Coping with ovarian cancer is physically, emotionally, and financially challenging. If your condition prevents you from working, long term disability benefits can provide crucial financial support. However, navigating the claims process can be complex, especially when insurers scrutinize your diagnosis, symptoms, and treatment to determine whether you meet the strict criteria for disability. Understanding your rights, the evidence required, and the potential hurdles can make all the difference in securing the benefits you deserve.
Below, we鈥檒l answer common questions about obtaining long term disability benefits for ovarian cancer. Whether you鈥檙e considering exiting work, facing a claim denial, or wondering if part-time work is an option, this information can help improve your chances of securing the benefits you deserve.
Yes, you can qualify for long term disability benefits if you have ovarian cancer, but your eligibility depends on the specific terms of your disability insurance policy and how your condition affects your ability to work. Most policies require that you meet the definition of disability, which usually means proving that you are unable to perform the essential duties of your job. Some policies evaluate whether you can do your own job (referred to as 鈥渙wn occupation鈥� coverage), while others may later require you to show that you cannot perform any job for which you are reasonably qualified (鈥渁ny occupation鈥� coverage).
To qualify, you鈥檒l need to demonstrate that your ovarian cancer or its treatment causes significant limitations that prevent you from working. These limitations can include:
Most policies also have additional requirements. This includes being under the regular care of a physician, following recommended treatments (unless there are valid medical reasons not to), and satisfying a waiting period, during which you must be continuously disabled before benefits begin. Policies can also have limitations, such as restrictions on benefits for certain conditions or for disabilities related to mental health. Understanding your policy鈥檚 specific language is crucial to determining your eligibility.
If your ovarian cancer prevents you from working and you meet your policy鈥檚 requirements, you may qualify for long term disability benefits. However, the claims process can be complex, and insurers may challenge applications, making it important to submit a detailed and well-documented claim. An experienced long term disability attorney can interpret the terms of your policy to clarify whether you are eligible for benefits and provide guidance throughout the claims process.
Undergoing chemotherapy or other treatments for ovarian cancer can significantly impact your long term disability claim, as these treatments often cause debilitating side effects that may interfere with your ability to work. Insurance companies will evaluate how your treatment plan affects your physical and cognitive functioning, and this information can be crucial in proving your eligibility for benefits.
Chemotherapy, radiation, and surgeries are common treatments for ovarian cancer, and they often result in a range of side effects that could support your claim, including:
These side effects can prevent you from meeting the physical and mental demands of your job. For example, if your position requires physical activity, standing for long hours, or high cognitive demands like intense concentration, the cumulative impact of these symptoms may make it impossible for you to work. Even sedentary jobs can become unmanageable if your cognitive or emotional symptoms impair your ability to focus or process information.
Medical evidence is the foundation of your ovarian cancer long term disability claim. Examples of medical evidence you can submit to your insurer include:
Vocational evidence is equally important to show how your condition impacts your ability to perform your specific job or any job for which you are qualified. This can include:
Specialized medical evaluations can provide further objective evidence to support your claim:
Combining medical and vocational evidence with objective testing creates a compelling case for why your ovarian cancer and its effects prevent you from working. A well-documented claim leaves less room for insurance companies to dispute your limitations, increasing your likelihood of approval.
Demonstrating the severity of your ovarian cancer symptoms to the insurance company requires both detailed documentation of your experiences and supporting medical evidence. Since many symptoms of ovarian cancer, such as fatigue or pain, are subjective and not easily measured through medical tests, it鈥檚 essential to present a thorough and credible case that ties these symptoms to your inability to work.
Symptom logs or diaries can play a key role in demonstrating the day-to-day impact of your condition. These logs should include:
One of the challenges of proving subjective symptoms is that they cannot always be confirmed by medical tests alone. Insurers may argue that without objective evidence, your symptoms are exaggerated or insufficient to warrant benefits.
To address this, your self-reported evidence must be supported by objective evidence whenever possible. For example:
Your healthcare providers can also substantiate your symptoms through their professional observations. Statements from your oncologist or other specialists should describe:
When subjective symptoms are well-documented and backed by objective medical evidence and expert opinions, they become more difficult for insurance companies to dismiss. Combining these sources of evidence creates a complete and credible case for the severity of your symptoms and their disabling impact. Consider consulting with a long term disability attorney who can work with you on how to most effectively build and present your evidence for your claim.
Insurance companies often deny long term disability claims for ovarian cancer not because the claims lack merit, but because they are incentivized to minimize payouts. Denials may be based on a narrow interpretation of your medical records or an overemphasis on gaps or inconsistencies in your evidence. Unfortunately, even when you are legitimately unable to work, insurers may attempt to find ways to reject or undervalue your claim to protect their bottom line.
Many denials hinge on technicalities or arguments that overlook the day-to-day realities of living with ovarian cancer. These tactics can feel frustrating and unfair, especially when you鈥檙e coping with the physical and emotional toll of your diagnosis.
Some of the most common reasons insurers deny ovarian cancer long term disability claims include:
Understanding the tactics insurers use helps you anticipate potential challenges and strengthen your case. It鈥檚 always recommended that you speak with a knowledgeable ERISA disability attorney. An experienced attorney will be familiar with these common insurer tactics and understand strategies to refute them effectively.
If your claim for ovarian cancer-related long term disability benefits is denied, you have the right to appeal the decision. Under ERISA (the 鈥�Employee Retirement Income Security Act鈥�), the appeal process is a critical step and may be your last opportunity to avoid costly and time-consuming litigation. It鈥檚 essential to approach this process carefully and thoughtfully to maximize your chances of success.
The first step in an ERISA appeal is to review the denial letter from your insurance company. This letter must explain the reasons for the denial and provide information about the evidence they relied on to make their decision. It will also outline the deadlines for filing your appeal, which are strict and usually require you to submit your appeal within 180 days of receiving the denial. Missing this deadline can permanently bar you from pursuing benefits.
When preparing your appeal, it鈥檚 important to provide all the evidence necessary to support your claim, as ERISA regulations generally prohibit introducing new evidence later if you proceed to litigation. This means your appeal is your final chance to submit:
The appeal process can be complicated, and insurers may use your submission to further scrutinize or deny your claim. For these reasons, it鈥檚 highly recommended to consult with an experienced ERISA attorney before filing your appeal. An attorney can help you identify gaps or weaknesses in your initial claim that led to the denial, gather and present the strongest possible evidence to support your appeal, and navigate the procedural requirements to ensure your appeal is timely and compliant with ERISA rules.
If your appeal is successful, your insurance company may reverse its decision and approve your benefits. However, if the appeal is denied, your next option is to file a lawsuit in federal court. Litigation under ERISA can be expensive and complex, making a strong appeal critical to avoiding this step whenever possible.
Appealing an ERISA denial is often your best chance to secure the benefits you deserve without entering into litigation. By consulting with an attorney and carefully preparing your appeal, you can give yourself the best chance of success and avoid the challenges of a prolonged legal battle.
Some long term disability policies include provisions for partial or residual disability benefits. These benefits may be available if you can work part-time but are unable to work full-time or earn as much as you did before your diagnosis.
To qualify for residual disability benefits, you鈥檒l typically need to demonstrate:
If your policy offers these benefits, your insurance company may reduce your monthly payment based on how much you鈥檙e earning from part-time work. This is often calculated using a formula outlined in your policy, such as deducting a percentage of your new earnings from your total benefit amount. Reviewing your policy鈥檚 language is essential to understanding how this calculation is applied. Having an attorney review your policy can be especially important to identify provisions that could impact your ability to earn part-time income while maintaining your benefits.
Even if your policy allows part-time work, it鈥檚 crucial to proceed with caution. Insurance companies may scrutinize your ability to work, arguing that if you can handle part-time employment, you might be able to work full-time or in a different capacity. Before returning to work, consulting with an attorney experienced with disability claims is highly recommended. They can review your policy, help you navigate its terms, and ensure that your part-time work does not inadvertently harm your claim. With their guidance, you can avoid pitfalls that might lead to a denial or termination of your benefits.
At Riemer Hess, we have over 30 years of experience helping professionals and executives secure the long term disability benefits they need to protect their livelihoods during challenging times. We understand the proven strategies for dealing with unfair insurer tactics, and our high-touch client service ensures you are well-supported at each step of the process.
Here is an example of a client we helped secure long term disability due to ovarian cancer:
Our client 鈥淟ucy鈥� turned to us for help after being diagnosed with ovarian cancer. As a senior financial analyst in a high-pressure role that required long hours and sharp cognitive focus, Lucy knew she could not continue working while undergoing intensive chemotherapy. She reached out to Riemer Hess to help navigate the disability claims process and protect her financial security during her medical leave.
Lucy鈥檚 diagnosis came just weeks before her first round of chemotherapy, and she needed to act quickly to secure short term disability benefits. Our attorneys immediately assessed her situation and crafted a personalized strategy to ensure she would have the support she needed. We prepared a comprehensive disability certification letter for Lucy鈥檚 oncologist, emphasizing how her job鈥檚 demanding nature made it impossible to perform while enduring the treatment鈥檚 grueling side effects. Simultaneously, we gathered critical medical evidence, including the operative report from her surgery, biopsy results, her chemotherapy plan, and treatment notes.
With these documents in hand, we submitted proof of claim for her state disability benefits, Family and Medical Leave Act (鈥淔MLA鈥�) coverage, and short term disability benefits with her insurer鈥攁ll before her treatment began.
As Lucy鈥檚 chemotherapy progressed, she experienced serious cognitive symptoms, including memory and focus issues, which prevented her from returning to work when her short term disability benefits were set to end. Riemer Hess stepped in to ensure a seamless transition to long term disability benefits. We coordinated with Lucy鈥檚 providers to gather updated medical evidence and secure the necessary documentation, while also submitting detailed statements from Lucy about how her symptoms affected her ability to perform her job. We referred Lucy to undergo a neuropsychological evaluation to further substantiate her cognitive impairment to her insurer. This proactive approach ensured Lucy鈥檚 benefits continued uninterrupted.
Over time, Lucy鈥檚 condition improved, and she expressed a desire to return to work. Riemer Hess carefully worked with her, her providers, and her employer to develop a plan that allowed her to resume her duties while safeguarding her benefits during the transition. With Riemer Hess鈥檚 guidance, Lucy successfully returned to her career without jeopardizing the financial support she had relied on throughout her recovery.