Lyme Disease And Disability Claims: What You Need To Know
May is Maternal Mental Health Awareness Month and the first Wednesday of May has been designated as lyme disease lyme disease in general , PMADs can affect women of all ages, income levels, cultures etc. Maternal Mental Health Day is important because it is meant to reduce the stigma of maternal mental illness.
lyme disease
lyme disease
lyme disease lyme disease
Springtime is upon us and with the warmer weather comes greater risk of contracting Lyme disease. Lyme disease is becoming more and more of a concern across Ontario and Canada wide due to global warming and the movement of tick populations.
The symptoms of Lyme disease can be debilitating and can last for an extended period of time, and you may be unable to continue working and find yourself applying for short term and long term disability benefits. Unfortunately, many of the symptoms can be confused for other illnesses and Lyme disease is often referred to as an invisible illnesses and can go undiagnosed for some time.
This blog post will cover:
- What is Lyme Disease?
- What are the Symptoms of Lyme Disease?
- Why Is it Misdiagnosed?
- How is Lyme Disease Treated?
- Prevention Tips
- What You Should Know about Lyme Disease and Disability Claims
- Reasons Your Disability Claim Could be Denied
- What You Can Do if Your Disability Claim is Denied
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.
How To Win Disability Benefits For Lyme Disease
Ive already touched on the difficulties of getting a firm diagnosis. Unsurprisingly, this translates directly into how insurance companies and the CPP will handle your disability claim. Youve probably already guessed or even experienced yourself that benefit providers arent exactly eager to give out disability benefits for an illness like Lyme disease, which is often treated as if it was all in the patients head.
Another point to consider are the different stages of Lyme disease. You will have to prove that your illness has progressed into a chronic disease. Meaning it doesnt allow you to lead a normal life anymore. In short, you need to prove that you are legitimately disabled from work.
The nature of the illness and the inadequate testing system makes this difficult, however. The most difficult challenge is to get an official diagnosis for Lyme disease. As mentioned previously, Canada has yet to improve the screening test to detect more than one strain of the bacteria.
So, insurance companies will have no qualms to debate you on this. And they will crush your hopes of receiving disability benefits if they can find a hole in your application. Insurance companies have to make a profit, and your disability claim reduces that profit. Therefore, every single claim will be scrutinized and eventually denied if its not 100 percent bulletproof.
You May Like: Signs You Have Lyme Disease
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.
Can You Prove Lyme Disease
There is no single test that can definitively diagnose Lyme disease, and the diagnosis is often made based on a combination of symptoms, lab tests, and clinical examination.
As a result, some people may question whether Lyme disease is real. However, the evidence clearly shows that Lyme disease is a serious condition that needs to be taken seriously.
You May Like: How Much Is A Lyme Disease Test
Touched By Lyme: Can You Get Disability Benefits For Lyme Disease
Guest blogger Peter Burke, an attorney who focuses on disability law, summarizes some of the challenges faced by Lyme patients.
Lyme Disease and Disability Benefits: The Challenges
Lyme disease is a bacterial infection caused by a tick bite. Its symptoms are diverse and can cause physical disabilities, including heart disease, joint swelling, fatigue, and extreme pain, along with a variety of mental symptoms, including memory loss, attention and executive function deficits, anxiety, panic attacks, and delusions. Victims often consult with as many as 20 or 30 doctors before getting an accurate diagnosis. To complicate the problem, symptoms mimic a range of other mental and physical conditions and are often inconsistent, with exacerbations and remissions.
Qualifying for Government Disability Programs
Because of the great variety in symptoms and the difficulty obtaining a diagnosis, many people suffering from this debilitating disease are unable to work. However, for those same reasons, they face challenges when applying for disability benefits, whether SSI or SSDI, far beyond those faced by people with other more common disabilities.
The RFC
Many people suffer from multiple symptoms that make it impossible to resume working, even if there is not a specific match to a blue book listing. In this situation, Social Security uses the Residual Functional Capacity to determine the combination of impairments is sufficiently disabling to keep you from returning to work.
Getting Help
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.
Also Check: Early Signs Of Lyme Disease In Dogs
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.
You could be eligible for up to $3,148 per month In SSDI Benefits
Bryant Legal Group: Illinois Trusted Disability Insurance Law Firm
At Bryant Legal Group, we guide disabled individuals through their complex short-term and long-term disability claims. If you or someone you love is living with Lyme disease or another tickborne illness, contact us today. We can help you understand your legal rights and suggest ways to strengthen your disability insurance claim.
To schedule your free initial consultation and get personalized advice from an experienced attorney, call us at or complete our online contact form.
Also Check: Antibiotics To Prevent Lyme Disease
Lyme Disease As Mental Illness
Your blood work can easily show that you have a bacterial infection associated with Lyme disease, but when the infection is cured, how do you prove youre still suffering from disabling symptoms? Its hard to medically prove your level of pain, stiffness, and the severity of migraines. Further, Lyme disease lab work is plagued by false positives.
For this reason, individual and group long-term disability insurance companies may label Lyme disease as a type of somatic symptom disorder, which is classified as a mental illness. Somatic symptom disorders are defined as when your focus on extreme pain or fatigue causes major emotional distress. Because the symptoms of Lyme disease persist after the initial infection is arguably cured, chronic Lyme disease may also wrongfully get grouped into this mental health category, subject to 24 months of benefits.
Similar to fibromyalgia, the extreme joint pain and fatigue associated with chronic Lyme disease symptoms are unfortunately subject to self-report. While your treating doctor can help confirm your symptoms, youre essentially asking your disability insurer to trust that you cant perform the important duties of your occupation.
Recommending Testing To Substantiate Your Claim
Your insurance company will require objective evidence demonstrating how your Lyme disease prevents you from working. You may consider undergoing additional testing to offer further proof of your symptoms and their impact on your physical functioning.
Additional testing options include functional capacity evaluations, neuropsychological evaluations, and cardiopulmonary exercise tests.
Functional Capacity Evaluation
If you experience physical symptoms such as muscle weakness due to Lyme disease, consider a functional capacity evaluation . An FCE is a series of tests, practices, and clinical observations that objectively measure your physical ability to perform activities such as sitting, standing, walking, lifting/carrying, pushing/pulling, gross or fine manipulations, and more.
Also Check: How Does Lyme Disease Affect You
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.
Dont Miss: How Serious Is Lyme Disease In Humans
Why Is Lyme Disease Misdiagnosed
Chronic Lyme disease is often mistaken for other illnesses, making it difficult to diagnose and treat and prolonging diagnosis. Lyme disease is hard to diagnose because blood tests can show negative test results when the disease is actually present. It is recommended that Lyme disease be diagnosed based on symptoms and risk (areas you visited or activities you did. As well, there are only a handful of blood tests can effectively detect Lyme bacteria and that is another reason why the infection is easily missed.
According to the Canadian Lyme Disease Foundation, Lyme disease can be mistaken for many other illnesses/diseases including Fibromyalgia, Chronic Fatigue Syndrome, Colitis/Crohns disease/IBS, Early ALS, Encephalitis, Lupus infectious arthritis/Osteoarthritis/Psoriatic arthritis/Rheumatoid arthritis, Multiple Sclerosis, psychiatric disorders, Menieres syndrome, Thyroid disease and Sleep disorders.
Also Check: Alternative To Doxycycline For Lyme
Lyme Disease Disability Insurance Claim Help From Lawyers
Our disability insurance attorneys understand how the nature of Lyme disease can result in significant limitations and struggles if not diagnosed quickly. However, many physicians do not properly diagnose Lyme disease from the initial stages. Lyme disease is a controversial diagnosis among the medical community and disputed within numerous medical publications. We have helped numerous claimants suffering with Lyme disease and our disability lawyers are familiar with all of the arguments used by the disability insurance companies. The tests used to detect Lyme antibodies, the enzyme-linked immuno sorbent assay and the Western blot, only have a 60 percent chance of accurately indicating the presence of the disease. Because several factors can affect the incidence of the antibodies, countless infected patients are turned away with a false negative test result. Additionally, about one out of four individuals who get Lyme disease never develop the most common sign of the disease a rash. This is why many do not know they have the disease until it reaches the devastating second and third stages. Once these stages are reached after being left untreated, individuals with Lyme disease may be severely affected by mild to serious long-term disabling conditions.
Is There A Link Between Veterans Suicides And Lyme Disease
According to many medical experts, the largest cause of death from Lyme disease is suicide. According to Dr. Robert Bransfield, a psychiatrist who has studied the link between Lyme disease and suicide, as many as 1,200 suicides each year may be attributed to Lyme disease or other tick-borne illnesses.
Ruben Lee Sims is just one example of the countless veterans who have Lyme disease. For 34 years, he went undiagnosed and untreated until he finally found a doctor who specializes in Lyme disease and tick-borne diseases. Misdiagnosis can make life even more difficult for struggling veterans.
Read Also: How Would I Know If I Had Lyme Disease
Disability Benefits For Lyme Disease
When it comes to claiming long-term disability benefits for Lyme disease in Canada, you might be eligible for one of two types of disability benefits if you are a worker. These are the Canada Pension Plan disability benefits and the long-term disability insurance benefits.
CPP disability benefits for Lyme Disease
The CPP, designed to support you after retirement, also covers disability benefits that start once you become disabled. These payments last until you are 65. After that, these disability benefits are converted into regular pensions. To qualify for the CPP disability benefits, you have to have worked for four out of the past six years and paid payroll taxes. To get CPP benefits, you have to prove that your disability is both prolonged and severe, leaving you unable to work.
Long-term Disability Insurance Benefits for Lyme Disease
Group disability insurance policies are the most common type of disability insurances in Canada. If your employer has insured you as part of a group, you are receiving your disability insurance through your job. These group disability insurance policies provide both long-term and short-term disability benefits.
If you are suffering from a chronic form of Lyme disease, you can apply for long-term disability benefits. If successful, you will be provided with monthly income payments during long absences from work.
Is Lyme Disease Considered A Social Security Disability
According to the Social Security Administration , Lyme disease can qualify as a disability if it meets certain criteria.
For Lyme disease to be considered a disability, the SSA requires that the claimant have objective medical evidence of the infection. The claimant must also have a severe impairment that prevents them from working regularly or participating in other activities.
Lyme disease can be challenging to diagnose and treat, so claimants need to work closely with their doctors and the SSA to document their claims properly.
Also Check: Vital Plan For Lyme Disease Anyone
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.