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Lyme Disease | Long Term Disability Claim Tips

Benefits Proof Lyme Disease

Contents:

This article will address several issues you need to think about before filing your long term disability claim for Lyme disease.

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, Chron’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.

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

[2]  See id.

The Required Proof of Diagnosis

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.[1]  Your doctor may choose to apply several different sets of interpretation criteria.

 

[1] http://www.igenex.com/

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 & Associates 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.

  1. 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 & Associates 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.

  1. 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 & Associates 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.

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