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Recent Lyme disease case a reminder of the importance of proper evidence

On Behalf of | Sep 22, 2023 | Long Term Disability Claim Denial

If you have Lyme disease you are not alone. The United States Centers for Disease Control and Prevention (CDC) reports that almost 500,000 Americans are diagnosed and treated for the disease every year. The disease can range in severity. Some will experience relatively mild symptoms that may include a headache and rash while others can find themselves with a severe reaction. This could include facial paralysis, severe headaches, irregular heartbeat, dizziness, and severe nerve pain.

How does Lyme disease qualify for long term disability benefits?

Treatment can help some recover from Lyme disease quickly while others report continued and persistent pain and fatigue. Those who continue to fight these serious symptoms may find it difficult or impossible to return to work.

In many cases, these individuals can qualify for long term disability benefits.

Once I have my benefits, is there anything else to worry about?

Unfortunately, this is not a one and done deal. There are situations when things may change, and you find yourself needing to fight to retain your benefits. In a recent example, a former nurse anesthetist received benefits for Lyme disease in 2009. In 2015, the insurer terminated benefits stating she no longer qualified.

Ultimately, the case hinged on the definition of totally disabled. In the beginning of the claim, the insurer defined total disability as something that kept the insured from completing work within their chosen occupation. However, the insured lost her benefits when the definition of disability changed to an “any occupation” standard. When attempting to make her case, the court opined the former nurse failed to provide adequate proof that she remained disabled. As such, the appellate court ruled in favor of the insurer.

The case serves as a reminder of the importance of experienced legal counsel in building a strong claim file to a long term disability denial. This woman was experienced in the medical field and clearly suffered from a debilitating disease but was unable to gather and present the appropriate evidence to win her case. It serves as a reminder of the importance of careful review and submission of all available evidence to make sure the information gathered and presented meets the insurance policy’s definition of disabled.