What Medical Conditions Qualify For Short
To qualify for short-term disability your medical condition must prevent you from doing your regular job duties. You must show how the symptoms or impairments from your medical condition interfere with your ability to perform you job duties.
To do this you will need to have an official list of your job duties. Then you can get your doctor review the list of duties and confirm that you cannot perform the majority of these duties because of your medical condition.
Most short term disaibltiy plans will require you to be continuously disabled for 7 days or so before you can qualify for benefits. This is called a waiting period or elimination period.
Following is an example of typical wording of the disability requirement for a short-term disability plan. Please note this is only an example, the exact wording is different for each plan:
An employee is entitled to payment of a short-term disability benefit if that employee proves that:
- the employee became totally disabled while covered
- the total disability has continued beyoned the elimintation period
- the employee has been following appropriate treatment for the disabling condition
An employee wil be considered totally disabled while the employee is continuously unable due to an illness to do the essentional duties of the employees own occupation in any setting.
Gathering Evidence And Writing The Appeal
When filing an appeal of a long-term disability claim denial, it is imperative to strengthen your appeal with as much objective medical evidence as possible. We will be sure to gather any and all documentation and file it with your appeal, such as:
- Test results
- Reports from your treating physicians
- Expert opinions
- Witness statements from you, your family, friends, or co-workers
Thoroughly gathering evidence is crucial, especially for ERISA-governed LTD appeals this is because in ERISA appeals, the administrative appeal stage is the final opportunity that a claimant has to submit substantive evidence into the record. When presenting our appeals, we use this evidence to explain how our clients meet their policys definition of disabled.
Resources To Help Veterans
There are several resources available to help veterans cope with the illness.
The Department of Veterans Affairs offers various services, including preventive education, diagnosis and treatment, and support for caregivers.
In addition, many state and local governments offer programs specifically for veterans with Lyme disease. These programs can provide financial assistance, transportation assistance, and other forms of support.
Finally, several non-profit organizations offer resources and support for veterans with Lyme disease. These organizations can provide information about treatment options, support groups, and financial assistance. With the right resources, veterans with Lyme disease can receive the care and support to manage their illness.
If you or someone you know has thoughts of suicide, please seek assistance right away. Many resources are available, and talking to someone who understands what youre going through can be very helpful.
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Using Clinical Evidence To Qualify For Individual Or Group Long
Chronic Lyme disease is closely associated with severe arthritis. While your individual or group long-term disability insurance company may limit your benefits for self-report conditions, you may still suffer from a clinical condition it will cover.
Bells Palsy, meningitis, nerve damage, and arthritis associated with Lyme disease are all separate, clinically diagnosed conditions. If your chronic Lyme disease symptoms manifest into these or other clinically diagnosable conditions that prevent you from working, you may qualify for additional individual or group long-term disability benefits.
In this case, how you present your medical evidence is essential, even at the beginning of the individual or group disability insurance claims process. Your medical records will need to confirm that you developed a clinical condition as the result of the initial tick infection. The experienced and award-winning individual and long-term ERISA disability attorneys at DarrasLaw can review the terms and limitations of your long-term disability policy and your medical records to see if you qualify for disability individual or group disability benefits.
Undergo A Functional Capacity Evaluation
A functional capacity evaluation is a test that gauges your ability to work and do daily activities. When you have a hard-to-understand diagnosis, like Lyme disease, it can be helpful to undergo an FCE.
During the examination, a physical or occupational therapist will have you perform a variety of tasks while observing your effort and abilities. Based on your performance, the therapist will assign detailed restrictions that may limit your ability to walk, lift, sit, bend, twist, and perform other physical activities.
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Interference With Ability To Work
The multiple limitations caused by Lymedisease may make it impossible for you to return to work even if you don’t meet a listing. SocialSecurity will evaluate your abilities and impairments using the ResidualFunctional Capacity to determine if all of your impairmentsconsidered together prevent you from being able to work.
For those with Lyme disease, pain in themuscles, joints, tendons, and back, numbness and tingling in the handsand feet, arthritis pain and swelling in the knees or other joints, andweakness in the legs can make physical activities such as walking,standing, and lifting difficult, depending on the severity of theirsymptoms. Additionally, problems with sleep, heart problems, andsignificant fatigue may make it hard to do any type of physical work.
Social Security will also evaluate yourability to do less strenuous, sedentary work. For those with Lymedisease, numbness in the limbs, arthritis, and balance issues mayprevent certain physical movements and fine motor skills, if yourfingers or hands are affected. In addition, facial weakness can affecteye sight.
How Is Lyme Disease Diagnosed
In order to properly diagnose Lyme Disease, doctors first study the patients medical history, observe the signs and symptoms they are experiencing, and consider the likelihood of exposure to ticks carrying the disease. Exposure risk is determined based on whether the individual remembers being bitten, if the patient is outside often, and the rate of infection where they live. An EM rash is the only objective physical sign that confirms a Lyme Disease diagnosis.
Because not every person diagnosed with Lyme disease experiences an EM rash, serological tests are required to detect the presence of antibodies in the blood. These antibodies are produced in response to the presence of Lyme-causing bacteria, Borrelia burgdorferi. These results can help determine if a patient has Lyme Disease, and can identify disease progression within the body.
The CDC recommends that physicians use a two-tier serological testing approach in order to determine whether a patient has Lyme Disease:
- Enzyme-linked immunosorbent assay
- If an ELISA test comes back negative, it is deemed that the patient does not have Lyme disease.
- The CDC recommends that only those with a positive ELISA screening should undergo the Western Blot test.
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Facts About Lyme Disease
Here are some of the facts about Lyme disease in the human population:
- About 94 percent of cases occur in 12 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Hampshire, New York, Pennsylvania, Virginia, and Wisconsin.
- There were over 20,000 confirmed cases in 2010, down from about 30,000 in 2009.
- People are most likely to have an onset of Lyme disease in July, followed by June, then August.
- In patients with this disease, about 70 percent experience erythema migrans, 30 percent arthritis, 8 percent Bells palsy, 4 percent radiculoneuropathy, 2 percent meningitis or encephalitis, and 1 percent cardiac problems.
How Can I Qualify For Lyme Disease Disability Benefits
Your medical records are the best way to show the SSA that you qualify for Lyme disease disability benefits. If you are unsure whether or not your condition makes you eligible to receive benefits, an experienced SSD representative can help. Additionally, many people who apply for SSD benefits are initially denied but you have the right to file a disability appeal. Working with an representative during the disability appeal process can also greatly increase your chances of being awarded the benefits you deserve.
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Getting Ssi Or Disability For Lyme Disease
The Social Security Administration, or SSA, provides disability benefits to individuals who, due to a severe illness or injury, become so disabled that they are unable to work. The different types of support you can receive include:
- Social Security Disability Insurance, or SSDI
- Supplemental Security Income, or SSI
To qualify for either SSDI or SSI, you need to prove that the symptoms youre experiencing limit your ability to do work significantly. Depending on your condition, this process can be pretty straightforward or challenging.
Many of the symptoms people experience with Lyme disease can mimic less severe conditions. These issues can end up being treated with medications and antibiotics.
Well now review how you can get SSI or SSDI benefits for Lyme disease. For an individual to get these benefits, at least one of two things has to be the case.
The first is that the individual meets the requirements of one of the medical conditions listed within the Social Security Administrations Blue Book.
When unable to meet the requirements, they must demonstrate how the effects they experience result from Lyme disease interfering with their ability to work.
Disability Benefits For Lyme Disease
Lyme disease can be debilitating, and it can make going to work difficult or even impossible. Since the symptoms of Lyme disease can last for a month or more and a person can have several times where the disease rebounds after a remission, getting the disability benefits that a person needs can be difficult. Anyone who is experiencing complications from their infection with the Lyme disease bacteria should find out whether or not they qualify for SSDI benefits for Lyme disease.
There are several criteria that a person must meet in order to qualify disability benefits, and since there isnt a specific listing for Lyme disease in the SSA Blue Book, people who wish to receive benefits must qualify under a different listing. For instance, many people with Lyme disease experience cardiovascular damage, which is listed in the Blue Book. Some other ways that people with Lyme disease can apply for benefits include mobility issues caused by musculoskeletal issues, anxiety or cognitive issues caused by the disease, or inflammatory arthritis caused by Lyme disease.
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How Do I Apply For Long Term Disability Benefits For Lyme Disease
To make a successful claim for LTD benefits for Lyme disease, it is important to work closely with your doctor. You will need to discuss your symptoms, limitations, restrictions, and potential treatment options. Your doctor will then be required to provide a diagnosis, describe your symptoms, and record his or her findings. The insurance company will use this information to assess your level of functional impairment and determine whether you qualify for Lyme disease disability benefits.
Because the symptoms of Lyme disease are so diverse and common to so many other diseases and illnesses, confirming an LTD claim for Lyme disease will be challenging.
The foundation for a successful disability claim for Lyme disease is a detailed record of symptoms you are experiencing, along with notes describing how those symptoms prevent you from working. Those notes should also include all the treatments you have undergone, along with their intended effect and their actual effect.
For these reasons, it is crucial to record how the disease has progressed and identify any possible patterns and/or correlations with other factors . In all cases, it is important to be honest and candid about your symptoms and to keep lines of communication open with your physician.
Can I Get Disability Insurance Benefits For Lyme Disease Or Post
To qualify for short-term or long-term disability benefits, you must prove that you are unable to work due to your Lyme disease and other medical conditions. It is possible to get disability benefits for Lyme disease and post-treatment Lyme disease syndrome. However, getting benefits may be difficult due to misconceptions about the disease and the limitations of our current testing system.
Disability insurance adjusters tend to deny claims where there isnt a clear diagnosis thats proven by objective evidence, like a blood test, MRI, or nerve conduction study. Unfortunately, many people with Lyme disease get inconclusive test results or receive a tentative diagnosis of probable Lyme disease.
The insurance company may argue that your chronic Lyme disease or PTLDS diagnosis is self-reported since symptoms like fatigue, pain, and dizziness are subjective and cannot be proven by a test. Most long-term disability insurance plans limit benefits for self-reported conditions to two years.
To fight back against these insurance company tactics, youll need help from an experienced ERISA lawyer who can help explain your complex diagnosis and bloodwork to the insurance company and a judge.
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Lyme Disease Is Difficult To Diagnose
Its often difficult to diagnose early Lyme disease since not everyone develops the telltale bulls-eye rash. Currently, doctors use a two-stage blood test that looks for Lyme disease antibodies. However, this test only has a 30-40% rate of detection for those with early Lyme disease. To further complicate matters, the Borrelia bacteria quickly leaves your bloodstream and enters your tissues and lymph nodes.
Your Lyme Disease Disability Case
Because there is no listing for Lyme disease and treatment allows individuals with the disease to lead otherwise healthy lives, qualifying for benefits may be difficult. The claim must clearly demonstrate that the individual is unable to work and function independently.
For some, this may be difficult to do and their first application might be denied. Applications can be denied because they were incorrectly filled out or the documentation did not meet all the requirements. Fortunately, there are attorneys who specialize in the Social Security Disability benefit application who can help. They offer consultations for little to no charge and can help individuals prepare the correct information. A good disability attorney will even help you present the information to Disability Determination Services. Hiring a Social Security disability attorney often makes the difference between receiving benefits and being denied, and may be a wise choice for someone seeking benefits with Lyme Disease.
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Determining Your Ability To Work
Suppose youre unable to meet any of the listings we just reviewed. You might be wondering, Can I get disability for Lyme disease or SSI even though I dont meet any of these listings? The fact is that you may.
In the case where there are limitations outside of these that youre experiencing as a result of Lyme disease that makes it impossible for you to work, you might be able to get these benefits.
Using an RFC, or Residual Capacity Form, the SSA tries to determine whether your impairments are severe enough to prevent you from carrying out your daily work activities.
For instance, they might review your ability to grasp, pull or lift items, walk, kneel, or stand or sit for an extended period.
Depending on which activities you can or cant do because of Lyme disease, the SSA might deem you capable of doing heavy, medium, light, or sedentary work.
This assessment, combined with your medical records, could demonstrate that youll qualify for disability benefits.
Dont Give Up Contact A Top
Youre tired and in pain, so the last thing you want to do is lose your individual or group long-term disability benefits. Whether youre already receiving long-term individual or group disability benefits for Lyme disease, were just diagnosed with the condition, or are suffering from chronic symptoms of the disease, we can help.
The award-winning individual and experienced long-term disability insurance lawyers at DarrasLaw can help you avoid a wrongful delay, denial, or termination of benefits and can help you fight for your legal right to the benefits youve dearly paid for.
Nationally renowned disability lawyer Frank N. Darras, who has more than 30 years of litigation and claim experience fighting for Americas disabled, leads DarrasLaw. His firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits. To schedule your free disability policy analysis and free claim consultation with one of Americas top-rated individual or award-winning group ERISA attorneys today, call us at 458-4577 or contact us online.
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Can You Get Disability Benefits For Lyme Disease
Lyme disease is caused by the transfer of bacteria as a result of a tick bite. When an infected tick bites someone, they can easily become ill with Lyme disease and begin experiencing a number of different health issues that affect the heart, nervous system and joint. When left untreated, Lyme disease can result in severe health conditions like fibromyalgia, depression, meningitis and more. If you or a loved one has been diagnosed with Lyme disease, the Social Security Administration may consider you for disability benefits depending on your medical history and the progression of the condition.
Contact A Social Security Disability Attorney At 512
Experienced Long-Term disability lawyer Lonnie Roach will fight for you. Dont give up, get the benefits you deserve.
Because insurance providers base their coverage criteria on CDC and IDSA guidelines, they dont recognize chronic Lyme disease as a legitimate, long-term illness.
Most insurance policies are clear about what they will and will not pay for when it comes to treating Lyme disease. For example, Aetna will cover only a four-week regimen of antibiotic treatment, claiming that further treatment has not been proven beneficial. The Texas Lyme Disease Association disagrees, stating that Lyme disease is not a rare illness that is easy to avoid, difficult to acquire, and simple to diagnose nor is it easily treated and cured. The longer the time elapsed between a tick bite causing infection and the diagnosis and treatment of Lyme disease, the more likely the illness will be serious and long lasting, and the cost of treatment very high.
Insurance companies may not recognize Lyme disease as a chronic disorder, but that does not change the fact that without proper medical treatment, Lyme disease may develop into carditis, arthritis and other neurological conditions which disable a person.
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