Cancer is a disease that afflicts hundreds of thousands of Americans each year. It is the number two cause of death in the United States, accounting for nearly 1 out of 4 deaths each year. However, in the context of Long-Term Disability (LTD) insurance coverage, cancer is somewhat unique in that the measures used to treat the disease can cause more significant impairments than the disease itself.
It is well known that cancer can occur in numerous places throughout the body. It most commonly appears in soft tissue tumors of the neck or head, various glands, the skin, skeletal system, breasts and in organs such as the stomach, pancreas, and prostate. If the cancer metastasizes, it can spread to other regions of the body. Because of all of the different variations in location, stage, responsiveness to treatment and side effects it is hard to predict the kinds of challenges a claimant may face when filling a cancer based disability claim. It is critical to have as clear a medical understanding as possible of the facts of a given case.
The unfortunate reality about cancer is that even in successfully treated cases not all cancer survivors are able to resume their “normal” lives after beating the disease. Treating and beating cancer is very hard on the body and can result in permanent damage. Radiation, chemotherapy, surgery and other treatments can all cause permanent damage to nerves and organs at or near the site of the cancer. This damage can result in chronic pain, and/or loss of sensation, control or functional capacity over parts of their body. When this occurs, it can have a significant impact on an insured’s ability to perform the same functions as before. Such problems are the hallmark of any long-term disability.
One of the obstacles that many claimants will face when applying for LTD benefits as the result of disabilities caused by cancer or cancer treatments is the uncertainty that surrounds the nature of the disease. Some claimants find that an insurance carrier will delay making a determination for as long as possible in an attempt to wait and see what course the disease takes. Another common issue has to do with present value assessments and with evaluating a claimant’s life expectancy. The argument often made by the insurer is that even when the disease has been arrested, a claimant who has had cancer is more likely to have it again and thus, their life expectancy is reduced. Responding effectively to this, and other arguments by insurers common in these cases requires strong and accurate opinion testimony by credible oncologists and other experts. Without such evidence these cases can be, and often are, substantially under settled.
Written by Alex MacDougall and Ray Bourhis