Sick and Vulnerable, Workers Fear for Health and Their Jobs – New York Times
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Excerpts below, my comments in italics.

By LISA BELKIN
Published: December 17, 2005

When Marty Domitrovich was first told that he had cancer, he was a 51-year-old sales executive, so successful that he had two goals: to reach $1 million in commissions and bonuses and to become chief executive of his company, where he had worked since his summers in college.

Before long, however, he could no longer travel, and on the bad days he did his work at home, lying on the couch and talking on the telephone.
When Shannon Abert was first told she had scleroderma, she was 35, and an employee is treated after crossing the stark line from worker to patient is broadly defined by legislation. But it is more specifically determined by things like the culture of a workplace and the sensitivity of a boss….

“The diagnosis is a crisis in itself,” said Carolyn Messner, an oncology social worker and director of education and training for cancer care in Manhattan. “The next crisis is telling people.”

Mr. Domitrovich announced his devastating news almost immediately after he received it on Jan. 1, 2000.

Interesting topic in this story is privacy: This instinct for privacy is common, said dozens of employees, employers, lawyers, health care providers and patient advocates interviewed for this article.”

Yet at times patients and caregivers (in my experience) resent those “outside” the illness for not knowing all about it by intuition.

The article points out that “while patients might prefer to keep silent, the law favors disclosure.”

“Two pillars of legislation have come to define the rights of ill workers in recent years: the Americans With Disabilities Act, passed in 1990, requiring employers to make ‘reasonable’ accommodations for disabled or seriously ill workers, as long as they can perform the ‘essential’ functions of the job; and the Family and Medical Leave Act, passed in 1993, allowing workers to take up to three months off from work without losing their health insurance or job.

‘Under each, employers are only obligated to help employees whose conditions are known to them. A worker who regularly misses work for chemotherapy treatments, but does not explain why, can be dismissed for absenteeism and cannot then appeal on grounds of disability

That creates a dilemma that is equal parts emotional and tactical.

“‘ I advise workers not to tell their employer, unless they want to ask for accommodation because of a disability,” said Sharona Hoffman, a professor at Case Western Reserve University School of Law and an expert on the legislation. “If you want to invoke the protection of the law, then you have to tell.”

The article points out that “The Catch-22 of the American health care system is that while many people work ‘for the insurance,’ when they become too sick to work and are most in need of that insurance, they are most at risk of losing it. This is particularly true of workers at small companies, which are not covered by existing law. (The Family and Medical Leave Act, for instance, only applies to workplaces with 50 or more employees.) One employee at such a company, who asked that her name not be used because she feared retribution from her former boss, learned the significance of this distinction the hard way when she had a brain tumor removed five years ago. Her employer, she said, ‘told me that my tumor came at a really bad time for the company.’”

A $20,000 raise this woman had received was rescinded to pay for an increase in the company’s group insurance premiums.

Of course, many people with cancer are living on less than $20,000 a year all told.