Legal Issues and Cancer - January 2019 Webinar

Legal Issues and Colorectal Cancer

TODAY’S WEBINAR
 SPEAKER(S)
 Monica Fawzy Bryant, Esq.
 QUESTIONS
 Ask a question in the panel on the RIGHT SIDE of your
screen
 WEBINAR ARCHIVE
 FightCRC.org/webinar
 TWEET ALONG
 Follow along via Twitter – use the hashtag #CRCWebinar

RESOURCES
TABOO-TY PODCAST MINI MAGAZINES YOUR GUIDE IN THE FIGHT

FIGHTCOLORECTALCANCERDISCLAIMER
The information and services provided
by Fight Colorectal Cancer are for
general informational purposes only.
The information and services are not
intended to be substitutes for
professional medical advice,
diagnoses or treatment.
If you are ill, or suspect that you are ill,
see a doctor immediately. In an
emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never
recommends or endorses any specific
physicians, products or treatments for
any condition.

MonicaFawzyBryant,Esq Monica is a cancer rights attorney, speaker, and author, dedicated to improving access
to, and availability of, quality information on healthcare-related issues. Monica is the
Chief Operating Officer for Triage Cancer, a national, non-profit organization that
provides education and resources on cancer survivorship issues.
Previously, Monica was Midwest Regional Director for a national cancer rights
organization she forged relationships with cancer organizations, hospitals, law firms,
other community partners, and members of underserved communities. Prior to
relocating to Chicago, Ms. Bryant served as Legislative Counsel for U.S. Congresswoman
Linda T. Sanchez and Law Clerk for U.S. Senator Dianne Feinstein. During her time in
Congress, Ms. Bryant focused on health, justice, civil rights, and women’s issues. She
was also heavily involved in the nomination hearings for United States Supreme Court
Chief Justice John Roberts and Justice Samuel Alito.
Throughout her career, Monica has provided hundreds of educational seminars, written
articles and blogs, and appeared on community television and radio shows discussing
healthcare-related legal issues.
Additionally, Monica is an Adjunct Law Professor at John Marshall School of Law in
Chicago, teaching a class on Cancer Rights. Monica currently serves on the Executive
Committee of the American Bar Association’s Breast Cancer Task Force.
Monica received a Bachelors of Arts degree in Law & Society, with an emphasis in
criminal justice, and Psychology from the University of California Santa Barbara and a
Juris Doctor from The George Washington University Law School. She is a member of
both the California and Illinois State Bars.

Legal Rights After a Cancer Diagnosis
This presentation provides general information on the topics presented. The authors and presenters are not engaged in rendering any
legal, medical, or professional services by its presentation or distribution. Although this content was reviewed by a professional, it should
not be used as a substitute for professional services.
No part of this presentation may be reproduced, distributed, or transmitted in any form or by any means, without the prior written
permission of the author, except properly attributed, noncommercial uses permitted by copyright law. For permission requests, contact the
authors at info@triagecancer.org
© 2019 Triage Cancer
Monica Bryant, Esq.
Cancer Rights Attorney
COO, Triage Cancer

7© 2019 Triage Cancer
About Triage Cancer
Triage Cancer is a national,
nonprofit organization that
provides education on the
legal and practical issues that
may impact individuals
diagnosed with cancer and
their caregivers.

Triage Cancer Speakers Bureau
International Speakers Bureau of experts & survivors experts in the areas of medicine,
mental health, nursing, social work, patient navigation, nutrition, oncofertility, law,
employment, education, financial management, insurance, relationships, sexuality and
intimacy, pain and palliative care, advocacy, and other areas of cancer survivorship

Triage Cancer Educational Events
In-person educational events for:
• Patients & survivors
• Caregivers
• Advocates
• Health care professionals
• & others
https://TriageCancer.org/Events

Triage Cancer Conferences
In-person educational events for:
• Patients & survivors
• Caregivers
• Advocates
• Health care professionals
• & others
Topics:
• Being an Advocate
• Health Insurance
• Finances
• Being Prepared
• Employment
• Disability Insurance
Free CEUS for nurses and social workers
2019:
• Chicago, IL – 5/11
• Chapel Hill, NC – 9/14
• Colorado - TBD
https://TriageCancer.org/Conferences

Triage Cancer Webinar Series
Recordings of Past Webinars https://TriageCancer.org/Past-Webinars
Free CEUs for nurses & social workers
• January 23 – Employment Rights After A
Cancer Diagnosis

Triage Cancer Materials
Quick Guides:
• ADA
• Reasonable Accommodations
• Chemo Brain
• Disclosure
• FMLA
• FMLA & Other Benefits
• COBRA
• Medicare
• Clinical Trials
• Medical Marijuana
• Bankruptcy
• Estate Planning
• Stress Management
• Legal Assistance
• Advocacy
• Legislative Advocacy
• Scientific Advocacy
http://TriageCancer.org/QuickGuides
Order form at:
TriageCancer.org/MaterialRequest
Checklists:
• Getting Organized
• Reasonable
Accommodations
Spreadsheets
• Financial Big Picture
Appeals Tracking Form

Triage Cancer Animated Videos
https://TriageCancer.org/AnimatedVideos
13

Triage Cancer International, National,
& State Resources
• State Government & State Legislative Information
• State Comprehensive Cancer Control Program & Plan
• Employment
• Estate Planning
• Medicaid & Medicare
• Clinical Trials
• Legal Assistance
• Advocacy
• Cancer Survivorship Research
• Cancer Community Partners https://triagecancer.org/resources

Triage Cancer Chart of State Laws
Employment, disability and health insurance, estate planning, & more
https://TriageCancer.org/StateLaws

CancerFinances.org

Triage Cancer Educational Blog
& E-Newsletter
http://triagecancer.org/blog

Putting Together The Pieces

Federal Laws, Regulations, & Programs
1
2
3
4
5
The Whole Picture
State Laws, Regulations & Programs
Finances, Medical Bills, & Assistance
Programs
Insurance Coverage: Health, Disability,
Life, etc.
Employer Policies & Benefits

Don’t Understand Health Insurance?
You Are Not Alone.
20
• Only 23% understood terms used in their
health policy
• Only 50% knew their monthly premium
• Only a few understood acronyms: HMO (36%),
PPO (20%) & HSA (11%) (eHealth, 2008)
• When asked to define insurance terms and
calculate their bill only 50% got it right (The
Regence Group, 2008)

Health Insurance Terms
Cost to Have Health Insurance
• Premium – each month
Costs When You Use Your Health Insurance
• Deductible – each year (fixed $ amount)
• Co-Insurance or Cost-Share – each time you get care (%)
• Co-Payment – each time you get care (fixed $ amount)
• Out-of-Pocket Maximum* =
deductible + co-payments + co-insurance
21
*usually only for in-network services

Case Study: David
David’s Plan: Deductible = $2,000
Co-insurance = 80/20 plan
OOP Max = $4,000
If David has a $102,000 hospital bill, what does he pay?
1. His deductible of $2,000
$102,000-$2,000 = $100,000 left
2. His co-insurance amount of 20%
20% of $100,000 = $20,000
But OOP max is only $4,000. So, he would only pay the $2,000 deductible +
$2,000 of the $20,000 co-insurance amount, for a total of $4,000.
22

ACA Health Insurance Rights (after 1/1/14)
1. Premium Rating
• Individual vs. Family Plan
• Geographic Location (Ex: CA has 19 regions)
• Age (64 can only be charged 3 times more than a 21 year old)
• Tobacco (some states have eliminated this – CA, DC, etc. )
2. No Pre-Existing Condition Denials/Exclusions
•Insurance companies cannot look at:
•Pre-existing condition (physical or mental) or health history
•Gender or age
23
Latest news:
Idaho
Iowa Farm Bureau
Texas vs. US

Short-Term Health Insurance Plans
24
Short‐term plans:
• Should have been eliminated under ACA & don’t have ACA protections
• Can exclude things like chemo
• High out‐of‐pocket costs, even if lower monthly premium
• Can end mid year
• Does not = creditable coverage or trigger SEP
Review of 45 short-term plans showed:
• 43% don’t cover mental health services;
• 62% don’t cover substance abuse treatment;
• 71% don’t cover outpatient prescription drugs; and
• None of the plans cover maternity care

Most U.S. citizens & lawfully present must have health
insurance
5
ACA Requirement to Have Health Insurance
How much is the penalty?
Fine collected through IRS
annual taxes
What coverage counts?
Employer or Individual Plans COBRA/HIPAA Plans
Medicare, Medicaid, Veterans Health High Risk Pools, & others
Latest news:
Individual Mandate
penalty drops to $0
in 2019
Year Adult
Penalty
Child
Penalty
Family
Max
or % of Income,
whichever is more
2014 $95 $47.50 $285 1%
2015 $325 $162.50 $975 2%
2016, 2017, 2018 $695 $347.50 $2,085 2.5%
2019 $0

https://triagecancer.org/texas-ruling-aca-cancer-community

ACA’s New Health Insurance Option
• “Exchanges” = insurance shopping mall
• Benefits:
• Cap on OOP max: $7,350 individual / $14,700 family
• $7,900 individual / $15,800 family (2019)
• Financial help
• Premium tax credits
• Cost-sharing subsidies
• No longer funded!
• Essential Health Benefits = Quality Control
27
State Health Insurance Marketplaces
Ins.
Company
Government:
Medicare, Medicaid,
Military, IHS, High
Risk Pools, etc.
Employer

Standardized cost-share:
Catastrophic coverage (under 30 or $ hardship)
28
Marketplace Plan Options
Now may
be 66%

© 2019 Triage Cancer 29
When to Enroll?
• Medicaid applications accepted year round
• 2019 Open Enrollment: Nov. 1 – Dec. 15, 2018
• D.C.: November 1, 2018 – January 31, 2019
• California: October 15, 2018 – January 15, 2019
• Massachusetts: November 1, 2018 – January 23, 2019
• Minnesota: November 1, 2018 – January 13, 2019
• Rhode Island: November 1, 2018 – December 31, 2019
• Others?
• Medicare: Oct. 15 – Dec. 7
• Employer plans: Varies (often in the Fall)

Special Enrollment Period
When you have a life-changing event . . .
. . . you have 60 days to enroll in Marketplace plan
30

Loss of Employer-Sponsor Health Insurance?
Pick a Lane
31
Trying to fill coverage gap while waiting for marketplace plan
to start? Can chose COBRA coverage only until Marketplace
plan is effective, but get Marketplace plan first, then COBRA
Lane 2:
Marketplace
Special Enrollment
Lane 3:
Other group plan
(spouse or parents)
Lane 4:
Medicaid or
Medicare?
Lane 1:
COBRA or
State COBRA

Comparing Plan Options
Marketplace
Plan
Marketplace
Plan
Employer
Plan
Employer
Plan
Marketplace
Plan
Employer
Plan
Medicare
Plan
Medicare
Plan

Do the Math!
The Math Matters!
Total potential costs for year =
12 months of premiums + OOP
max
#1:
$173x12 = $2,076
+ OOP = $6,000
Total = $8,076
#2:
$271x12 = $3,252
+ OOP = $5,200
Total = $8,452
#3:
$398x12 = $4,776
+ OOP = $1,150
Total = $5,926

What are the differences between
plans?
• Cost
– Premium, Out of Pocket, Co-Pay, Deductibles,
Cost-Share
• Networks of doctors and hospitals
– Check to make sure your doctors are covered by
the plan you choose
• Prescription drug coverage
– Which drugs are covered?
– Is there a separate drug deductible?

Checking Providers, Facilities, & Drugs
35

CancerFinances.org
© 2019 Triage Cancer36

Employment Rights
Fair Employment Laws
• Americans with Disabilities Act (ADA)
• Discrimination protections for patients and caregivers
• Reasonable Accommodations for patients
• Rehabilitation Act of 1973
• State Fair Employment Laws
• Discrimination protections for patients and caregivers
• Reasonable Accommodations for patients
Leave Laws
• Federal Family & Medical Leave Act (FMLA)
• State Leave Laws
Employment & Union Contracts

Employer Policies
• Employee Benefits
• Health/dental/vision insurance
• Short-term and/or long-term disability insurance
• Life and/or accidental death insurance
• Other Benefits
• Sick time
• Vacation time or paid time off (PTO)
• Pool of donated hours
• Flex time/job sharing/telecommuting
• EAP and financial counseling programs
• Medical Leave Process
• Reasonable Accommodation Process

Enforced by: Equal Employment Opportunity Commission
www.EEOC.gov
Eligibility:
• Private employers with 15 or more employees & State/Local
Governments
- Note: Federal employees covered by Rehabilitation Act of 1973
(similar to ADA)
- ADA does not apply to tribal employers
• Be a “qualified individual”
• “Can perform essential functions of the job with or without a
reasonable accommodation”
• Have a disability under the ADA’s definition
Americans With Disabilities Act (ADA)
Title I

Definitions
• Disability:
- “A physical or mental impairment that substantially limits
one or more major life activities”
• Major life activity:
• Eating, breathing, speaking, walking
• ADA Amendments: concentrating, thinking, sleeping,
operation of major bodily functions
- Predictable assessments: cell growth
Americans With Disabilities Act

4 ways to use the ADA:
1. Currently
2. History
3. Regarded
4. Association
Applies to all phases of the employment process
Benefits:
• Protection from Discrimination (1 - 4)
• Employers can’t make employment-related decisions based on medical
information
• Reasonable Accommodations (1 & 2)
Americans With Disabilities Act

Reasonable Accommodations
Adjusting Work Space
• Moving offices
• Accessible work
equipment
• Special furniture requests
• Hand controls on cars
• Closer parking spot
• Different work location
Adjusting Schedule
• Telecommuting
• Working from home
• Working from another
location
• Working part-time
• Flexible schedule
• Additional breaks
• Extended leave
Other Options
• Use of Technology
• Change in Policy
• Shift Job
Responsibilities
• Change Job
“Any change in the work environment or in the way things are customarily done that
enables an individual with a disability to enjoy equal employment opportunities”

• Do employers have to accommodate you?
• Yes, unless undue hardship or direct threat
• Has to be “reasonable” and “effective”
• Can get more than one!
• Caregivers not entitled to accommodations, but could still ask
Reasonable Accommodation Tips
*Quick Guide to Reasonable Accommodations
https://TriageCancer.org/QuickGuide-ReasonableAccommodations
Checklist: Reasonable Accommodations
https//TriageCancer.org/Checklist-ReasonableAccommodations

• When do you ask?
– As soon as you realize you need one
• How do you ask?
– Job Accommodation Network: www.AskJan.org
– Check employer’s policies
• Whom do you ask?
– Supervisors vs. HR
– Requests must be confidential, but limitations
– Check employer’s policies
• Needs can change over time
• Interactive process (negotiation and monitoring)
Reasonable Accommodation Tips

• Similar to ADA
• But, can be more protective in 3 ways
1. Broader definition of disability
• Ex: CA, IA, IL, NY, WA, WI
2. Specifically list cancer as a potential disability
• Ex: CA, ME, OH, VT
3. Cover employers with fewer than 15 employees
State Fair Employment Laws
http://triagecancer.org/statelaws

1 2 3 4 5 6 8 9 12
AK
HI
IL
ME
MI
MN
MT
NJ
ND
SD
VT
VA
WI
CO
WY
CT IA
KS
NM
NY
OH
PA
RI
CA
ID
MA
MO
NH
OR
KY
TN
WA
AR (but 15
for RA’s)
WV
Employer Size -
State Fair Employment Laws
*If state is not listed, it requires 15 employees

Enforced by: U.S. Dept of Labor Wage & Hour Division www.dol.gov/whd
• Federal law for:
- Employees with a serious medical condition
- Employees with a spouse, parent, or child with a serious medical condition
• Parents
• Spouses (common law spouses & same-sex spouses as of 3/27/15)
• Note: not domestic partners
• Children (biological, foster, adopted, step, or in loco parentis)
• 18+ only if “incapable of self-care because of a mental or physical disability”
Family & Medical Leave Act (FMLA)

Employer: private employers with 50+ employees and all
government employers (federal, state, local)
• 75 mile radius
• “As the car drives, not as the crow flies”
Employee: 1,250 hours, 12 months
• 12 months = total of 12 months in 7 years
• Paid vacation or sick leave counts
• 1,250 hours = 24 hours each of the 52 weeks/year
• Only count hours physically worked, not breaks, vacation, travel time
FMLA Eligibility

Protections
• Up to 12 weeks leave, per year
• Unpaid leave
• FMLA Bubble:
• FMLA protects job where sick leave/STD/LTD don’t
FMLA Benefits
Quick Guides ~ https://triagecancer.org/QuickGuide-FMLA and
http://triagecancer.org/QuickGuide-FMLAExtended
• Job protected
• Health
insurance
protected

• Can be used in segments or intermittently
• Deciding the year period
• Asking for FMLA & giving notice
- Foreseeable v. unforeseeable
• Employers can’t make employees use/exhaust PTO, vacation, & sick
leave before using FMLA
• Employers can require use of PTO, vacation, & sick leave
• Employees can request use of PTO, vacation, & sick leave
• Can work with the ADA
FMLA Tips

State Leave Laws
• FMLA type leave for smaller employers:
• DC (20), ME (15 pvt, 25 public), MD (15), MN (21), OR (25), RI (30 public), VT (15)
• Expanded definition of family:
• CT, DC, HI, MD, NJ, OR, RI, VT, WI
• Expanded use of FMLA leave:
• CT, ME, MD, OR
• Paid sick leave:
• DC, CT, CA, MA, OR + Cities – see chart
• Federal Contractors - EO
• Unpaid leave to take family members to routine medical visits: MA, VT
https://triagecancer.org/statelaws

Disclosure Rights
Generally, not required, but may need to disclose some
information to use . . .
• ADA’s discrimination protections
• Reasonable accommodations
• Medical leave
*Quick Guide to Disclosure, Privacy, & Medical Certification Forms
http://TriageCancer.org/QuickGuide-Disclosure

• You have choices about what you share
• Make conscious disclosure decisions
– Then communicate those decisions
• Long-term impact
• Impact outside of employment
– Relationships & dating
• Can use sites like MyLifeline, CaringBridge,
or Life Extraordinary
53
Disclosure Decisions
© Cancer and Careers & Triage Cancer© 2019 Triage Cancer

• Employers ARE entitled to medical certification for RA’s & FMLA
• But diagnosis may not be required
• Patients should talk to their healthcare team
• DOL Model FMLA Forms
• Be careful of employer forms & FMLA requirement of healthcare
provider's type of practice/specialization
• FMLA health care professional =
• MDs, DOs, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, nurse
practitioners, nurse-midwives, clinical social workers, Christian Science practitioners, or
any HCP recognized by employer or employer's group health plan
Medical Certification

Triage Cancer Resources on Employment
Resources by Topic 
Employment
https://triagecancer.org/
employment

Triage Cancer Resources on Employment
Resources by Topic 
Health Insurance
https://triagecancer.org/
healthinsurance

Continued Relationship with
Triage Cancer
• Attend Webinars
• https://TriageCancer.org/webinars
• Read our Blog
• https://TriageCancer.org/blog
• Order Materials
• https://TriageCancer.org/materialrequest
• Connect on Social Media
• Twitter: @TriageCancer
• Facebook: @TriageCancer
• Instagram: @TriageCancer

Q
&
A
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sponsors: Bayer, Fujifilm, Myriad Genetics and Taiho
Oncology!
Flex a “strong arm” & post it to Twitter or Instagram using the
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Legal Issues and Cancer - January 2019 Webinar

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