Mesothelioma is a devastating form of cancer. A diagnosis will naturally shock anyone, and it often leaves them scrambling to come up with the funds to pay for all the ensuing medical treatments. Indeed, after the disbelief of a mesothelioma diagnosis, many patients and families find themselves stressed about financial issues.
Mesothelioma claims allow patients and their families to pursue financial assistance in a variety of ways. Unless you are independently wealthy, you will likely need to file a claim of some sort in order to pay for all the medical treatments and procedures you receive.
There are generally 3 types of mesothelioma claims:
- Insurance (usually some form of medical insurance)
- Legal (lawsuits and asbestos trust funds)
- Benefits (workers’ compensation and Veterans Affairs claims)
These are necessary because the costs associated with mesothelioma can accumulate very quickly. With no insurance or insurance that covers very little, you may be tasked with paying hundreds of thousands of dollars in hospital bills and other medical and secondary costs.
Mesothelioma legal claims and benefits claims can be filed against employers and product manufacturers who knowingly included asbestos in their workplaces or their products. This is because asbestos is the primary cause for mesothelioma and many of those companies used the substance despite knowledge of its health hazards.
The most common way to get mesothelioma financial help early on is with health insurance of some kind.
Mesothelioma Insurance Claims
If you have health insurance, your insurer may cover all or a portion of the costs associated with mesothelioma. Primary mesothelioma costs usually deal with diagnostic procedures or treatment options.
These can include:
- Blood tests
- Fluid and tissue biopsies
- Surgical procedures
- Radiation therapy
- Other treatments like immunotherapy
Every insurance policy is different, and it is important to understand your documentation before filing any mesothelioma claims. Specific terms are used across all types of health insurance.
The percentage of medical costs an individual must pay. The insurer is required to pay the other portion. For example, a 10% coinsurance would mean you pay 10% of medical costs while the insurer pays 90%.
The usually monthly payment an individual pays for a health insurance policy.
The set amount of money an individual pays for a doctor’s visit or prescription medication.
The amount of money an individual has to pay for out-of-pocket medical costs before an insurer begins to pay. For example, if your deductible is $4,000, then that is the most you will have to pay for medical services on your own (insurers may require coinsurance payment after that).
The standard coinsurance percentage that you will have to pay is around 20%. With that in mind, let’s also say that you have a deductible of $4,000. A treatment or procedure that costs $10,000 would require you to pay $4,000 out-of-pocket to meet the deductible limit. After that, the insurer’s coinsurance would kick in. They would pay 80% of the remaining $6,000 cost ($4,800), leaving you with a $1,200 payment. Of course, any treatments or procedures after that would be 80% covered by the insurer.
Unfortunately, mesothelioma costs can rise rapidly. Just one round of chemotherapy can cost as much as $50,000, and many mesothelioma patients undergo multiple rounds of treatment. Add that to any surgical procedures, radiation therapy, and other secondary costs, and it can become overwhelming. Even if your insurer covers 80% of a $300,000 medical bill, you would still be left on the hook for the remaining $60,000.
Again, all insurance policies are different, and you may have a plan that is better than the example above. You may also have one that is worse. That’s why it’s important to understand exactly what you are entitled to in terms of health insurance claims.
Individuals typically receive health insurance coverage from one of three options:
- Individual plans
- Work-sponsored plans
- Government-sponsored plans
If you purchase an individual health insurance plan, then you have two options: in-network or traditional fee-for-service. Network plans are more commonly referred to as health management organizations (HMOs) or preferred provider organizations (PPOs). These policies only allow you to receive treatment from plans that are in the HMO or PPO network, which may preclude you from seeing a mesothelioma specialist. HMOs and PPOs do, however, allow you to make insurance claims more easily and are generally more cost effective.
Traditional fee-for-service plans do not limit you to a specific network of providers. While these plans are more expensive, they may allow you to still receive insurance coverage for a mesothelioma specialist that is out of your area. These plans require you to fill out all the paperwork to make claims and may also lead to you paying for services up-front and filing a claim afterward. Both in-network and fee-for-service plans are usually purchased on the health insurance marketplace as set up by the Affordable Care Act (also known as, Obamacare).
Many people receive their insurance plans from their employers, unions, or other entities to which they belong. Premiums for these plans are usually paid with pre-tax earnings, meaning that a portion of each paycheck goes to the insurance provider. Some employers allow you to choose from a list of providers including HMOs and PPOs while other employers may limit your options to a single insurer.
Some individuals may also qualify for government-sponsored plans like Medicare or Medicaid. Medicare is health insurance that is typically reserved for people who are 65 or older while Medicaid is an option for low-income individuals. Your state or locality may have other health insurance programs that can be of assistance as well.
There are many other, supplemental types of policies that can help you make mesothelioma insurance claims should you be diagnosed.
Some of these include:
Insurance that can be purchased via a healthcare exchange, included in employer-sponsored policies, or qualified for through Social Security that provides income on a monthly basis that you would have otherwise earned had you not had a disability (in this case, mesothelioma)
Insurance that begins paying out after the diagnosis of a life-threatening or otherwise debilitating illness like mesothelioma
Similar to critical illness insurance, but it pays out after the diagnosis of cancer (mesothelioma is a type of cancer)
A standard health insurance policy will likely pay a portion of costs associated with hospitalization, but hospital insurance supplements that, usually with a lump sum
Of course, many of these need to have been purchased before a diagnosis of any major illness. That is to say; you won’t be covered for much if you buy a critical illness insurance plan after you’ve been diagnosed with mesothelioma.
Life insurance may also be an option for the families of mesothelioma victims who have passed on. Payouts from life insurance policies can help cover the lingering medical expenses that were incurred during your loved one’s life.
Mesothelioma Legal Claims
One of the most effective ways to get mesothelioma financial help is by filing a legal mesothelioma claim. There are generally two types of legal claims that you can file: lawsuits or asbestos trust funds. With lawsuits, mesothelioma patients can essentially hold asbestos product manufacturers and distributors responsible for their negligent use of the toxic mineral.
There are two types of mesothelioma lawsuits that can be filed:
- Personal injury – lawsuits filed by mesothelioma patients seeking restitution for themselves and compensation for medical bills
- Wrongful death – lawsuits filed by family members of mesothelioma patients who have passed
Mesothelioma is a preventable illness because of asbestos exposure, the disease’s primary cause, was also very preventable. The dangers of asbestos were known as far back as the 1920s and 30s, but the prevalent use of the substance continued into the 1970s. In order to make a successful legal claim against employers or companies who used asbestos, you will need to compile evidence.
This usually consists of:
- Employment record – You’ll need to prove that you worked in a location known to have contained asbestos to some degree
- Eye witness testimonies – Individuals who can corroborate your version of events will help
- Medical documentation – This helps prove you have mesothelioma
- Military history – If you were in the military, you’ll need evidence that shows you were at a base or in an occupation that contained asbestos
- Expert statements – Expert statements also help corroborate your version of events
Getting qualified mesothelioma legal assistance with a legal team that specializes in the disease is important to ensure you get the best result. A mesothelioma lawyer can also help you decide what type of lawsuit to file.
Personal injury and wrongful death suits can fit into one of three categories:
- Individual suit – one plaintiff against a company (or group of companies)
- Multidistrict litigation – a group of individual suits that use a similar structure for proceedings
- Class action – This option is not often used for mesothelioma cases, but it includes everyone who may have a similar claim against a company or group of companies (g. a large group of construction workers who worked on job sites that used a specific brand of asbestos insulation)
It’s important to seek out legal assistance as soon as you can. Understandably, your primary goal will be to improve your quality of life and survive as long as you can, but many states have a statute of limitations on when you can file lawsuits. Some states, like California, have a statute of limitations as short as 1 year after diagnosis.
Successful lawsuits will end with either a settlement or a verdict. Settlements are usually paid out by companies if they believe they have little chance of winning a trial. An average settlement award is usually around $1.3 million. If the lawsuit is allowed to go to a trial and you receive a verdict in your favor, then the average payout is around $2.5 million.
In addition to lawsuits, you may also want to seek out compensation from asbestos trust funds. These trusts were generally set up during bankruptcy proceedings for asbestos product manufacturers who acknowledged their liability in the development of asbestos-related diseases. Around $30 billion is available in asbestos trust funds throughout the United States.
Like lawsuits, you will need to compile evidence before making a claim against an asbestos trust. Most asbestos trust funds only pay out an average of 25 to 30% of the full claim. This means that a $1,000,000 claim against a trust will usually only pay out $250,000 to $300,000. Trustees may pay out more or less depending on the evidence and documentation provided. The reason they rarely pay 100% of a claim is because they need to reserve money for individuals who will be diagnosed with asbestos-related illnesses in the future.
It is possible to make a claim against an asbestos trust fund while also filing a lawsuit against currently existing companies. But, keep in mind that receiving an award from an asbestos trust may affect the payout of successful lawsuits.
Mesothelioma Benefits Claims
Mesothelioma benefits claims are another way to receive mesothelioma financial help. Benefits claims can be filed against employers or organizations with which a mesothelioma patient was or is affiliated. The most common benefits claims are Veterans Affairs (VA) benefits and workers’ compensation.
Many former service members were exposed to asbestos while in the armed forces. The United States military used the substance frequently to help mitigate the risk of fire on military bases, in marine vessels, and in a variety of other applications. Thirty percent of all mesothelioma sufferers in the United States are veterans.
Because of this, the United States Department of Veterans Affairs (VA) has set up a system to allow affected service members to seek compensation.
Eligibility and evidence requirements needed to file a VA benefits claim include:
- Proof that asbestos exposure occurred during military service
- Documentation that identifies where the claimant was stationed or on what vessels they may have served
- Medical documentation that verifies that the claimant has a disease or disability associated with their service
- Claimant must not have been discharged on a dishonorable basis
After a claim is submitted, the VA will either approve it or return it and ask for more evidence. You may also send in a “Fully Developed Claim” that can expedite the process as the VA will not send the claim back for more evidence. Representatives at the VA will determine whether the claim should be approved and what award the claimant should receive if it is approved.
Workers’ compensation is another type of mesothelioma benefits claim that you can file. These claims are filed against employers by individuals who suffered an injury or illness on the job. Mesothelioma claimants again have to provide evidence in order to make a successful workers’ compensation claim. A governing board will assess the claim’s validity and approve or deny it based on the evidence provided.
If they approve the claim, they will base the award on a variety of factors including:
- Medical expenses related to mesothelioma
- Lost income as a result of being out of work
- The worker’s pre-illness salary
- Any secondary costs (like travel or lodging) associated with the illness
Both workers’ compensation and VA benefits claims are usually paid out on a monthly basis if the claim is successful. Claimants who file a successful workers’ compensation claim cannot legally file a lawsuit against the company for further damages. They can, however, file lawsuits or other legal claims against asbestos product manufacturers.
As always, it is a good idea to consult a legal team that specializes in mesothelioma claims to understand what avenue is best for you.