FAQs

FAQs About Lyme Disease As A Disability

Los Angeles Disability Insurance Bad Faith Attorneys

If your disability insurance claim for Lyme disease was unfairly denied or delayed, our lawyers may be able to help you get benefits you may be entitled to receive. Our firm is skilled at litigating these cases and helping clients pursue the money they have coming to them under the policy. Contact our law firm today to discuss your specific case. We serve clients in the Los Angeles area and throughout all of Southern and Northern California.

Is Lyme a disability covered by Social Security benefits or private disability insurance policies?

Lyme disease may not necessarily be automatically covered as a disability by itself, however, it may be considered a disability if complications or other conditions caused by Lyme disease prevent you from working, or, in the case of own-occupation disability insurance, prevent you from performing the main functions of your profession.

Lyme affects people in different ways, for some, full recovery is quick and complete, for others, treatment and resolution of symptoms may take longer. For others, Lyme can cause debilitating symptoms and conditions that may qualify the individual for disability benefits.

The CDC reports that 10-20% of people infected by Lyme do not respond to an initial course of antibiotics, and will experience more serious symptoms that may not be cured by simply taking more antibiotics:

“Approximately 10-20% of patients experience fatigue, muscle aches, sleep disturbance, or difficulty thinking even after completing a recommended course of antibiotic treatment. These symptoms cannot be cured by longer courses of antibiotics, but they generally improve on their own, over time.”

For some, symptoms never improve and Lyme develops into a long-term chronic condition that can have a dramatically negative impact on social, physical, and psychological well-being.

The Social Security Administration’s Position On Lyme Disease Disability Claims

As in the case of most disabilities, there are standards of evaluation and, when certain criteria is met, a disability may be established. The Social Security Administration (SSA) issues a “blue book” on qualifying disabilities and under 14.00-Immune-Adult diseases and disorders, Lyme disease is specifically listed for consideration as a disability (on a case-by-case basis):

6. Inflammatory arthritis (14.09). …”c. Inflammatory arthritis involving the peripheral joints. In adults, inflammatory arthritis involving peripheral joints may be associated with disorders such as: … (v) Lyme disease.”

Symptoms of Lyme, when pronounced, may be considered a disability, and, the lack of treatment may be insufficient cause alone for denying a disability insurance claim. Symptom-based factors that the SSA’s blue book lists for evaluation include pain, severe fatigue, and malaise:

“1400. H. Your symptoms, including pain, severe fatigue, and malaise, may be important factors in our determination whether your immune system disorder(s) meets or medically equals a listing or in our determination whether you are otherwise able to work. In order for us to consider your symptoms, you must have medical signs or laboratory findings showing the existence of a medically determinable impairment(s) that could reasonably be expected to produce the symptoms. If you have such an impairment(s), we will evaluate the intensity, persistence, and functional effects of your symptoms using the rules throughout 14.00 and in our other regulations. See §§ 404.1528, 404.1529, 416.928, and 416.929. Additionally, when we assess the credibility of your complaints about your symptoms and their functional effects, we will not draw any inferences from the fact that you do not receive treatment or that you are not following treatment without considering all of the relevant evidence in your case record, including any explanations you provide that may explain why you are not receiving or following treatment.”

Additionally, the SSA notes that, among other diagnostic and evaluation criteria, diminished cognitive functions may also be considered a disability under certain conditions:

“14.00 I.8. Completing tasks in a timely manner involves the ability to sustain concentration, persistence, or pace to permit timely completion of tasks commonly found in work settings. We will find that you have a “marked” limitation in completing tasks if you have a serious limitation in your ability to sustain concentration or pace adequate to complete work-related tasks because of symptoms, such as pain, severe fatigue, anxiety, or difficulty concentrating, caused by your immune system disorder (including manifestations of the disorder) or its treatment, even if you are able to do some routine activities of daily living.”

Private Disability Insurance Claims And Lyme Disease

Individual disability insurance policies have different coverage benefits, exclusions, and parameters. However, in general, if you purchased disability insurance, and become disabled and are unable to work, Lyme disease may be covered if your symptoms meet the criteria of the insurance policy. If you have Lyme, and you and your doctor believe you are disabled, your insurance company may still deny your claim. However, as experienced consumer trial lawyers we routinely see insurance companies either creating or using loopholes to exclude coverage even when a claimant is entitled to received benefits.

If you have disability insurance and your claim for Lyme disease was unfairly or wrongfully denied, don’t accept that decision as a final say in the matter. Contact our law offices immediately for a free, initial legal consultation. Oftentimes, we are able to get you the benefits you are entitled to without having to go to court. However, when we take on insurance companies for insurance bad faith, you can rest assured that we have the experience and resources necessary to take your case to trial. [See Sample Case Results]

Examples Of Lyme Symptoms That May Be Considered A Disability

The Lyme disease patient pictured on the right shows the signs and symptoms indicative of arthritic changes to his right knee due to a Borrelia burgdorferi bacterial infection. Approximately 60% of patients with untreated infection may begin to have intermittent bouts of arthritis, with severe joint pain and swelling. Large joints are most often affected, particularly the knees3. Arthritis caused by Lyme disease manifests differently than other causes of arthritis and must be distinguished from arthralgias (pain, but not swelling, in joints).

Up to 5% of untreated patients may develop chronic neurological complaints months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems with short-term memory.

Some examples of conditions caused by Lyme disease that may be considered a qualifying disability include:

  • Arthritis caused by Lyme may also become disabling if damage to your knees leads to an inability to bear weight (to stand or walk), or has made it impossible to use your hands for own-occupation professions such as for doctors, surgeons, and dentists.
  • Heart problems or damage that restricts your ability to work.
  • Muscle and/or or nerve damage that has severely affected your ability to walk, or use your arms, hands, or eyes.
  • Damage to the brain including cognitive abilities, memory loss, or mental health concerns sometimes associated with Lyme including debilitating anxiety and/or panic attacks.

My insurance company says I am “cured” of Lyme, and therefore, not entitled to any benefits.

There currently are no tests to show someone has been cured of Lyme disease. Tests that are commercially available to doctors only show whether or not someone has recently had the infection, and had it long enough that the patient has made antibodies to the bacteria that causes Lyme disease.

Lyme tests can also produce false negatives, and, can still show positive results months or even years after a person has been infected — even if they no longer have any symptoms.

If you have symptoms of Lyme disease that have persisted, you may have chronic Lyme, and, if you have developed heart problems you may have Lyme carditis. Because Lyme disease affects individuals to varying degrees, only a doctor is able to medically determine whether or not you have chronic, debilitating Lyme or complications of Lyme.

I was denied disability benefits for Lyme disease because my insurance company says I never had Lyme because my serum blood test was “normal.”” (or, if you never had a test done)

 

Both the CDC and National Institutes of Health make it clear that Lyme can be diagnosed by a medical doctor even without blood work based on symptoms, risk factors, and even other types of tests.

“A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. The most commonly used is the ELISA for Lyme disease test. An immunoblot test is done to confirm ELISA results. Be aware, though, in the early stage of infection, blood tests may be normal.

In areas where Lyme disease is more common, your health care provider may be able to diagnose early disseminated Lyme disease (Stage 2) without doing any lab tests.”

Other tests that may be done when the infection has spread include:

  • Electrocardiogram
  • Echocardiogram to look at the heart
  • MRI of the brain
  • Spinal tap (lumbar puncture to examine spinal fluid

Although insurance companies are allowed to make decisions about whether or not you have coverage for the claim you are making, insurance companies can, and do make mistakes, and insurance underwriters may not substitute their own opinions for those of a medical doctor’s evaluation. If you believe your claim has been wrongfully denied, call us today. There is no obligation, and we will talk with you for free. We may be able to help you get benefits for Lyme as a disability, and if we are able to take your case, there is no fee to you until we recover on your behalf.

More Information About Lyme Disease As A Disability

Lyme Disease Disability Insurance Claims Lawyers

From Los Angeles Area Offices In El Segundo, We Represent Clients Throughout All Of California

If your disability insurance claim for Lyme disease was denied, or delayed, our lawyers may be able to help you get your benefits paid.

When insurers unreasonably refuse to honor their side of the insurance contract, those denied coverage still have options. Our firm is skilled at litigating these cases and helping clients pursue the money they have coming to them under the policy.

Contact us today to discuss your specific case. We serve clients in the Los Angeles area and throughout Southern and Northern California.