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Breast cancer is a challenging journey that can have long-term implications for an individual’s ability to work. For many, this may lead to the need for long-term disability support. Navigating the complexities of breast cancer and disability benefits can be overwhelming, but we will guide you through the eligibility criteria and how to appeal a long-term disability denial.
Breast Cancer and Long-Term Disability
Breast cancer is a prevalent and life-altering condition that affects individuals worldwide. It starts with abnormal cell growth in breast tissue. It’s the second most common cancer in women in the US, after skin cancer. But it’s not just a women’s issue – anyone can get breast cancer because we all have breast tissue.
Prevalence of Breast Cancer
Globally, breast cancer is one of the most common types of cancer diagnosed in women, affecting millions each year. In 2020 alone, doctors reported over 2.26 million cases. The trend of breast cancer diagnosis has been on the rise, emphasizing the importance of early detection and effective treatment.
Stages of Breast Cancer
Doctors categorize breast into different stages based on the extent of its spread and the likelihood of recovery. The stages range from 0 to 4. A lower stage shows less advancement and a higher chance of being cured. Stage 0 breast cancer refers to cancer confined to a breast duct without spreading into the breast tissue. As the cancer progresses into the breast tissue, the stages increase. Stage 4 breast cancer shows the cancer has metastasized to other body parts.
Symptoms of Breast Cancer
Breast cancer symptoms can encompass a range of symptoms that may hinder a person’s ability to work. Physical symptoms may include:
- Lump in the breast or underarm area.
- Changes in breast size or shape.
- Unexplained swelling or shrinkage of the breast.
- Skin irritation or dimpling on the breast.
- Breast pain that doesn’t go away.
- Nipple pain or retraction.
- Redness, scaliness, or thickening of the nipple or breast skin.
- Nipple discharge other than breast milk.
- Changes in the appearance or texture of the nipple.
- Swollen lymph nodes near the breast.
Emotionally, the stress, anxiety, and fear that accompany a breast cancer diagnosis can also affect one’s daily functioning.
Treatment Side Effects
The side effects of breast cancer treatment may be disabling. Chemotherapy, radiation therapy, and surgery can lead to symptoms such as peripheral neuropathy, lymphedema, and cognitive issues that may interfere with work responsibilities. If your symptoms or treatment side effects prevent you from working, it’s essential to explore whether you qualify for long-term disability benefits.
Qualifying for Long-Term Disability because of Breast Cancer
Qualifying for long-term disability benefits because of breast cancer involves meeting specific medical eligibility criteria and documenting the impact of the condition on daily activities.
Medical Eligibility Criteria
To qualify for long-term disability benefits because of breast cancer, individuals need to meet specific medical requirements. These criteria usually involve a detailed medical assessment by healthcare professionals to determine the severity of the cancer diagnosis and its effects on the individual’s ability to work. Medical documentation such as biopsy results, imaging studies, treatment plans, and physician reports are typically required to support the disability claim. Your long-term disability insurance policy explains the specific requirements for your claim.
Documenting Disability and Functional Limitations
When applying for long-term disability benefits related to breast cancer, it’s essential to document the functional limitations caused by the condition. This involves providing detailed information about how breast cancer affects daily activities, such as walking, standing, lifting, and concentrating. Documentation from healthcare providers, including oncologists, surgeons, and other specialists, can demonstrate the challenges you face from having breast cancer and undergoing breast cancer treatment.
We had a case where a client had surgery to remove cancerous growths. Unfortunately, the surgery resulted in significant scarring around the pectoral muscles of the patient. Because of the scarring, the patient had significant pain and had difficulty with movements such as lifting and carrying, pushing and pulling, reaching, etc. These impairments kept her from doing most work activities.
By accurately documenting the functional limitations resulting from breast cancer, individuals can strengthen their long-term disability claim and increase their chances of qualifying for financial support during their treatment and recovery period. Gathering comprehensive medical records, test results, and physician statements can provide a clear picture of the impact of breast cancer on an individual’s ability to perform essential job duties, improving your chances of obtaining long-term disability benefits.
Appealing a Denied Long-Term Disability Claim
If the insurance company denies your long-term disability claim for breast cancer, it can be disheartening and overwhelming. However, it’s crucial not to lose hope. Long-term disability denials are common, and you have the right to appeal an LTD denial. Understanding why the insurance carrier denied your claim and taking strategic steps to refute these reasons can significantly increase your chances of a successful appeal.
Reviewing the Denial Letter
The denial letter you receive contains essential information about why your claim the insurance company rejected your disability claim. Take the time to review this letter carefully, as it outlines the specific reasons for the denial. Understanding these reasons is the first step in preparing a solid appeal. Look for missing documentation, inconsistencies in the medical evidence, or other issues that led to the denial.
To strengthen your appeal, gather all the documents and information needed to address each reason cited in the denial letter. This may include medical records, test results, statements from your doctors, and any other relevant documentation. You can build a compelling case for your appeal by thoroughly reviewing and addressing the specific reasons cited in the denial letter.
Seeking Legal Assistance
Navigating the appeals process can be complex and challenging, especially when dealing with the debilitating effects of breast cancer. If you’re unsure how to proceed or feel overwhelmed by the process, you have the right to seek legal assistance. A long-term disability attorney can provide valuable guidance and support throughout the appeal process.
How an Attorney Can Help You Appeal a Long-Term Disability Denial
Navigating the complexities of a long-term disability claim for breast cancer can be overwhelming, especially when facing a denial. In such challenging times, having the support and expertise of an attorney can make a significant difference in the outcome of your claim.
- Understanding the Legal Process: An attorney specializing in disability claims can guide you through the intricate legal process with their knowledge and experience. They can explain your rights, interpret complex legal jargon, and ensure you meet all deadlines and requirements.
- Building a Strong Case: One of the key roles of an attorney is to help you build a strong case to support your disability claim. They will gather medical evidence, get statements from healthcare providers, and ensure that all necessary documentation is in order to present a strong case on your behalf.
- Advocating for Your Rights: An attorney acts as your advocate throughout the claims process, representing your best interests in communications with insurance companies and during any appeals or hearings. They will fight for the benefits you deserve and work tirelessly to overturn a denial of your claim.
- Expert Negotiation Skills: If your claim proceeds to litigation, it may involve negotiations with your insurance company to reach a fair settlement. Attorneys skilled in negotiation can use their experience to ensure you receive the maximum benefits you deserve.
- Peace of Mind: Perhaps most importantly, having an attorney by your side provides peace of mind during a challenging and often emotionally taxing process. Knowing that you have a dedicated professional handling your case can reduce stress and allow you to focus on your health and well-being.
Request a Review of Your Long-Term Disability Denial
Consider consulting with a disability lawyer who specializes in handling denied claims, such as national disability attorney Nick Ortiz. He and the experienced legal team at Ortiz Law Firm can assist you in understanding your rights, reviewing your case, preparing a robust appeal, and representing you in a lawsuit. Legal help can significantly increase your chances of a successful appeal and protect your rights throughout the process. Call (888) 321-8131 today for a free case review.
Sources
- Mayo Clinic. “Breast cancer.” Retrieved from: (https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470) Accessed on March 25, 2024.
- Centers for Disease Control and Prevention. “Breast Cancer.” Retrieved from: (https://www.cdc.gov/cancer/breast/basic_info/what-is-breast-cancer.htm) Accessed on March 25, 2024.
- World Cancer Research Fund International. “Breast cancer statistics.” Retrieved from: (https://www.wcrf.org/cancer-trends/breast-cancer-statistics/) Accessed on March 25, 2024.
Last Updated: March 25, 2024 // Reviewed and Edited by: Ortiz Law Firm