Keeping Your Job When You're Ill

Federal laws provide sick workers with some protection, but you need to play your cards carefully

Kathy Flora told her boss and co-workers immediately when she found out she had breast cancer in 2003. Judi Swedek hid the news when diagnosed with the same disease several years ago. She scheduled radiation treatments at the end of her work day and declined chemotherapy, worried that symptoms such as hair loss would draw attention to her illness. "At the time I was more afraid of losing my job [at a New York investment bank] than I was of the cancer," says Swedek, now a business consultant in Colorado. If they had it to do over, each would handle the disclosure of her illness differently. Flora, who worked for an outplacement firm from her Bedford, N.H., home would be more deliberate about whom she told and when, while Swedek, who found the fear of discovery only magnified her stress, wishes she had been less secretive. As new treatments for cancer, AIDS, and other illnesses allow people to continue working, more are facing such issues. Recent court rulings have limited who can qualify under a 1990 law requiring employers to accommodate disabled workers. At the same time, the courts have made it easier to win coverage under a law providing extended unpaid leave.


More than 130 million Americans -- almost half the population -- live with some chronic condition. These can range from common ailments like arthritis and high blood pressure to cancer and psychological disorders, according to a 2004 study at Johns Hopkins University. While many have no impact on an employee's ability to do the job, serious ones raise questions for sick employees and their managers. When and how should an employee tell about an illness? Should co-workers know? How can one decide how much leeway to ask for, given office politics and the shifting legal terrain?

Two federal laws come into play when a worker is disabled or seriously ill. The Americans with Disabilities Act requires employers with 15 or more employees to make a "reasonable accommodation" for a disabled worker as long as it does not present an "undue hardship" to the company and the employee can perform the job's essential functions. The Family & Medical Leave Act (FMLA), applies to companies with 50 or more workers. It provides up to 12 weeks of unpaid leave that can be taken all at once or over time for an employee with a serious illness or who is caring for a sick spouse, child, or parent. The employee is guaranteed his or her old job or an equivalent one upon return and company-subsidized health insurance during the time away. States and cities may have their own laws.

While sick employees need to understand their rights, litigation should be a last resort, says David Landay, an attorney who represents the chronically ill. Who needs a lawsuit while struggling through an illness? Not to mention the cost, which L. Susan Slavin, a Jericho (N.Y.) litigator, says can easily run $50,000, even if the case is settled.

When deciding how to handle news of an illness, Landay advises talking to a company veteran who can say how other sick employees have been treated. Some companies -- fearful a chronic illness will jack up their insurance rates or that the work won't get done -- push sick workers out or into a lesser job, says Slavin. Large companies are better with chronic illness than small ones, she says. It's easier for them to cover an employee's absences, and the insurance risk is spread among more staffers. Plus they have human-resource workers and in-house lawyers who know the company's obligations under the law.

Some practical reasons argue for disclosing an illness. Hiding it can be emotionally draining and interfere with treatment, as Swedek discovered. And if you haven't told your boss, you're not protected from discrimination under the ADA. If you'll need an accommodation under the ADA (time off for treatment, say, or to work at home), your company will have to know. Ditto if you'll want to take a leave under the FMLA. Letting co-workers know may mean the difference between their support or resentment as they take on some of your duties.

When you tell, do it in a way that presents solutions, not problems, advises Page Tolbert, a social worker at Memorial Sloan-Kettering Cancer Center in Manhattan. Wait until you know what kind of treatments and time away will be required (something Flora wishes she had done before alarming her supervisor). Then, you can sit down with suggestions for covering your absences. "Bosses feel much calmer if you go in with a plan rather than if you march in and say: 'I'm going to disrupt the office,"' says Tolbert.

Review your company health, life, and disability coverage and then find out if you can upgrade during the company's annual sign-up period without taking a physical, Landay advises. If you need to look for another job, know that group plans, by law, generally must cover pre-existing conditions as long as you don't allow your insurance to lapse more than 63 days, and you were covered for 12 months under your former plan, he says. Landay suggests you don't tell a prospective employer about your condition -- at least not till you get a job offer.


Remember your illness likely presents difficulties for your boss as well. Frank Morris, a labor and employment lawyer in Washington tells of one company where three of four tech help desk employees went out under the FMLA at the same time. The company had to hire an outside firm to pick up the slack.

Still, many businesses want to accommodate sick employees, considering it a morale booster and a better alternative than finding and training a replacement. While the law doesn't require FMLA leave to be with pay, New York Life, an insurance company based in Manhattan, continues to pay those on medical leave, with duration depending on length of service.

Both Swedek and Flora left their jobs within months of their diagnosis. In the end, Swedek decided she wanted a less pressured environment and moved to Colorado. Flora's position was cut during a restructuring. Both women successfully completed their cancer treatment.

Hanging on to a job can mean medical insurance, pay, and stability. But, says Flora, while your co-workers care about you, they aren't family. At some point, what they care about most is getting the job done. That's why it's important to manage your illness in the most professional way possible.

By Carol Marie Cropper

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