You are here: Home Work Issues Work: At Work Work How To ... Overview
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.



It is not unusual to need a change at work because of a treatment such as chemotherapy or radiation, doctor's appointments, or a health condition itself. Such changes are commonly referred to as an "accommodation."  It used to be that you had to rely on the good faith of your employer or as a right as a member of a union to get an accommodation. Today, you may also be entitled to an accomodation thanks to either federal or state law.

The federal Americans with Disabilities Act (ADA) is the basic law in this area. Since the other federal and state laws generally follow the pattern of the ADA, this discussion will focus on the ADA.

Before asking for an accommodation:

  • Check to see whether your employer is covered by the ADA or similar state law and if you are eligible for coverage. If you are a member of a union, check with your representative to see if you have additional rights. Even if you are not legally entitled to an accommodation, it is worth trying to obtain one to help you do your job. If you can't perform your job as expected without an accommodation you may well face being let go for poor performance. 
  • Even if covered by the law check to see if your employer is friendly to people with your health condition. If your employer is not friendly, you may have to negotiate for an accommodation to keep from being fired for not doing your  job. Still,it is good to know
  • Check with your medical  team to learn what to expect as a result of your condition and/or treatment, and how it is likely to impact your work.

Studies show that the majority of accommodations do not cost an employer anything. About l/3rd of accommodations have a one time cost of under $500.

As a practical matter, the key to getting the accommodation you need is to think about it as a negotiation which includes the following steps, each of which are described in other sections of this article:

Step 1. Think about what accomodations are reasonable and what to ask for. 

Step 2. Pull together information to support your request.

Step 3. Decide what you do and do not want to tell your employer.

Step 4. Decide who to ask.

Step 5. Be prepared to negotiate.

Step 6. Put your request in writing.

Step 7. Decide how to handle the negotiation.

After an accommodation is agreed to, follow-up by writing a letter to your employer that describes what was agreed to..

  • if the entire transaction was oral: The letter should  also ask that your employer sign a copy of the letter. For example, you can start the letter by saying something like: "Following is my understanding of the agreement between us."  End it with a sentence that reads: "Please signify your agreement to my understanding by signing, dating and returning a copy of this letter agreement to me." 
  • If your request was in writing: The confirmation letter can merely confirm with your employer that an agreement has been reached on the terms described in the (memorandum) dated XXXXXXX.  End it with a sentence that reads: "Please signify your agreement to my understanding by signing, dating and returning a copy of this letter agreement to me." . If the agreement was different than the accommodation requested, also spell out what was agreed to.

At the very least: If you don't write a follow-up letter, withn 24 - 48 hours after reaching an agreement, record in your files complete information about any verbal request made to your employer regarding an accommodation as well as your employer's response. It is not as good as a written agreement signed by your employer, but it would be a help in case there is a later question.

If ultimately your employer does not grant a reasonable accommdation, you can seek to enforce the law relatively easily by complaining to a governmental agency. If that doesn't work, you can go to court. (Be aware that if you do go to court, the action is a matter of public record which can be found by any potential future employers).

Keep in mind that your employer has to keep disclosure of your health condition confidential. While this is the law, you may want to let co-workers know what is going on so they don't become upset at the accommodation(s) you are given, and the additional work they may have to do as a result.


  • If the accommodation you seek is a reduction in the number of hours you work, check eligibility provisions of all benefits you have through work to determine which, if any, are affected by the lower number of hours. For instance, many employers only offer health insurance and/or disability income insurance to full-time employees. "Full-time employees" are frequently defined by the number of hours a person works for the employer - for instance, 30 hours a week.
  • When seeking protection under the ADA, your employer may request "sufficient documentation" to substantiate that you have a disability under the ADA and that you need the requested accommodation. "Sufficient" includes:
    • The nature, severity and duration of an impairment; 
    • The activity or activities the impairment limits; 
    • The extent to which the impairment limits the ability to perform the activity or activities;
    • Showing why a reasonable accommodation is needed. 
  • If your employer does not agree to the accommodation you need, you can ask for a mediator to help decide the issue. You can also file a complaint with the state fair employment agency or the federal Equal Employment Opportunity Commission (EEOC). You can also contact a lawyer and start a lawsuit.

For related information, see:

Step 1. Think About What Accommodations Are Reasonable And What To Ask For

A reasonable accommodation is any modification or adjustment to a job or in the work enviornment that will enable a qualified applicant for a job or an employee with a disability to participate to perform the essential functions of a job. 

When thinking about the accommodation you need, keep in mind:

  • That the goal is to permit you to do your the essential functions of your job at the same level of performance as the average, similarly situated person without a disability.
  • The accommodation has to be "reasonable".  What is reasonable depends on the particular situation. Reasonable could turn on cost or other factors.  For instance:
    • With respect to cost,  it may be reasonable to ask a huge, multinational corporation to put in an elevator. This would be unreasonable for a small company. 
    • With respect to other factors, it would not be reasonable to ask to have your work area moved into your boss's office because her office is closer to the bathroom.

For help determining a reasonable accommodation for your job, click here.

NOTE: It would be helpful to settle on at least two alternatives. Since requesting an accommodation can result in a negotiation, it is always helpful to have a fall back position.

Step 2. Pull Together Information To Support Your Request

If you belong to a union, or have a contract with the employer

Look to the union contract or your own contract to see if there are any provisions about accommodations if needed to help you do your job.

Look at the federal and state law to determine if you are legally entitled to an accommodation.

If you are legally entitled to an accommodation, you can use the law as the basis for your negotiations. You can mention your legal entitlement if the moment seems appropriate. Knowing you have a legal right to something may also make it easier to negotiate for what you need.

If there is no legal entitlement to an accommodation, you will know to base your negotiation on finding a mutually advantageous solution.

To learn more, see: Am I Eligible For A Legally Required Accommodation At Work?, Americans With Disabilities -- The State Laws

Arm yourself with information to address any concerns that your employer might have regarding your ability to perform the essential functions of your job.

This could include statistics regarding the survival and/or cure rate for your particular diagnosis or statistical data relating to the productivity of other individuals with the same type of disability or diagnosis.

Find out whether there are other employees at your company with the same or similar health condition you have who have received an accommodation and successfully performed their job.


  • What accommodation did they receive?
  • With whom did they negotiate?
  • What were the negotiations like?
  • What did they tell the employer?
  • What was the employer concerned about?

If you don't know any such employees: some employers have support groups and/or mentor programs for individuals diagnosed with a particular illness, and even for individuals caring for others in their families. If your employer has programs such as these, you consider joining or at least learn who is in the group.

If you can't learn this information in your company, perhaps members of a support group, your social worker, a union representative, your local disease specific non-profit organization or health finance counselor can give you guidance.

Step 3. Decide What You Do And Do Not Want To Tell Your Employer

Resist the urge to "spill your guts" to your employer. If it's not necessary, don't get into too much detail about your health condition. 

Consider whether to attempt to request an accommodation without disclosing your specific health condition, indicating only that you are a person with a disability. If your employer wants more information, he or she will ask.

While you can start by telling as little as you want, keep in mind that the employer has a right to request additional information and proof of your disability. This is not necessarily the same as being entitled to a copy of your medical record or even all the details about the extent of your condition.

Also keep in mind that if your employer knows the nature of the disability, it may be easier for both of you to determine an appropriate accommodation.

Whether or not you choose to disclose your diagnosis to your employer, don't expect your employer to know what you need and why you need it.  In fact, don't assume your employer knows anything about your situation, or anything about your condition. Think about the best way to describe your situation and why you need an accommodation in terms your employer will understand. 

Step 4. Decide Who To Ask

Who to ask depends on your specific work enviornment and your relationship with the people at work. 

A place to start to answer the question of who to ask is your work manual, if there is one. If the manual suggests speaking with your immediate supervisor, consider going to someone else if you have a bad relationship with your supervisor.

If there is no manual, consider speaking with the Human Resources (HR) department if there is one -- preferably with a supervisor who is more likely to know the law than a lower level HR person, or with someone with whom you have a relationship if there is such a person.

If there is no HR department, speak with your supervisor (unless you have a bad relationship with him or her, in which case go higher up the organizational ladder).

Step 5. Be Prepared To Negotiate

Be prepared to negotiate in person for the reasonable accommodation you want. Deciding on an appropriate accommodation should be a process that addresses the mutual needs of both you and your employer.

Identify the person to speak to in the human resources department or in a supervisory capacity following the normal chain of command in your company.

When thinking about what to request, consider your employer's point of view   Be prepared to talk about your employer's needs in addition to your own.

  • Your employer needs someone to do your job, to do it well and at or close to a pre-determined cost. 
  • Perhaps your employer has additional concerns in general, or specifically about you or your job. How can you satisfy those concerns? 
  • If you were your employer, what would convince you to grant the accommodation you want?

Even if you don't care about the needs of your employer, now is a good time to fake it.

Employers are obligated to negotiate in good faith. They cannot just say "no." In fact, employers must engage in an "interactive process" in good faith.

  • Keep in mind that  while an employer is obligated to negotiate in good faith, there is no obligation to agree to a specific accommodation.
  • An employer doesn't have to agree just because you identify an accommodation that you believe would work for you and not impose an undue burden on your employer.

Likewise, you don't have to accept the accommodation that your employer suggests -- but you don't want to just reject it without any negotiation or alternative position. This doesn't mean you have to roll over, but you do have to show a show a willingness to negotiate.

If you're going to present your request in person, practice what you want to say. A particularly helpful way to practice is in a mirror, keeping eye contact with yourself. Keep repeating the points you want to make until you're comfortable with them and can say them in a friendly, natural manner. Actors on a stage are comfortable with what they do because they rehearse and rehearse and rehearse.

Look for someone with whom you can "game plan" the meeting -- a person who can pretend to be the person to whom you're going to negotiate an accommodation.

If you don't think you should negotiate for yourself, your local disease specific non-profit organization may have someone available to do the negotiation for you. If not, an attorney, social worker, or health finance counselor could do it for you. 

Step 6. Guidelines For Putting Your Request For An Accommodation In Writing

Check with your human resources department or your employer's web site to find out if your employer has a form to be used for the purpose of requesting an accommodation.  If there is such a form, complete it.

If your employer doesn't have a form, create your own written request. You may wish to consider including the following items in your written request:

  • Indicate that you are a person with a disability. You do not have to disclose the extent of your health condition beyond the fact that you are "disabled."
  • Indicate that you wish to have your employer provide you with an accommodation.
  • Identify why you need the accommodation. If you make the request without indicating why you need the accommodation it can look less like a disability related request and more like a request for a perk -- especially when the requested accommodation is something cool like working at home.  For example: "Because of the nausea caused by my medication, I have to lie down after each meal for approximately a half hour until the nausea passes. This affects the time I arrive at work in the morning and the time I return from my lunch hour."
  • Indicate your ideas for an accommodation.
  • Indicate how the accommodation could potentially benefit the employer as well as you.
  • Be sure to indicate that you welcome additional accommodation ideas or feedback from your employer.
  • If your employer is aware of your medical condition, or if you have decided that you will disclose your condition to your employer:
  • Ask your specialist for a letter or statement that confirms from a medical point of view the existence of a disability as the word "disability" is defined in the ADA. (See Am I Eligible For A Legally Required Accommodation At Work?"). It's even better if the document can include the doctor's opinion about your need for an accommodation.
  • Talk with your specialist for your health condition about what in your medical record you don't want to be disclosed to your employer. For instance, the letter or other documentation does not have to include the identity of your diagnosis, or if it does, the extent of your current condition. 
  • Ask that your employer respond to your written request within a set reasonable time period. 

For a sample letter that incorporates these points, see Sample Letters To Request An Accommodation.

Take the original of your written request with you to the meeting.

In case you need reminding: be sure to keep a copy or record of your written request. 

Step 7. How To Negotiate For The Accommodation You Need

Since a discussion about an accommodation should be a friendly negotiation, it is generally preferable to start the process by meeting face-to-face with the appropriate human relations person.

When you negotiate for an accommodation, keep in mind that it is up to your employer to decide what accommodation to grant, and that the employer can shut down the negotiation. 

Tips for the negotiation:

  • Do not make the negotiation a power struggle. You are not adversaries. You are on the same team with the same goal. You both want to get the job done -- and done well.
  • Negotiate in a friendly manner.  A demand for an accommodation or a threat of a lawsuit could make your employer much less willing to work with you. Most people don't respond well to demands or threats. You can attract more flies with honey than with vinegar!
  • Present your request in a manner that permits you and your employer to come together cooperatively to address the concerns of both parties. For example, "here's the problem I'm having. I have an idea that would be useful. If you have a more practical idea, that would be helpful."  Or "I'd appreciate any ideas you may have as well."
  • Stick to the basics. Don't get into too much detail. If the employer wants more information, you will be asked.
  • Don't expect your employer knows what your disability is and why you need what you need. You may think it's obvious to your employer and that the employer knows as much as you do, but that is not necessarily the case. In fact, don't assume the employer knows anything about the situation.
  • You do not have to use the words "Americans With Disabilities Act" or the name of your state law. If your employer needs education about the law and an employer's obligations, you can recommend speaking (for free) with the Job Accommodation Network at 800.526.7234 ( offsite link).  
  • Be prepared in the event you reach a stalemate with your employer, or your employer wants to stop the discussions entirely.  If this happens, or even if the conversation does not go well, consider asking that the conversation be adjourned to another day so both of you can "sleep on it" and then meet again.  It's best not to have an all-out "knock down, drag out" confrontation.