Disability for Cancer: Where to Start

June 30, 2020

Caribou

Caribou

June 30, 2020

Many people who are diagnosed with cancer continue to work full or part time. However, factors such as medical appointments, chronic pain, and fatigue often make working very difficult. 

The amount of time needed off work will depend on your treatment plan, side effects and the type of work you do. If you are unable to work, financial assistance for cancer patients is available and you might have to consider applying for disability insurance to compensate for the loss of income.

The first hurdle to overcome is understanding what benefits you qualify for. Let’s walk through the application processes.

Option 1: Short term medical leave of absence

The Family and Medical Leave Act (FMLA) requires certain employers to grant family and medical leave when needed. In most cases, the act also requires employers to reinstate you to your job (or an equivalent one) upon your return to work.

A few key points to keep in mind for the FMLA:

  • Not all employers are bound by the FMLA, and not all employees are covered by it. The act applies to all public agencies and local schools, as well as to private employers who employ 50 or more workers (within a 75 mile radius of the employees work site) for at least 20 workweeks during the year. To be an eligible employee, you must have worked for the employer for at least 12 months for at least 1,250 hours during the last 12 months.

  • Workers who qualify are entitled to a total of 12 workweeks of leave during a 12-month period. Employees can take the 12 weeks all at once or in parts, called "intermittent leave." This can work to your advantage. For example, you can take a couple of days off because you are feeling unwell due to treatment or take one day off because of a doctor’s appointment.

  • Employers are required to continue your health insurance coverage as if you were still working. So, if you were responsible for any of the premium while you were working, you will be required to continue doing so while on leave. But, this only applies to health insurance. It’s possible that your employers can choose to stop paying all other benefits while you are out on leave (e.g. disability and life insurance).

  • When you return from leave, you must be given back your original job or one that is equivalent in pay, benefits and other conditions. Exceptions are sometimes permitted if the result would cause serious economic injury to an employer's operations.

  • The medical leave under the FMLA is unpaid. Your workplace is entitled to request that you use your vacation, sick, and personal days while on this leave. 

  • Currently, only California, Hawaii, New Jersey, Rhode Island, New York and Puerto Rico have state run short-term disability. Check your state’s department of labor details for more information.

Option 2:  Long Term disability leave

The Social Security Administration (SSA) offers two types of long term federal disability benefits programs to help individuals and families: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To be eligible for either of these programs, you must meet the SSA’s definition of disability - having an illness or injury that is expected to last 12 months or longer. 

Let’s dive into both of these programs so you know which one you can qualify for.

Social Security Disability Insurance (SSDI)

Do you have a strong record of past work or have you been holding a steady position but are no longer able to due to your medical condition? SSDI would be the right program for you. 

SSDI is a payroll tax-funded federal insurance program. SSDI provides you with income if you are unable to work due to a disability or until your condition improves. 

In order to qualify, you must have insured status. This means that you have been paying into the Social Security system generally for at least 5 out of the last 10 years. This counts towards your work credits and your pay stubs would have shown deductions for the Federal Insurance Contributions Act (FICA). Once qualified, SSDI provides monthly cash benefits to the work and their eligible dependents.

The average SSDI payment for 2020 is $1,258 per month. To qualify, you must:

  • Be between 21 and full retirement age

  • Have worked five out of the last ten years

  • Be significantly limited in you ability to work and are expected to be unable to work for 12 months or longer, or have a terminal condition

  • You must meet SSA’s very strict definition of disability, according to The Blue Book.

Supplemental Security Income (SSI)

Some people have insufficient work history to meet the requirements for SSDI.

In those cases, SSI is a cash assistance welfare program available to financially eligible individuals who are over the age of 64, blind or disabled. This program is based on financial eligibility. It is not based on work history.

In order to qualify, you must be income eligible and resource eligible. To be income eligible, your ‘countable income’ must be less than the ‘standard of need.’ Your combined earned and unearned income must not exceed $2000.

In 2020, the average SSI payment is $771/month per individual . SSI is not available in Arizona, Mississippi, West Virginia, Puerto Rico and North Dakota.

To qualify, you must:

  • Be 65 years of age or older

  • You have very limited income and financial resources

  • You must meet SSA’s very strict definition of disability, according to The Blue Book.

The above points are broad because claims are evaluated on a case-by-case basis, subject to a complex set of rules and calculations. In most states, approval rates for SSI and SSDI are roughly the same: 65% of first-time applications are denied. This is why the appeals process is very important.

Speak to one of our qualified Healthcare Advisors today to pick the most suitable program, guide you through the application process and answer any questions.

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