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Dealing with cancer can be more stressful for lower-income employees than for those with better-paying jobs, bigger savings accounts and better health insurance plans. Here, you'll find some advice and resources to help deal with the additional challenges, including:
- Advice from three attorneys who specialize in workplace issues of lower-income cancer patients
- Referrals to additional resources
Joanna L. Morales, Cancer Rights Attorney
Joanna is the former director of the Cancer Legal Resource Center at the Disability Rights Legal Center in Los Angeles (www.cancerlegalresourcecenter.org, 866-843-2572), as well as the CEO of Navigating Cancer Survivorship (navigatingcancersurvivorship.org), Employment and health insurance issues are often a concern of cancer patients who reach out to these organizations. Here is Joanna's best advice for lower-income workers with cancer worried about income and other work issues.
- Find out what your employer provides as a disability plan. We advise workers to check the employee policy manual. Lower-income cancer patients often worry about income when they are off work. The first place to look is the employer manual to see what the company policy is on leave time and employee benefits. It depends on the size of the employers. They need to treat all "similarly situated" workers equally. For instance, all employees who are full-time must have access to the same benefits.
- Know your rights. We walk workers through what their rights are, such as the Family Medical and Leave Act, which provides for up to 12 weeks of unpaid leave and continuing health insurance coverage for qualified employees who are seriously ill. We try to figure out if the worker is actually discriminated against. We have a panel of people we turn to, including lawyers, accountants and insurance agents, to get advice. We try to figure out the best next step to enforce the right. For instance, workers often do not know that you are still eligible for COBRA health insurance if you drop down below the minimum hours worked at which health insurance is offered. Many workers mistakenly think that COBRA applies only if you leave a job. Not so.
- Don't think of lawsuits as a first resort. Most of the time, litigation is not best for a cancer patient with job-related issues. If you like your job and want to resolve the issue, avoiding litigation may be especially important. This doesn't apply, of course, to egregious examples of discrimination, such as the time an employee was left a message on a home answering machine, told that he was being fired and it was due to the cancer. We referred that person to an attorney, and he won the case. But it's all about what you can prove in court. Winning depends on having strong evidence. Most of the time, we try to give people with work problems related to their cancer treatment solutions that do not involve litigation. Lawsuits are just time consuming. For a health insurance case, for instance, you could wait a couple of years to get to trial. Have a conversation with your boss first to try to resolve issues.
Phyllis Katz, Attorney
Phyllis Katz, an attorney at Sands Anderson Marks & Miller in Richmond, Va., is a two-time cancer survivor. She is a co-founder of LINC (Legal Information Network for Cancer, 877-644-5462, www.cancerlinc.org ). She has this advice for lower income workers with cancer.
- Think like your boss. While it's obviously a very difficult time for you, the cancer patient, especially with limited resources, absences in certain lower-income jobs may be harder for employers to tolerate. An assembly line, for instance, will be in trouble, production wise, if it is missing too many people. Being aware of how your diagnosis will affect your employer can give an added perspective.
- Compensate for that difficulty. You can do this by focusing on communication with your supervisor to minimize the inconvenience while maximizing your recovery. If you are on chemo, for instance, you may not know if you will feel well enough to go to work until right before your shift starts. Talk to your employer and let him or her know that how you feel changes from day to day, and that you can't predict how a single chemo treatment, for instance, will leave you feeling. Set up a system so that your employer knows he can hear from you within an agreed upon window, so he won't wonder if you are coming in to work that day or not. Ask your supervisor: How do you want me to handle this? By what time do I call you if I am not feeling well enough for work?
- Ask your doctor to help. He or she can do so by understanding that you have less flexibility built into your work schedule than people who are supervisors or managers might have. Ask your doctor to schedule your appointments at times that make it easier for you to meet your work demands--and to schedule you when the wait time is the least during the day. Don't be afraid to be direct: Doctor, you need to schedule my appointments so that I can work, because I have my health insurance through my job. Or I need the income and can't lose the job.
- Be "proactive" when asking your boss for accommodations. For instance, if you would like a cot to put in the break room so you can nap during lunch or coffee breaks, don't ask: Can you provide me a cot? Instead, ask: May I bring a cot to nap on during assigned breaks?
David McDaniel, Attorney
As a former attorney for LegalHealth at the New York Legal Assistance Group, David McDaniel worked exclusively with patients with cancer in the New York area, helping them to get accommodations in their work schedules or solve other job-related issues (www.nylag.org, 212-613-5095). The firm represents low-income, disabled and seriously ill clients. Here is his advice for low-income workers with cancer:
- Have a plan. "I don't think employers know what to do [when an employee is going through cancer treatment and needs workplace accommodations]. The employers don't understand the course of the cancer treatment. I help workers develop a plan, how they will carry out the job during the treatment. It might mean a change in hours, telecommuting or moving equipment closer to the cubicle. You can’t just go to your employer and say vaguely, 'I need help.' So I help workers develop a plan in writing. Then if someone [later] says, for example, 'Your hours are irregular, you can point to the plan [which spells out your agreed upon hours and other particulars]."
- Write everything down. "Keep a record of the things said [about the cancer diagnosis and work schedules], when it was said. Get a copy of all the personnel guidelines, benefit summaries, and go over them.”
- Expect less understanding on the job if this is a subsequent cancer. "I find that employers tend to be harder to deal with when it's a recurrence or when additional treatment is required [more so than an original cancer diagnosis]."
- Seek free legal help for job issues before hiring someone. Providing pro-bono services for employment related issues is a growing trend. LegalHealth, for instance, refers low-income workers to such programs regularly. Or workers can check with their local bar association to find such programs.
Legal Help for Lower-Income Workers
A number of regional legal networks operate to help patients dealing with job-related or insurance-related issues along with their cancer. Among them:
- Legal Information Network for Cancer (LINC, www.cancerlinc.org, 877-644-5462). Services include explanation of insurance benefits and help with appeal for coverage denial; the getting of public benefits such as Medicaid or Social Security Disability, management of debt, including negotiation to ward off collections, arrangements for care and custody of children.
- LegalHealth at the New York Legal Assistance Group has legal clinics for low-income patients in the New York area dealing with job and other issues, and other services (www.nylag.org, 212-613-5095).
- Cancer Legal Resource Center (www.cancerlegalresourcecenter.org, 866-843-2572) in Los Angeles offers nationwide assistance with job and health insurance related issues.
- The Patient Advocate Foundation (www.patientadvocate.org, 800-532-5274) offers counseling as well as referrals for cancer patients dealing with job discrimination, insurance issues and other problems.
Payment for Treatments
A number of nonprofit organizations can help with financial assistance when treatment expenses for cancer are overwhelming. A sampling:
- CancerCare (www.cancercare.org, 800-813-4673), offers financial assistance in the form of limited grants for certain treatment expenses. Services also include practical help and support via the free phone line or the website.
- National Marrow Donor Program (www.marrow.org, 888-999-6743) has a patient assistance program that helps with costs for searching the donor program registry and some post-transplant costs.
- The Leukemia and Lymphoma Society (www.lls.org, 800-955-4572) offers some financial aid to patients with leukemia, non-Hodgkin lymphoma, Hodgkin's lymphoma or multiple myeloma who qualify as needing the assistance.
- The Patient Advocate Foundation (www.patientadvocate.org, 800-532-5274) also sponsors a Co-Pay Relief program for qualified patients.
- The Federal Health Resources and Services Administration (HRSA) Bureau of Primary Health Care has health centers nationwide that provide health care based on ability to pay. To locate a health center, visit the web page at http://findahealthcenter.hrsa.gov/Search_HCC.aspx.
Payment for Medications
Relief from the high costs of medications is often needed. Among the organizations that help:
- NeedyMeds, at www.needymeds.com, is a nonprofit that helps patients by referring them to patient assistance programs to help with medication costs.
- Patient assistance programs are offered by some pharmaceutical companies. To find them, ask your doctor or social worker or find the drug's manufacturer and visit the company site. Look for a section titled "patience assistance programs" or similar wording.
Payment for Transportation and Lodging
- Hope Lodge is a housing program supported by the American Cancer Society, providing free housing on a temporary basis for cancer patients undergoing treatment. For information and a listing of lodges, visit the web site at http://www.cancer.org/docroot/subsite/hopelodge/index.asp or call 800-227-2345.
- Road to Recovery, another ACS program, offers transportation to and from treatments for cancer patients. More information is available by calling your local ACS office or the toll-free national number, 800-227-2345.
Fundraise to Cover Expenses
- Give Forward is a website where you can ask family and friends to donate to your treatment, medications etc., thus helping to ease your financial burden. Simply create a customizable site for your cause and you're up and running!