When you work, you get an income, and you may get other important benefits, like health insurance. Working also gives you a feeling of self-esteem. But when you have cancer, you may run into some blocks along the way to finding and keeping a job. This can lead to problems with paying bills and getting enough health insurance.

Most employers treat people who've had cancer fairly and legally. But this is not always the case. Some employers may have staff policies that are outdated or a supervisor who is not informed or up-to-date. As a result, people who've had cancer may face unneeded and sometimes illegal difficulties with job opportunities. Some people who've had cancer may be let go from their job or may not be hired. They might be put in lower positions or not get a promotion or benefits because of their cancer status. Others may be moved to a less desirable department or face resentment by coworkers. But you can protect yourself from job discrimination. Learn how to speak up for your rights in the workplace. Here's what you need to know.

When it comes to your job and what you do as part of that job, federal law and many state laws make it clear that an employer cannot treat you differently from other people because of your history of cancer. This is true as long as you are capable of doing the job. These laws protect you only if:

1. You have the skills, experience, and education needed for the job, and you can do the most important duties of the job.
2. Your employer treated you differently from other workers in job-related activities because of your history of or treatment for cancer.
3. At some time, your cancer greatly limited your ability to do everyday job activities, or your employer thought that your cancer limited your ability.

The Americans with Disabilities Act (ADA) does not allow some types of job discrimination against people who have or have had cancer. This includes employers who have at least 15 employees, employment agencies, and labor unions. Every state also has a law that controls, to some extent, job discrimination based on disability. Some laws clearly do not allow discrimination based on cancer status, while others have never been applied to workers with cancer. State laws also vary as to which employers—public or private, large or small—must obey the law.

Under federal law and most state laws, an employer must provide you with a reasonable accommodation. An accommodation is a change, such as a change in work hours or duties, so that you can do your job during or after cancer treatment. Employers can make more than one accommodation. For example, if you need to take time off for treatment, your employer may let you work flexible hours until you finish treatment. But an employer does not have to make changes that would be too costly or upsetting to the company.

In some cases, the family members of people with cancer may be protected from discrimination. The ADA does not allow discrimination because of a family member's relationship or association with a person who is disabled. Employers may not assume that a family member's job performance would be affected if that person needs to care for a family member who has cancer. For example, employers may not treat you differently because they assume that you would use too much leave time to care for your spouse who has cancer. Also, employers that give health insurance benefits to their employees for their dependents may not decrease these benefits to an employee solely because that employee has a dependent who has cancer. State laws, however, do not protect you if an employer treats you differently because a family member has cancer.

According to the ADA and many state laws, discrimination based on genetic information relating to diseases, such as cancer, is not allowed. For example, an employer may not ask you for the results of a genetic test or treat you differently because of your genetic history.

You also may have the right to take medical leave under your employer's policies, a state law, or a federal law. The Family and Medical Leave Act (FMLA) is a federal law that requires employers with 50 or more employees to provide up to 12 weeks of leave. During this time, you are not paid, but your job position is protected. This law covers family members who need time off to care for their own serious health condition (which includes most cancers). It also covers family members who need time off to care for a seriously ill child, parent, or spouse or a healthy newborn or newly adopted child. You must have worked at least 1,250 hours over the past 12 months or about 25 hours per week for 1 year to be covered. You must also reasonably try to arrange medical care that is likely to be needed so that it does not overly disrupt the workplace. An employer must continue to provide benefits—including health insurance—during the leave period.

The ADA does not require employers to provide health insurance. But the ADA and some state laws do require those employers who offer health insurance to be fair. For example, your employer gives health insurance to all employees with jobs similar to yours but does not give you health insurance. Your employer's refusal may be considered discrimination under the ADA. The employer must prove that not giving you health insurance is based on valid statistics or that the insurance plan would suffer serious financial problems. For example, if your employer is a small business that can prove it is unable to get an insurance policy that will cover you, the employer may not have to give you the same health benefits given to your coworkers.

Every state has laws that control the insurance industry. For example, some states do not allow insurance companies to look at your cancer history when issuing a new policy. Contact your state insurance commissioner about the rights in your state. And if you have health insurance through a group plan at work, there's a federal law that prohibits your employer from firing you to prevent you from collecting your benefits. This law is the Employee Retirement Income Security Act of 1974 (ERISA).

Lawsuits are not the only or the best way to fight job discrimination. State and federal laws against discrimination help people with cancer in two ways. First, they discourage discrimination. Second, they offer ways to correct discrimination when it does happen. But these laws should be used as a last resort. Lawsuits can be high in cost and take a lot of time. And the results may be different than you expect. The first step is to try to avoid discrimination. If that fails, the next step is to attempt a reasonable settlement with the employer. But if informal efforts don't work, then a lawsuit may be the next step.

If you are looking for a new job, you can take several steps to reduce the chances that you will face discrimination because of your cancer history.

• Do not freely give information that you have or have had cancer unless it directly affects your ability to do the job. An employer has the right—under accepted business practices and most state and federal laws—to know only if you can do the necessary duties of the job.
• Do not put false information on any application. If you are hired and your employer later learns that you gave false information, you may be fired. Insurance companies may refuse to pay benefits or may cancel your coverage if you give false information about your condition on an insurance form. Federal and state laws that prohibit job discrimination do not guarantee that all employers will hold back from illegally asking people about their cancer history or gaps in education or employment. If you are asked a question that you think is illegal, give an honest (and perhaps indirect) answer that emphasizes your current ability to do the job.
• Keep in mind your legal rights. For example, under the ADA, an employer may not ask about your medical history, make you take a medical exam, or request medical records from your doctor before making a conditional job offer. Once an employer has made a conditional job offer, the employer can require you to have a medical exam only if it is required of all other persons who apply for the job. The medical exam may take into account only your ability to safely do the required duties of that job.
• Keep the focus on your current ability to do the job you are applying for. Employers may not ask how often you were absent from past jobs. But they can ask if you can meet the employers' current rules for attendance.
• Apply only for jobs that you are able to do. It is not illegal for an employer to not hire you for a job if you are not qualified for it, regardless of your medical history.
• Explain any long periods of not working during cancer treatment, if possible, in a way that shows your illness is past and that you are in good health and are expected to remain healthy. One way to take the focus off of a gap in your school or work history because of cancer treatment is to organize your resume by experience and skills, instead of by date.
• Offer your employer a letter from your doctor that explains your current health status, prognosis, and ability to work. Be prepared to teach the interviewer about your cancer and why cancer often does not result in death or disability.
• Find a job counselor or social worker who can help with resume preparation and job interviewing skills. Practice answers to expected questions such as, "Why did you miss a year of work?" or "Why did you leave your last job?" Be honest when answering these questions. But stress your current qualifications for the job and not past problems, if any, resulting from your cancer experience.
• If you are interviewing for a job, do not ask about health insurance until after you have been given a job offer. Then ask to see the benefits package. Review the information before you accept the job to make sure it meets your needs.
• Do not discriminate against yourself by assuming that cancer leaves you unable to work. Although cancer treatment leaves some people with physical or mental disabilities, many people are able to do the same duties and activities as they did before having cancer. With the help of your medical team, do an honest review of your abilities and compare them with the mental and physical demands of the job.

If you think that you are being treated differently at work because of your history of cancer, think about an informal solution before jumping into a lawsuit. Here are some ways to begin standing up for your legal rights.

• Use your employer's policies and procedures to settle employment issues informally.
• If you need some kind of modification to help you work, such as flexible working hours to keep medical appointments, suggest several alternatives to your employer.
• Teach employers and coworkers about cancer and address any false beliefs that people cannot survive cancer and remain productive workers.
• Ask a member of your care team, such as your doctor or social worker, to write or call your employer to help settle the conflict and suggest ways for your employer to accommodate you.
• Seek support from your coworkers.
• If informal solutions don't work, keep in mind these steps to protect your right to file a lawsuit:
  • Keep carefully written records of all job actions, both good and bad.
  • Pause before you sue. Carefully review your goals. For example, do you want your job back or a change in working conditions? Or do you want certain benefits, a written apology, or something else? Look at the positive and negative aspects of a lawsuit. Positive aspects can include getting a job and monetary damages, protecting your rights, and tearing down blocks for others who have cancer. Negative aspects can include long court battles with no promise of winning. Some cases can drag on for 5 years or more. And there can be legal fees and expenses and stress. You may experience a harsh relationship between you and the people you sue, and your reputation in your field may be impacted.
  • Consider settling your complaint in an informal way. Someone such as a union representative, a human resources or personnel officer in your company, or a social worker may be able to help you and act as a go-between. Your state or federal representative or local media may help influence your employer to treat you fairly. Keep in mind that the first step most government agencies and companies take when they receive a complaint is to try to resolve the dispute without a costly trial.
  • Be aware of filing deadlines so that you do not lose your option to file a complaint under state or federal law. You have 180 days from the date of the action against you to file a complaint under the ADA. You would file the complaint with the U.S. Equal Employment Opportunity Commission. If you work for the federal government, you have only 45 days to begin counseling with an equal employment opportunity counselor. Under most state laws, you have 180 days to file a complaint with the state agency. If you file a complaint and later change your mind, you can drop the lawsuit at any time. To file a lawsuit, you must follow the procedures established by each law.
    • Americans with Disabilities Act (ADA). To file a complaint covered by the ADA, you must file a complaint with the Equal Employment Opportunities Commission (EEOC) to enforce your rights. To get the location of the EEOC office in your area, call the EEOC Public Information System in Washington, DC, at 800-669-4000. You can get publications from the EEOC that explain the ADA and how to enforce your rights under the law by calling 800-669-EEOC (800-669-3362).
    • Family and Medical Leave Act (FMLA). To file a lawsuit under the FMLA, you have two choices. You may file a lawsuit in court. Or you may file a complaint with the Employment Standards Administration, Wage and Hour Division of the U.S. Department of Labor. For information about the Department of Labor office closest to you, call 866-4USWAGE (866-487-9243). Most complaints filed with the Wage and Hour Division are resolved informally.
    • State laws. Most states have a state agency that carries out the state's fair employment practices law. Some states allow you to file a lawsuit in state court. For more information about the laws in your state, check out your state division on civil rights or human rights commission or talk with an attorney who is experienced in job discrimination cases. The EEOC Public Information System at 800-669-4000 can help you find the appropriate state enforcement agency. Also check your local phone book under "State Government."

Even if your legal rights were violated, there is no guarantee that a public agency or court will give you the solution you seek. A trained job counselor, social worker, nurse, or clergy may help you deal with the personal issues that result from job discrimination due to your cancer history.

You can learn more about your employment rights and cancer survivorship from Cancer Nation (formerly the National Coalition for Cancer Survivorship):

Cancer Nation

8455 Colesville Road Suite 1025

Silver Spring, MD 20910

877-622-7937 (877-NCCS-YES)

http://www.canceradvocacy.org/

You can learn more about your employment rights and other basic skills to meet challenges posed by a cancer diagnosis from the Cancer Survival Toolbox. The Toolbox is a free set of audio programs developed by the National Coalition for Cancer Survivorship, Oncology Nursing Society, and Association of Oncology Social Work. The programs are available in English and Spanish and cover:

1. Communicating.
2. Finding information.
3. Making decisions.
4. Solving problems.
5. Negotiating.
6. Standing up for your rights.
7. Finding ways to pay for care.
8. Caregiving and various topics for older persons.

The Toolbox can be found at: http://www.canceradvocacy.org/toolbox/.