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Do I Qualify For Disability Insurance Benefits If I Have Lyme Disease?

CaveyLaw.com > Practice Areas  > Long Term Disability & ERISA Lawyer  > Long Term Disability Disabling Conditions > Do I Qualify For Disability Insurance Benefits If I Have Lyme Disease?

Disability insurance companies don’t always make it easy for policyholders who have Lyme disease to get the disability benefits they deserve.

Lyme disease is a complex, multi-system inflammatory disease that affects major organs in your body. The diagnosis is complex and, unfortunately, many patients are misdiagnosed with multiple sclerosis, chronic fatigue syndrome, rheumatoid arthritis, or they’re told it is all in their heads.

Because of the wide variety of symptoms and the long period of incubation, it can be challenging to get a correct diagnosis. That is one of the reasons disability carriers are notorious for denying and terminating many Lyme disease claims.

Common Reasons Lyme Disability Claims Are Denied

Disability carriers often argue that coverage under the policy is excluded because of the pre-existing condition clause, or that benefits are limited under the subjective limitation clause. Headaches, pain, fatigue and side effects of treatment can be the most disabling symptoms, but they are subjective complaints. Carriers routinely dispute them.

It is not uncommon for policyholders to have had Lyme disease for years and not been disabled. You will have to overcome the carrier’s argument that you have been working with these problems for years and nothing has changed.  It is crucial that your medical records develop the progression of your symptoms.

Carriers often argue that treatment will allow you to continue to work so you couldn’t possibly be disabled.

As a result, many disability claims for Lyme disease are denied. Carriers also deny claims saying:

(1) There is no objective basis of the diagnosis because you didn’t have a bull’s eye rash, you have no history of tick bites, and the Western blot and ELISA tests are negative,

(2) There is no objective basis for the restrictions and limitations assigned by your physician because of your Lyme disease or any restrictions aren’t permanent,

(3) There is no causal relationship between your Lyme’s disease and/or restrictions and limitations, and your inability to do your own or any occupation.

Nancy Cavey, who has 35 years experience handling disability cases, has successfully represented many policyholders with Lyme’s disease. She overcomes a claims denial by working closely with you and your physician. She has seen first-hand clients suffering the devastating effects of Lyme disease and understands what you are going through.

Nancy Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your disability claim.

What Are the Symptoms of Lyme Disease?

The symptoms can vary from patient to patient, and are dependent upon the stage and the severity of the Lyme disease. Symptoms include:

  • Fever,
  • Headaches,
  • Rash,
  • Pain,
  • Fatigue,
  • Vertigo,
  • Speech impediment and visual changes,
  • Cognitive impairment, including difficulty with memory and concentration,
  • Difficulty with limb movement and walking, with numbness in the arms and legs,
  • Heart symptoms,
  • Bladder control issues,
  • Mood swings,
  • Hallucinations, and
  • Depression.

It is crucial that your medical records document not only your symptoms but how those symptoms impact your ability to function around your home and at work.

How Do I Get The Disability Insurance Benefits I Deserve?

Regardless of your diagnosis, Lyme disease can interfere with your daily activities and with your ability to work. If you no longer can work or your doctor has told you to apply for disability benefits, you should take steps before you apply:

  1. Obtain a copy of your disability policy. See how it defines “disability,” “occupation” and “self-reported conditions.” You’ll need to understand what you have to prove and if there are limitations in your coverage.

Some policies consider Lyme disease without objective findings to be a subjective condition and limit benefits to just two years. You’ll want to know what’s in your policy before you apply for benefits.

  1. Obtain a copy of your medical records. Review them to see if there is an objective basis for your diagnosis, what your records say about your report of symptoms and your restrictions and limitations.

In denying claims, carriers often say there is “no objective evidence to support your subjective complaints.’’ Carriers often make a leap of logic and conclude that the policyholder either is exaggerating or faking their pain. Nancy Cavey knows what proof is necessary to meet the policy definition of disability.

  1. Get treatment from a claimant-friendly Lyme disease specialist.
  2. Undergo neuropsychological testing with a claimant-friendly neuropsychologist to confirm your cognitive problems,
  3. Undergo a Functional Capacity Evaluation by a claimant-friendly physical therapist, to document your physical restrictions and limitations.
  4. Undergo testing at a claimant-friendly fatigue lab to document the impact of fatigue on your ability to function.
  5. Obtain a copy of your personnel file to see if your Lyme disease has affected your work performance.
  6. Obtain a copy of your job description. Create your own description of your physical duties with an explanation of how your symptoms impact your ability to do your occupation.
  7. Provide your doctor with the occupational description. Ask your doctor to prepare a report that explains the objective basis for your diagnosis, the objective basis of your restrictions and limitations, and the objective reasons you can’t perform some or all of the material and substantial duties of your occupation.
  8. Prepare a pain diary that explains your pain, side effects of medication, and gives examples of how your pain, fatigue and other symptoms interfere with your ability to do things on a daily basis. Your pain may even give you problems with concentration.

11 Hire Nancy Cavey to help you file your initial application. The application process is confusing and designed so you and your physician make mistakes that can result in a delay or even a denial of your benefits. Ms. Cavey knows how to prepare and file a winning shock and awe disability application that leaves the carrier little reason to question your claim.

  1. Hire Nancy Cavey to help you appeal a wrongful denial or termination of your disability benefits. Disability carriers are in the business of collecting premiums and not paying disability benefits. They’ll use any reason to deny your Lyme disease claim. The odds of getting your benefits on appeal are greater when you are represented by an experienced ERISA/private ID policy disability attorney.

Contact Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live

Lyme disease can make it difficult, if not impossible, to work. You owe it to yourself and your family to get help today! Nancy Cavey can review your policy and your medical records, and explain to you what your policy says and how to get your disability benefits.  Call today for a free consultation at 727-894-3188.