Pancreatic Cancer and Long Term Disability: What You Need to Know

Does pancreatic cancer qualify as a long term disability?

Yes, you may qualify for long term disability insurance benefits because of pancreatic cancer.  Pancreatic cancer is a serious condition that may result in long term disability due to its symptoms and the potential impact of treatment side effects.

Despite the seriousness of pancreatic cancer, your insurance company will not automatically approve you for benefits on the basis of a diagnosis alone.  Your insurer will require you provide proof of the severity and frequency of your pancreatic symptoms and evidence of how these symptoms affect your ability to work before approving benefits.

Below we will discuss how pancreatic cancer causes disability, how to prove your pancreatic cancer is disabling, and how an experienced ERISA attorney can help you successfully file a claim for long term disability benefits.

How does pancreatic cancer cause disability?

Pancreatic cancer is a stomach cancer that originates in the pancreas tissue.  If left untreated, pancreatic cancer will spread to other organs in the body.  The symptoms of pancreatic cancer may include pain, digestive problems, and fatigue, all of which may affect your level of functionality and prevent you from working.

Treatment options for pancreatic cancer such as surgery, chemotherapy, and radiation therapy can cause side effects that may also limit your ability to function normally.  You may require ongoing care and support after treatment, which can also contribute to a long term disability.

Disabling Symptoms of Pancreatic Cancer

Pancreatic cancer can cause disability in several ways, depending on the stage of the cancer and the specific symptoms and complications you experience.  Some of the disabling symptoms caused by pancreatic cancer include:

• • Pain: Pancreatic cancer can cause severe and chronic abdominal pain.  This pain can limit your ability to perform daily activities, including work, and may require ongoing pain management.
  • Fatigue: Pancreatic cancer can cause significant fatigue, making it difficult for you to carry out your job functions and other daily activities, as you may require extra rest and support.
  • Digestive problems: Pancreatic cancer can interfere with the normal functioning of the pancreas, leading to digestive problems such as nausea, vomiting, and diarrhea.  These symptoms can be severe and make it difficult for you to perform your job duties on a regular and consistent basis.
  • Weight loss: Many people with pancreatic cancer experience significant weight loss, which can be due to a combination of factors such as a loss of appetite, digestive problems, and cancer-related cachexia.  This weight loss can weaken your overall health and limit your ability to perform daily activities, including work.

Stages of Pancreatic Cancer

Like most cancers, pancreatic cancer is measured in stages:

• • Stage I: When the tumor is smaller than two centimeters and limited to the pancreas.
  • Stage II: When the tumor has begun growing outside of the pancreas, but has not spread to any major blood vessels.  At Stage II, the tumor may have spread to lymph nodes.
  • Stage III: The tumor has spread outside of the pancreas to major blood vessels and/or nerves.
  • Stage IV: The cancer has spread to other areas of the body outside the pancreas, beyond blood vessels and nerves, such as the liver.

Pancreatic cancer often is not diagnosed until later stages due to the prevalence of symptoms only emerging once the cancer has progressed.  Oftentimes symptoms do not appear until the pancreatic cancer has spread to other organs.  Additionally, pancreatic tumors are not discoverable during routine examinations, meaning that it is difficult to catch in the early stages.

Cancer Treatment Side Effects

As discussed above, typically pancreatic cancer is not detected until advanced stages.  By the time you receive a diagnosis, your symptoms may be very severe and require aggressive treatment.

Treatment options for pancreatic cancer may include:

• • Surgery
  • Chemotherapy
  • Radiation therapy

Each of these treatment options may cause significant side effects that limit your ability to function normally.  For example, surgery may cause pain and limit mobility, while chemotherapy and radiation therapy may cause fatigue, nausea, and other symptoms.

When filing a long term disability claim for pancreatic cancer, make sure to document any treatment side effects that impair your ability to work.  Your insurer will take these into account when reviewing your claim.  In some cases, your cancer treatment side effects may be the main cause of your disability compared to your pancreatic cancer diagnosis.

How do I prove pancreatic cancer disability to my insurer?

Your insurer will not approve your pancreatic cancer disability claim with a diagnosis alone.  Instead, they will require you to provide substantial evidence of your pancreatic cancer symptoms and explain how they specifically prevent you from working.  Below we’ll expand on the types of evidence you can submit to your insurer to prove your medical disability and inability to work due to pancreatic cancer.

Objective Medical Evidence of Pancreatic Cancer Disability

One of the best ways to prove your pancreatic cancer disability claim is with objective medical evidence.  Objective medical evidence of your pancreatic cancer may include:

• • Proof of your diagnosis: Pancreatic cancer can be diagnosed in a number of ways, including by CT scan, PET scan, MRI, ultrasound, biopsy, and tissue testing.  The results of these tests and imaging demonstrate the presence of your tumor and can be submitted to your insurer as evidence of your pancreatic cancer and progression of the disease.
  • Medical records: Medical records from your treating providers can include office visit notes, test results, and treatment summaries.  These records can help demonstrate the progression and severity of your condition and the impact on your ability to work.  Additionally, if you suffer from severe treatment side effects, these records will reflect your treatment schedule and any related symptoms that result.
  • Keep a “bad news” symptom diary: Keep a daily record of the symptoms you experience, including pain, fatigue, and digestive problems.  The more detailed you are, the better.  This diary can provide important details about the impact of your condition on your daily activities.
  • Obtain a letter from your healthcare provider: Ask your healthcare provider to write a letter that details your diagnosis, treatment plan, restrictions and limitations due to your symptoms, and prognosis.  This letter can help provide additional documentation to support your claim.  It’s generally recommended to obtain this letter from your oncologist or other specialist, who will be most familiar with your pancreatic cancer and related symptoms.
  • Neuropsychological Evaluation: If your pancreatic cancer or cancer treatment side effects cause significant cognitive impairment, you may consider undergoing a neuropsychological evaluation.  A neuropsychological evaluation is an assessment of your cognitive abilities conducted by a neuropsychologist.  The evaluation tests different areas of cognitive functions including memory, processing speed, reasoning, recall, and mood.  The results of the neuropsychological evaluation can provide your insurer with objective evidence of how your condition impairs your cognitive abilities.
  • Functional Capacity Evaluation: A Functional Capacity Evaluation (“FCE”) may be a good option if your pancreatic cancer and/or cancer treatment side effects cause physical symptoms.  The FCE measures different areas of your physical functioning, such as ability to sit, stand, walk, squat, hand dexterity, strength, and endurance.  The results of the FCE can demonstrate to your insurer any physical limitations and restrictions caused by your pancreatic cancer.

Vocational Evidence of Pancreatic Cancer Disability

Along with objective medical evidence, your insurer will require proof that you cannot work due to your pancreatic cancer symptoms.  There are various kinds of vocational evidence you can submit to your insurer to explain your job role and occupational duties.  This includes:

• • Your resume: Your resume provides valuable information on your education, work history, special skills, certifications, and other background;
  • Your official job description: An official job description from your employer will outline your job responsibilities and duties;
  • A personal affidavit: You may consider writing a personal affidavit that explains the physical and cognitive demands of your job role, your day-to-day responsibilities, the onset of your pancreatic cancer disability and how these symptoms prevent you from working;
  • A statement from your employer and/or co-worker(s): You may have your employer and/or a co-worker write a personal statement that attests to your job role and functions, and any decline in your performance due to your pancreatic cancer they have witnessed;
  • A vocational expert’s report: A vocational expert can provide you an in-depth assessment of your occupation, its material duties, and their expert opinion on how your pancreatic cancer symptoms prevent you from performing your job role.

All of this vocational evidence can give your insurer a clearer idea of the demands of your job and how your pancreatic cancer impacts your ability to perform your occupational duties.

How can an attorney help me get long term disability for pancreatic cancer?

Proving pancreatic cancer disability to your insurer can be a complex process, and it is important to have a clear understanding of the specific requirements and procedures of your insurer.  To file a successful long term disability claim, you must support your claim with sufficient medical evidence and proof of appropriate treatment.  Knowing how to substantiate your claim will significantly increase your chances of approval.

An experienced long term disability attorney will know how best to substantiate your claim with evidence of your pancreatic cancer diagnosis, symptoms, cancer treatment side effects, and the physical, cognitive, and emotional impairments your condition causes, as well as how they specifically interfere with your job duties.

If you’re looking to file a long term disability insurance claim for pancreatic cancer, appeal a wrongful claim denial, or litigate your insurer, Riemer Hess can help. Contact us today at (212) 297-0700 or click the button below for a consultation on your disability case.