Long term disability insurance companies can be skeptical of Lyme disease or Post-Treatment Lyme Disease disability claims.
Lyme disease is a bacterial infection spread by blacklegged ticks. It can cause symptoms such as fever, headache, and fatigue. If left untreated, Lyme disease can cause more serious complications, including heart problems, arthritis, and cognitive impairment. Many people who are diagnosed with Lyme disease will develop some form of disability, either during the acute infection or post-infection.
The CDC estimates that about 400,000 Americans contract Lyme disease each year. As serious as the condition is, insurance companies are often skeptical of Lyme disease disability claims, especially when symptoms last beyond the expected recovery period.
Short and/or long term disability insurance benefits may be available for those who experience severe Lyme disease symptoms. In this article, we’ll explain the best strategies for filing a Lyme disease short or long term disability claim.
Lyme Disease Symptoms and Treatment
Lyme disease can cause a variety of serious symptoms, including but not limited to:
Widespread muscle, nerve, and/or bone pain
Irregular heartbeat/heart palpitations
Dizziness and lightheadedness
Cognitive impairment (inability to concentrate, stunted attention span, memory problems, etc.)
Lyme disease symptoms will typically worsen if the disease goes untreated for an extended period of time.
There is no singular diagnostic test for Lyme disease. Most diagnoses are made by assessing the patient’s symptoms, exposure to ticks, and through a blood test that determines the presence of antibodies. Antibodies can only be detected weeks after the initial infection, so the test can only diagnose a patient if they have had the infection for a lengthy period of time. On the other hand, if a patient waits too long to seek treatment, the antibodies may no longer be present in the blood.
Lyme disease is treatable, typically through an antibiotic such as Doxycycline. The dosage and length of course for the antibiotic will depend on the nature and severity of the patient’s Lyme disease symptoms.
Post-Treatment Lyme Disease
Even though most Lyme disease patients respond well to antibiotics, there are cases of symptoms persisting past treatment. The lasting symptoms of Lyme disease are known as Post-Treatment Lyme Disease, or “Chronic Lyme.” Post-Treatment Lyme Disease can include a number of enduring symptoms affecting different bodily systems, including:
Neurologic Lyme Disease: This occurs when Lyme disease bacteria attacks the peripheral or central nervous systems. Common symptoms of Neurologic Lyme Disease include facial palsy, neuropathy/tingling in the extremities (arms and legs), and chronic headache.
Lyme Arthritis: Lyme disease bacteria can affect the joint tissue of a patient and cause ongoing arthritis. Lyme arthritis causes swelling and pain in the joints, including the knees, shoulders, hips, and wrists. This arthritis does not always resolve with antibiotic treatment and may become a permanent condition, especially if the original Lyme disease infection was not diagnosed and treated in a timely manner.
Lyme Carditis: Lyme disease bacteria can infect the heart, causing serious cardiovascular complications. Symptoms of Lyme Carditis include dysautonomia, fainting, lightheadedness, chest pain, and irregular heart activity such as palpitations. The cardiac damage caused by a Lyme disease infection may persist even after antibiotic treatment.
Little is understood about why some who contract with Lyme disease end up suffering from Post-Treatment Lyme Disease, though it has been speculated that immunologic factors can cause symptoms to be resistant to antibiotics. There are no known cures for Post-Treatment Lyme Disease. Treatment options will depend on the presenting symptoms of the patient.
Inability to Work Due to Lyme Disease
The symptoms of Lyme disease and Post-Treatment Lyme Disease can result in an inability to work, either for a period of months or on a permanent basis, depending on the individual.
For example, you may suffer from physical ailments caused by your Lyme disease such as muscle pain and chronic headaches. It can be too difficult to keep up with the required duties of your occupation, whether they involve sitting at a desk for extended periods, traveling for business purposes, or walking through an office.
Cognitive impairment can also occur as a result of Lyme disease. There is a higher risk of cognitive effects if you are diagnosed with Neurologic Lyme. Your Lyme disease may cause cognitive symptoms such as a shortened attention span or an inability to concentrate. As a result, you may become disabled on a cognitive basis due to your Lyme disease if your job requires you to perform tasks demanding high executive function. For example, you may no longer be able to read lengthy documents, participate in meetings, or keep up with extensive electronic communications.
How Insurance Companies Evaluate Lyme Disease Disability Claims
As mentioned above, insurance companies can be skeptical of Lyme disease or Post-Treatment Lyme Disease disability claims. This is because Lyme Disease symptoms, especially outside of the expected recovery period, can be difficult to prove with objective evidence. Common Lyme disease symptoms such as fatigue, chronic pain, and headaches are considered “self-reported” and subjective. In this context, subjective means that the patient reports the symptoms, but there are few tests that can provide concrete evidence of their existence. Subsequently, your insurance company may accuse you of malingering or exaggerating your condition.
In addition to proving the medical basis of your Lyme disease disability, your insurance company will require you to prove that you cannot work in your occupation because of your symptoms. This means you must connect the dots for your insurance company between your Lyme disease and your inability to work.
In this section, we’ll discuss ways to prove your Lyme disease on a medical and vocational basis.
Proving Your Lyme Disease Diagnosis and Symptoms
As discussed above, there is not one straightforward diagnostic test for Lyme disease. One common early sign of Lyme disease is erythema migrans. Erythema migrans is a skin rash caused by the tick bite which resembles a “bull’s eye” due to its rings of redness. If you sought medical treatment for this rash, you will have strong supporting medical evidence of your Lyme disease diagnosis.
Your doctor will also most likely test you for the presence of antibodies created by a Lyme disease infection. If you do test positive for these antibodies, you will have further objective medical evidence of your Lyme disease infection.
Of course, not everyone catches their Lyme disease early enough to document an erythema migrans rash, and the testing for antibodies is not always conclusive. For example, you may not have developed the antibodies yet at the time of testing, or you may have waited too long and the antibodies are no longer present in your system. This test alone does not rule out a Lyme disease infection.
Your doctor can also diagnose Lyme disease by evaluating your symptoms and your likelihood of exposure to tick bites. Also, Lyme disease symptoms may overlap with other pain, cardiovascular, and neurological conditions. By ruling out those alternative conditions through testing, imaging, and other means, your doctor may narrow in on a Lyme disease or Post-Treatment Lyme Disease diagnosis.
Beyond diagnostic evidence, you can provide your insurance company with evidence of your lasting symptoms. First, you should report all of your symptoms to your doctor at every visit. You should also seek treatment from a specialist for the type of Lyme disease you are experiencing. For instance, if you suffer from Neurologic Lyme, you should treat with a neurologist. If you have Lyme arthritis, you should treat with a rheumatologist, and Lyme carditis should be treated by a cardiologist.
If your Lyme disease symptoms impact your physical functioning, you may want to undergo a Functional Capacity Evaluation. A Functional Capacity Evaluation is an assessment done to measure your physical capabilities such as walking, standing, sitting, lifting, squatting, and hand dexterity. The evaluation report will provide a more comprehensive overview of your true physical capabilities than your medical records.
If your Lyme disease symptoms impact your cognitive functioning, you may consider a neuropsychological evaluation. A neuropsychological evaluation tests your cognitive skills, including but not limited to memory, language, recall, and attention span. The resulting report will detail the extent of your cognitive impairment due to your Lyme disease.
Proving You Cannot Work Due to Lyme Disease
The second component of a Lyme disease short or long term disability claim is proving you
cannot work due to your Lyme disease symptoms.
This means showing how exactly your symptoms prevent you from working. Remember that your insurance company may make assumptions about your job role and related functions. For example, if you work a desk job, your insurance company may presume your role is completely sedentary and that your Lyme disease physical impairments are not significant enough to affect your work performance.
It’s essential to explain to your insurance company the extent of your job responsibilities. You can provide vocational evidence such as the following:
Your full job description from your employer
A personal statement explaining your occupation and how your Lyme disease prevents you from working
A witness statement from a co-worker detailing how your Lyme disease has negatively impacted your job performance
You may also enlist the help of a vocational expert who can provide a formal assessment. A vocational assessment is an analysis done by an expert in the vocational field. The expert will review your resume, job description, and personally interview you to better understand your occupation’s functions and responsibilities. The expert can also review your medical records to understand your Lyme disease symptoms and how they prevent you from working. The ensuing assessment report can be submitted to your insurance company in support of your short or long term disability claim.
The Maddox Firm Can Help Prove Your Lyme Disease Disability Claim
Lyme disease short and long term disability insurance claims face unique and complex challenges that an ERISA attorney can assist you with. The experienced team at The Maddox Firm has helped prove countless disability claims for individuals and understands what the insurance companies are looking for in order to approve your benefits.
Here is how we help:
We examine your insurance policy. Insurance policies are the pillars of any disability claim strategy. The terminology in these policies can be convoluted and confusing. The Maddox Firm will examine your policy to understand the terms and what standard of disability you must meet to be granted benefits. From there, we can provide you a personalized strategy for your Lyme disease claim.
We gather your evidence. The Maddox Firm will request your medical records from your doctors to evaluate what existing evidence you have, and then see what evidence is needed for your insurance company to approve your claim. If needed, we can refer you for additional testing or a vocational analysis. We will also coordinate with your doctors to obtain a letter in support of your Lyme disease disability that can be submitted to your insurance company.
We handle all communications with your insurance company. Once you have The Maddox Firm on your side, we take over all communications with your insurance company so you no longer have to deal with the hassle and paperwork. We make sure everything goes through us and that your insurance company handles your claim fairly and in a timely manner. Should your insurance company request an interview, we will prepare you for the meeting and be present to make sure the representative does not try to ask any misleading questions. The Maddox Firm will provide your insurance company what is needed to approve your claim, and make sure your rights are protected in the process.
We can appeal your denial or termination. If your Lyme disease short or long term disability claim has been denied, or if your benefits were originally approved and later terminated, the Maddox Firm can help you appeal their adverse determination. We will review your denial letter, pinpoint the insurance company’s justification for benefit denial, and ensure that all necessary evidence to counter their arguments is gathered. We’ll prepare a lengthy, comprehensive appeal letter that addresses and refutes all of your insurance company’s arguments, and include any needed additional evidence of your Lyme disease disability.
We always recommend speaking with a trusted attorney before filing or appealing a Lyme disease disability insurance claim. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.