As an oncologist and medical reviewer, I’ve had the unique opportunity to evaluate more than a hundred disability-related cases over the past six months. These cases span a wide range of cancer types, treatment timelines, and patient recovery experiences. What’s become abundantly clear is the disconnect that can sometimes occur between well-meaning clinical advocacy and objective disability determination.
Cancer Recovery and the Evolution of Disability
Cancer is a life-altering diagnosis. The emotional, physical, and financial toll it takes on patients is immense. During active treatment—chemotherapy, radiation, immunotherapy, surgery, bone marrow transplant—many patients are genuinely disabled. They are unable to work, their daily functioning impaired, and they often need extensive medical and social support. Disability benefits are essential during this time, and in nearly every case I’ve reviewed, insurance carriers have appropriately supported these patients.
However, time passes. Treatments end. Scans improve. Tumor markers normalize. Neuropathies lessen. Fatigue resolves. Patients regain strength, report feeling better, and, in many cases, express joy in traveling, exercising, or returning to family life. Their ECOG performance status improves to 0. And yet, in a surprising number of cases, providers continue to submit disability forms stating that the patient remains impaired, limited, or restricted.
The Tension Between Advocacy and Accuracy
I understand the physician’s instinct to advocate for their patients. We care deeply. We’ve walked them through a terrifying journey. When they ask us to “sign the form,” many of us do so without hesitation, especially if the patient insists they aren’t ready to return to work or are financially struggling.
But as someone who now regularly reviews these cases, I’ve seen the other side. When documentation doesn’t match the clinical picture, it raises red flags. When a patient’s chart notes repeatedly say they’re doing “great,” with no ongoing treatment, no symptoms, and normal labs and imaging—and yet the same chart includes signed disability paperwork saying the opposite—it creates legitimate concern.
Definitions Matter: Restrictions, Limitations, and Impairments
It’s helpful to understand the disability framework:
- Restriction: A medically necessary caution or prohibition based on potential risk. Example: A seizure-free patient still restricted from driving for 6 months.
- Limitation: A current, active inability to perform a function. Example: Neuropathy causing balance issues, preventing prolonged standing.
- Impairment: The result of restrictions and/or limitations that interfere with job duties.
In addition, disability evaluations often consider the physical demands of a person’s occupation. These are typically categorized into the following levels:
- Sedentary Work: Involves mostly sitting, with occasional walking or standing and minimal lifting (usually up to 10 pounds).
- Light Work: Requires more standing and walking, with lifting of up to 20 pounds occasionally and up to 10 pounds frequently.
- Medium Work: Involves lifting 20–50 pounds occasionally and 10–25 pounds frequently, with a good deal of walking or standing.
- Heavy Work: Requires lifting 50–100 pounds occasionally and 25–50 pounds frequently.
- Very Heavy Work: Includes lifting objects over 100 pounds occasionally and 50 pounds or more frequently.
Understanding a patient’s prior occupation and how their current condition aligns with these categories is essential when determining disability status. A person may be unable to return to heavy labor but still be capable of performing sedentary or light work. These distinctions are critical in assessing functional capacity and return-to-work readiness.
Patients May Not Be Disabled—And That’s a Good Thing
We are getting better at treating cancer. Many patients with Stage IV disease are living full, active lives. If a patient with metastatic breast cancer is stable on hormonal therapy for years with no side effects—are they disabled? Not necessarily, and in most cases would not be considered eligible for ongoing disability support unless there is an acute change or deterioration in their condition. At that point, a new claim or re-evaluation would be required through the appropriate disability determination process.
Similarly, a patient who finished chemo 18 months ago, is in remission, and is fully functional may no longer meet the threshold for disability, even if they had a tough journey to get here. That’s a victory. That’s what we all wanted.
What Providers Can Do
- Have honest conversations: If a patient insists they’re still impaired, but your assessment says otherwise, talk about it. Consider referring to a physiatrist or PM&R physician for a formal evaluation.
- Document clearly: Describe the specific issue, its functional impact, and whether it is temporary or chronic.
- Understand your role: Your notes are not just for the clinic. They’re reviewed by insurers, peer reviewers, and sometimes attorneys.
- Don’t be pressured: Signing disability forms that contradict your clinical judgment doesn’t help the patient—and it can damage your credibility.
For Patients: Your Role and Responsibility
We understand that the road back to work can be complex. But if you’re healthy, active, and functional, continued disability claims may be questioned. In some cases, insurance investigators will review social media, travel history, or even conduct surveillance. Some of the more surprising—and admittedly entertaining—cases involve patients who report being confined to bed or the sofa due to severe symptoms, while simultaneously posting photos from ski trips in the Alps or beach vacations in Aruba and Mexico. These inconsistencies, while sometimes astonishing, highlight the importance of accurate documentation and candid communication between patients and providers.
If you genuinely have ongoing issues—be open about them. But also be open to the idea that you may no longer be disabled. That’s something to celebrate. Most cases that are strongly supported by medical records—those involving new diagnoses, active treatment, ongoing complications, or defined recovery periods—are typically not contested and do not require specialist review. These are well-documented, medically supported, and usually result in appropriate continuation of benefits. However, when a discrepancy arises—when the attending physician and the initial medical reviewer have conflicting perspectives—that’s when a specialist consultant is engaged to provide an objective, comprehensive opinion. The goal isn’t to deny support, but to ensure that determinations are grounded in consistent clinical evidence and thoughtful interpretation of each patient’s functional reality.
Final Thoughts
This blog isn’t about denying support. It’s about accuracy, integrity, and clarity. As clinicians, we must advocate honestly. As patients, we must reflect candidly. And as reviewers, we must evaluate responsibly.
Cancer may have changed your life. But if you’ve beaten it—or if you’re living well with it—don’t let an outdated disability claim define you. Let your strength speak for itself.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
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