New York Disability Insurance Lawyers

Lyme Disease: Still a Complicated Disability Issue

Can Lyme disease be disabling?

Lyme disease is a tick-borne illness that ranges widely in presentation and severity.  The infection can cause a diverse number of physical and mental symptoms, which can vary in severity from mild to debilitating.  Yes, for many, the condition results in short and/or long term disability.

Symptoms of Lyme disease are unpredictable

Most victims of Lyme disease suffer an unpredictable combination of physical and/or mental symptoms.

Physical symptoms may include fatigue, joint swelling, widespread pain, fever, headache, weakness, digestive problems, and general malaise.  In some cases, the physical symptoms mimic mild flu-like symptoms which resolve after treatment with antibiotics.  For others, the symptoms are far more debilitating and chronic.

Mental symptoms may include cognitive deficits, memory loss, impaired ability to focus, anxiety, panic attacks, executive function deficits, delusions, and confusion.  Not everyone suffers mental symptoms.  For those who do, the mental symptoms may vary in severity from barely noticeable to severely incapacitating.

Symptoms may resolve quickly following antibiotic treatment.  In certain cases, however, symptoms may persist for months to years.  Symptoms are more likely to persist if the Lyme infection goes undetected or untreated for a long period of time.  Symptoms are also more likely to persist if the victim was previously infected with Lyme.

The condition is further complicated by the waxing and waning of symptom severity resulting in periods of remission and exacerbation.  If the symptoms are severe and frequent enough, they can certainly result in short and/or long term disability.

Challenges in diagnosing Lyme disease

According to the Center for Disease Control (“CDC”), Lyme disease is diagnosed by:

• Clinical signs and symptoms; and
• A known history of exposure to infected blacklegged ticks.^[1]

While laboratory blood tests may be helpful, positive results are not necessary for a proper diagnosis.^[2]

Unsurprisingly, the inconsistency of Lyme’s clinical presentation often makes it difficult to diagnose.  The clinical signs and symptoms are frequently mistaken for other illnesses, such as chronic fatigue syndrome, Crohn’s disease, early ALS (Amyotrophic Lateral Sclerosis), arthritis, early Alzheimer’s, or multiple sclerosis.

It may also be difficult to identify exposure to an infected tick.  Although the tick bite often causes a distinct “bulls-eye” skin rash called “erythema migrans,” many victims never not develop the rash.  Thus, some physicians are forced to estimate the likelihood of exposure based on the victim’s proximity to known areas with infected ticks.  In New York, infected ticks are known to exist throughout Long Island (particularly in Suffolk County), the Hudson Valley, and Upstate.

For these reasons, Lyme disease often goes undetected and untreated for quite some time.  Many victims consult with multiple physicians and undergo a battery of tests before the diagnosis is confirmed.

Laboratory testing

While serological testing is not necessary to confirm Lyme disease, the results may certainly be helpful.

Laboratory blood tests typically involve two-tiered testing for evidence of antibodies against the Lyme disease bacteria.  The first step uses a procedure called “EIA” (enzyme immunoassay) or sometimes, an “IFA” (indirect immunofluorenscence assay).  The second step involves an immunoblot test, which is commonly referred to as a “Western Blot” test.

The Western Blot is arguably more important as it seeks to identify the presence of specific antibodies–referred to as IgG and IgM antibodies–against Lyme.  A positive Western Blot is usually a reliable indicator of Lyme, but a diagnosis may be made without it.

The positivity of serological results will vary depending on the set of interpretation criteria applied.

The CDC publishes its own standards for a positive tests results for epidemiological purposes only —  not for diagnostic purposes.  Other reputable serological interpretation criteria exist for diagnostic purposes, including IGeneX.^[3]  Your doctor may choose to apply several different sets of interpretation criteria.

How we prove disability due to Lyme disease

There are many challenges in proving a short or long term disability claim for Lyme disease.  These include: (1) getting the insurance company to acknowledge your diagnosis; (2) demonstrating the frequency and severity of your symptoms; and (3) proving how your specific symptom set prevents you from working.

1.      Acknowledging your diagnosis

One of the biggest challenges in proving a Lyme-related disability claim is getting the insurance company to acknowledge your diagnosis.

Lyme disease is a difficult condition to diagnose, given the wide ranging symptoms that victims experience.  For this reason, many insurance companies improperly require positive laboratory blood test results to confirm your Lyme disease.  However, as discussed above, a positive test is not necessary to confirm a diagnosis of Lyme disease.  A claimant may have negative blood results and still have Lyme disease.

Riemer Hess frequently corrects insurance companies when they place undue reliance on blood results.  We spell out the proper diagnostic criteria to the insurance companies and demand that they apply the correct criteria.  We may also solicit a letter from your treating physician to comment on your proper diagnosis.

2. Demonstrating the frequency and severity of symptoms

Insurance companies often deny Lyme disability claims because they do not believe that the symptoms are severe or frequent enough to prevent you from working.

Lyme symptoms vary greatly in severity and type.  Symptoms also tend to wax and wane over time.  You may have some days with little to no symptoms, and other days where you cannot even leave your bed.  Yet, the insurance company may point to “good days” recorded in your medical records to deny your claim.

Riemer Hess does several things to prevent the insurance company from discounting the severity and frequency of your symptoms:

• We always recommend that you talk to your doctor and report all of your symptoms during each visit to produce strong documentation in your medical records.

• We will typically ask your doctor to complete a customized questionnaire to address the disabling nature of your symptoms.

• We may obtain a narrative letter from your doctor describing how your particular symptoms prevent you from working.

• We may ask you to write a statement or keep a daily diary regarding your symptoms, which can later be presented to the insurance company.

• We may also obtain written statements from your friends, family, and/or coworkers about your symptoms and resulting limitations.

Strong and clear documentation of your symptoms is key.

3. Proving how your symptoms prevent you from working

Even if your claim file contains strong documentation of your symptoms, the insurance company may still deny your claim if it does not believe that your particular symptoms would prevent you from working.

Riemer Hess addresses the specific requirements of your job and outlines why you can no longer perform those duties.  We may do this by:

• Obtaining written statements from your employer about your job responsibilities.

• Obtaining a vocational expert assessment on your behalf. The vocational expert will read your job description and interview you about job responsibilities with you before reviewing your medical records.  The vocational expert will then draft a detailed report addressing how your medical condition impacts your ability to work.

• Obtaining written statements from your employer about your job responsibilities.

• Obtaining your past employee performance reviews to demonstrate any decline in your work performance following your diagnosis.

Obtaining legal assistance

Riemer Hess highly recommends obtaining legal representation before filing a short and/or long term disability claim for Lyme disease.  The condition is extremely complicated and it is often difficult to assess a resulting degree of disability.  Having an experienced legal team in your corner will increase your chances of approval.

^[1]  http://www.cdc.gov/lyme/diagnosistesting/

^[2]  See id.

^[3] http://www.igenex.com/

Disability Issues for Common
Illnesses and Injuries: Lyme Disease

Lyme disease is a bacterial infection passed to humans through deer tick bites. If caught early, it can be treated with a regimen of antibiotics. However, without treatment, it progresses through stages with increasingly debilitating effects. A Lyme disease sufferer may have a difficult time convincing a long term disability insurer to grant benefits because it is hard to diagnose and passes through periods of exacerbation and remission. Our New York disability insurance lawyers have considerable experience with Lyme Disease claims and know how to prepare and present a compelling case.

The Three Progressive Stages of Lyme Disease

The effects of Lyme disease are not uniform. However, one unifying characteristic of all sufferers is that their condition manifests itself in three stages. While the disease is treatable, at least initially, each stage brings progressively worse symptoms.

1. Stage One. Many sufferers mistake early symptoms for the flu. Head and body ache and an overall feeling of being sick pervade the early days of Lyme disease. Onset of first symptoms from infection is usually a few days, but it can occur weeks after the fact.
2. Stage Two. Weeks or months may pass before the second stage begins, but the sufferer experiences much more pronounced pain in the joints, muscles and tendons. Dizziness is common, as well as pain that makes sleep difficult. A patient may experience reduced control of facial muscles, alteration of mental state and even meningitis or heart ailments as the disease attacks the central nervous system.
3. Stage Three. A sufferer may enter this most serious stage within months of being bitten, but it can take years for the following symptoms to become apparent: chronic problems with the nerves, vision, joints and heart, as well as damage to the brain. The disease may bring on encephalopathy and chronic encephalomyelitis, which are progressive neurological conditions marked by trouble concentrating, cognitive impairment, vertigo, bladder control issues, and difficulty walking and controlling limb movement. Delusions are not uncommon.

Patients who do not receive treatment until in the later stages of the disease may have suffered long-term damage to the nervous system or joints. Somewhere between 10 to 20% of patients continue to experience debilitating symptoms even after completing antibiotic treatment.

Proving Disability With Lyme Disease

Our New York disability insurance attorneys will work closely with you, your employer, and your doctors to make sure that your story is convincing and your claim is properly documented.

• We will interview you extensively to determine your job duties, symptoms, and how they prevent you from performing the material duties of your occupation or profession (or of any occupation for which you are suited, if that is the applicable standard).
• We will help you present that story to the insurer by way of a written statement or video.
• We will obtain your job description and performance evaluations from your employer.
• We will guide your doctor in preparing a report that explains your diagnosis and prognosis, symptoms and how they restrict your activities, medication side-effects, and inability to work.
• If your Lyme Disease has caused cognitive impairment, we will refer you for neuropsychological testing and a SPECT scan, which will provide the objective evidence that is persuasive to insurers.

For Help with Your Long Term Disability Insurance Claim

It’s never too soon to seek help from New York disability insurance lawyers. The legal advice you receive before applying for benefits can be the most valuable. If your claim has already been denied, it’s not too late, but you must move quickly. A claimant has up to 180 days to appeal the denial. Contact an attorney as soon as possible because it often takes the full 180 days to prepare a comprehensive appeal.Call Riemer Hess LLC, Attorneys at Law today at 212-297-0700.