(Money Magazine) -- When you're diagnosed with a long-term health problem -- such as multiple sclerosis, bipolar disorder, even arthritis or back problems -- the cost of your care is just one of your money worries. There's also a threat to your earning power. Should you reveal the condition to your boss or hide it as long as possible? When your employer finds out, could you fall off the promotion track? Get pushed into a dead-end position? Lose your job altogether?
There are laws to protect workers, but whether you are covered by them will depend on the size of your company, says Chris Kuczynski of the U.S. Equal Employment Opportunity Commission.
What's more, filing a discrimination charge against your employer may not get you very far. So how do you keep your career and income moving in the right direction? Employment lawyers and disability advocates suggest the following strategy.
If you know you're having trouble doing certain parts of your job, don't let fear of discrimination keep you from saying something, says Krista Pratt, an employment attorney in Boston. Silence is risky, because people who are demoted or fired before speaking up usually aren't protected by the law.
However, before you talk, be prepared.
Ask your doctor what accommodations -- reasonable changes to your work environment -- may become necessary. For example, you may need ergonomic fixes in your office or a delayed start time if meds make you drowsy in the morning. (Find a list of common accommodations on AskJan.org, run by the Job Accommodation Network, a federally funded service.)
Next, research your rights.
Assuming you work at a firm with 15 or more employees, under federal law you can't be fired for a disability as long as you can perform the "essential" functions of your job -- even if you need accommodations. (AskJan.org has more details.) And at firms with 50 or more employees, workers are typically entitled, if a doctor says it's necessary, to 12 unpaid weeks of leave within a 12-month period. State and local laws may apply to small companies; contact your state's equal employment office.
Worried that your company is going to be hostile to your request? Consult an employment lawyer. Cost: $100 to $400 for a one-time meeting. Find one at nela.org.
You may not feel comfortable opening up to your immediate boss about your condition. So start by presenting your HR department, or the higher-up you most trust, with a letter from your doctor that simply says you have a medical condition and that you'll need accommodations. Your company can ask for another letter stating the diagnosis, but the conversation often doesn't go that far.
Be as specific as possible about the accommodations you want and try to offer your employer more than one option. That lowers the chance that they'll balk, says Brian East, an attorney at Disability Rights Texas, an advocacy group. By law, companies can deny any accommodation that causes undue hardship. But according to the Job Accommodation Network, 56% of accommodations cost employers nothing; the rest average a reasonable $600.
If you do end up in court, taking a cooperative approach from the start will make a good impression on a judge or jury, says East. Keep written records of all discussions.
Even after granting accommodations, your boss may eventually decide that you can no longer do your current job. In such cases, an employer with at least 15 workers must offer to move you to a comparable position in the firm, as long as one is available and you can do it. But if there's no vacant slot on par with yours, you may be offered a job lower in status and in pay.
Rather than simply accepting a lesser position, propose a new role that has clear benefits for the company. Let's say you're in sales but can no longer travel regularly to meet with clients. You might propose taking over local clients, plus adding office duties such as training.
"Stress how it will be a win-win," advises Linda Batiste of the Job Accommodation Network.
These steps aren't always enough. Depending on the severity of your condition, you may ultimately have to find a different kind of job at another company or go on disability. In that case, ask for severance.
Most employers don't grant it, says Pratt, but when you've built up goodwill while managing your condition, some firms will try to help you through the transition. 
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