Taking Medical Leave While Dealing with Sarcoma

Laura Singleton is a leiomyosarcoma patient. In this article, she provides some basic information to help sarcoma patients and their families think through employment issues that may arise during cancer treatment.

Cancer can cause work interruptions for patients and their loved ones. Fortunately, the United States federal government provides most workers with job protection if they need time off for family or medical leave.

As workers, it is our responsibility to know our rights and obligations, as well as our employer's rights and obligations, when it comes to medical situations. As unfair as that may sound to a person dealing with cancer, it is a reality, and it is imperative that we educate ourselves for the best possible outcome.

Know the FMLA

Cancer patients and their families should consider reading the Family and Medical Leave Act (FMLA) or the Employee's Guide to the FMLA. Becoming familiar with its rules and restrictions is a great step toward educating yourself and knowing your rights.

Generally speaking, FMLA grants a worker a total of 12 weeks of job-protected leave in a 12-month period. FMLA does not guarantee or provide for pay during leave; instead it guarantees leave with the ability to return to work and the ability to stay medically insured (at the worker's expense) during the leave period.

An employer has the right to terminate an employee who does not return to work after exhausting 12 weeks of FMLA leave in a 12-month period. This is not bullying; this is their right. Employers have the right to require appropriate medical documentation stating whether an employee can or cannot return to work. Many employers will terminate an employee on the first day after the last day of leave if an employee cannot or does not return to work.

Know Your Employer's Policies and Benefits

It is important to obtain a copy of your employee handbook (if your employer publishes one) and to read it very carefully. Learn and know what your employer's policies are specifically in regard to leave, vacation time, sick time, short term disability, and long term disability. Often someone within the organization's human resources department can clarify these policies.

Short Term Disability (STD) and Long Term Disability (LTD) Insurance

Find out if you have STD and/or LTD insurance as a benefit. If you do, READ the policies.  If you don't and you have the opportunity to sign up for it during your company's enrollment period - DO IT! Short and Long Term Disability insurance policies are designed to replace income during a period when one is unable to work for medical reasons. This is an INSURANCE BENEFIT that can be offered by employers and private insurance companies. It has nothing to do with FMLA or SSDI, and no employer is required to offer it as a benefit for their employees, but many do. It is even possible to purchase STD/LTD privately if they are not offered by your employer.

Generally speaking, Short Term Disability (STD) replaces a worker's pay at an average rate of about 65% while he is out on approved STD leave, usually up to 12 weeks. This has nothing to do with FMLA. An employee can have a STD benefit and work for a company that does not qualify under FMLA. An employee can work for a company that does qualify under FMLA but does not offer an STD insurance benefit. An employee can work for a company that does qualify under FMLA and does offer STD insurance. Research and know your situation.

Generally speaking, if a worker is medically unable to return to work after exhausting 12 weeks STD leave, he will usually transition to Long Term Disability (LTD). LTD generally replaces earnings at about the same rate of 65% until usually one is able to resume working or turns 65. Typically, when an employee transitions from STD to LTD, the employee is terminated by his employer. 

Social Security Disability Insurance (SSDI)

An LTD policy typically requires that LTD recipients apply for Social Security Disability Insurance (SSDI) within a certain time frame. Once approved, a person receives his SSDI. His LTD just makes up the difference, if there is any, to reach the 65% earnings replacement. For example, if one earns $100 per month normally, on LTD he would earn $65.00. If he is approved for $50 per month from SSDI, LTD kicks in the other $15 totaling still $65. 

BEWARE: You cannot "double dip" in this system. If you have received STD or LTD payments, and later SSDI retroactively awards you disability benefits for the same period of time, you will have to reimburse your STD/LTD company for the "overpayments." Ex: You begin receiving LTD in February of 2013, and now it is December 2013. Your SSDI is approved and SS deemed you disabled in February 2013.  You have already collected LTD from Feb to December. SSDI pays you retroactive to the date you were deemed disabled, in this case Feb 2013. Your LTD insurance company will be informed of your SSDI award and will require that you reimburse them for payments made to you equal to the amount you received lump sum from SSDI.

Health Insurance Issues

If you are not receiving a paycheck directly from your employer during FMLA leave, they have no mechanism (your paycheck) by which to deduct your health insurance premiums! That means that you will likely have to actually write your employer a check each month, or bi-weekly, or however often payments are normally required by your your health insurance company in order to keep up your insurance. If you do not pay, they are not obligated to continue your insurance. Remember this above all else! Find out how much is required how often, and make sure your payments are in the right hands on time.

Lastly, in transitioning from STD to LTD, most people can go on COBRA for continued health insurance coverage. A qualified disabled person can extend his COBRA eligibility for up to 29 months if needed. COBRA can be extremely expensive, so no one wants to be on it for long, but it is an option if it is needed as a bridge. If COBRA is simply too expensive for your family, it may also be possible to apply at the Health Insurance Marketplace to obtain a less expensive (and potentially government-subsidized) policy.

Editor's Note: It is important to understand that even the most expensive policies in the Health Insurance Marketplace may offer a more limited network of physicians and hospitals, more managed care (less patient choice), higher deductibles and higher co-pays than employer-provided policies. Sarcoma patients can lose guaranteed insured access to their sarcoma specialists/teams when switching insurance policies. Indeed, there are serious costs for any cancer patient, especially one with a rare disease, to consider before switching insurance plans (and possibly giving up high-quality insurance when it is needed most).


While it is difficult to consider, cancer can cause the loss of a job and benefits. There are some companies that do much more than the law requires to assist their employees during medical crises. Most employers, however, will follow the government guidelines set forth by the FMLA.

This article provides a general overview of the issues that workers dealing with cancer should consider. It is critical that each cancer patient knows the law, understands his situation as fully as possible, and acts accordingly.