patient’s benefits, making careful and expert analysis essential.
Cancer diagnosis include a long list of origination and specific disease, which may vary by insurance policy.
Origination:
- Soft tissue tumors of the neck or head
- Skin
- Soft tissue sarcoma
- Lymphoma
- Leukemia
- Multiple myeloma
- Salivary glands
- Thyroid gland
- Breast
- Skeletal system
- Temporal fossa, orbit, or maxilla
- Nervous system
- Lungs
- Mediastinum or pleura
- Stomach or esophagus
- Small intestines
- Large intestines
- Gall bladder or liver
- Pancreas
- Adrenal glands, kidneys, ureters
- Urinary bladder
- Genital tract (female)
- Prostate gland
- Testicles
- Penis
- Unknown original site
- Diseases treated by stem cell transplantation or bone marrow transplantation
Qualifying Malignant Neoplastic Diseases:
- Acute Leukemia
- Cancer
- Chronic Lymphocytic Leukemia
- Chronic Myelogenous Leukemia
- Colon Cancer
- Lymphoma
- Macroglobulinemia
- Mesothelioma
- Myelofibrosis
- Prostate Cancer
- Testicular Cancer
- Oral Cancers
- Trabecular Cancer
The stage of the cancer is essential when determining long-term disability benefits. Early stage compensation may be delayed pending a long-term prognosis, while advanced cancers may qualify for benefits similar to compensation allowance (CA), providing a basis for long-term disability and more expedient compensation.
The burden of proof lies with the treating physician and subsequent IMEs, which may differ in prognosis. Obtaining qualified legal assistance during the claim process is essential in achieving long-term disability benefit approval.
Medical Documentation must include specific information, as required by your insurer. Among the most common requirements are:
- Origination of malignancy
- Extent/Stage of malignancy
- Historical documentation of treatment (including any surgery, chemotherapy, transplantation, radiation, or oral treatments.
- Detailed record of the patient’s response to treatment
Additional Therapies - Side-effects, or residual, of all treatments
- Pathology reports and operative documentation
- Documentation from all specialists involved in diagnosis or therapy
- All evaluations provided by specialists since the initial diagnosis
The patient may also be requested to provide information related to other conditions, medications, treatments or diagnosis.
Some insurance policies limit the requirements of documentation to several months, while others may request information related to the condition for a longer period. Before filing a claim, it is essential to collect all information and supporting reports and test results available.
Conditions that qualify a cancer patient for long-term disability include:
- Inoperability
- Anaplastic carcinomas
- Unresectable
- Distant metastases
- Transplantation
- Recurrence
Stem cell or bone marrow transplants may carry special conditions, as outlined in your policy.
