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Lyme Disease

Appealing a denied long-term disability (LTD) claim with the insurance company can prove to be a taxing and complicated process. We understand that you need stability and resources long-term disability benefits provided when recovering from a condition such as Lyme Disease.  Insurance companies are motivated by their own financial interests. They will not readily provide you with the benefits you deserve unless you prepare a winning appeal. The skilled team of attorneys at Chisholm Chisholm & Kilpatrick LTD has years of experience winning our clients’ ERISA and non-ERISA LTD appeals.

We help to ease the stress that our clients encounter while appealing a denied long-term disability claim.  We may be able to assist you. Consultations are always free. Contact our office at: 401-331-6300.

Understanding Lyme Disease:

Lyme disease is a bacterial infection that manifests itself as a multisystem inflammatory disease. Lyme Disease mostly affects the skin in its early, localized stage, but can spread to joints, the nervous system, and other organ systems as the disease progresses.1

Researchers estimate that about 329,000 cases of Lyme Disease occur annually in the United States.2 The condition is most prevalent in the Northeastern and Midwestern United States, with 95% of all confirmed Lyme Disease cases within the U.S. confined to these areas.3

Cause:

Lyme Disease is an infection caused by the bacterium known as Borrelia burgdorferi. Human transmission is caused by a bite from an infected blacklegged tick, otherwise known as a deer tick. In order to transmit Lyme Disease to a human, the infected tick must be attached for 36 to 48 hours.4,5

Symptoms:

If Lyme disease is left untreated, symptoms can worsen as the disease progresses.  Symptoms that one may encounter, and their severity, vary on a case-by-case basis. The CDC categorizes Lyme Disease progression and symptoms into stages: localized acute symptoms, early disseminating symptoms, and late-stage symptoms:

Localized Acute Symptoms:

  • Flu-like symptoms: fever, chills, fatigue, muscle and joint aches, headache, and swollen lymph nodes.
  • Erythema migrans (EM) rash:
    • Appears as a target, or “bulls-eye,” shaped rash and can manifest anywhere on the body.
    • Approximately 70% to 80% of people infected with Lyme Disease will develop an erythema migrans (EM) rash.
    • The rash begins to form at the site of a tick bite between 3 and 30 days after being bitten.
    • EM rashes gradually expand over time, sometimes reaching up to 12 inches across.
    • These rashes can feel warm to the touch, but are not usually itchy or painful6

Early Disseminating Symptoms:

If left untreated for months or years, Lyme Disease can spread through the blood to other parts of the body and manifest in more severe ways:

  • Facial palsy similar to Bell’s Palsy: a form of temporary facial paralysis in which muscles on one side of the face weaken or become paralyzed. This can be observed by drooping or stiffness in one side of the face.7
  • Severe headaches and neck stiffness
  • Multiple erythema migrans (EM) rashes spreading to other parts of the body
  • Enlarged lymph glands
  • High fevers above 100°
  • Severe fatigue and sleep impairment
  • Vision changes

Late-Stage Symptoms:

  • Arthritis, typically manifesting in the knee or in other large joints, accompanied by severe joint pain and swelling.
  • Neurological disorders such as: memory loss, confusion, inability to concentrate, and disorientation.
  • Numbness of extremities8

How is Lyme Disease diagnosed?

In order to properly diagnose Lyme Disease, doctors first study the patient’s 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 (blood serum) 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.9

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 (ELISA)
    • 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.10
  • Western blot (immunoblot) test
    • When testing for Lyme disease, immunoblot tests are used to detect two different classes of antibodies: IgM and IgG.
      • A positive IgM immunoblot is used to identify the disease within the first four weeks of infection, but is known to give false positive results.
      • An IgG immunoblot test is used for patients who have been ill for longer than four to six weeks, as it takes the body that amount of time to produce detectable levels of antibodies.11

Both of these tests must yield a positive result for a proper diagnosis to be made12. Lyme Disease can take some time to detect when the patient shows no sign of an EM rash; this is because the blood tests used to diagnose the disease can often yield questionable results, especially when conducted early-on.

Blood test results are often inconclusive when performed within the first 30 days of infection because the body has not had time to react to the presence of Lyme-causing bacteria by producing antibodies. Both tests have been shown to have low-sensitivity during early stages of the disease; in fact, ELISA testing has been found to miss 35%-50% of Lyme disease cases. In addition, the ELISA test has been known to occasionally result in false positives. These tests are considered to be more accurate when conducted at least one month after the initial infection.13,14,15

How is Lyme disease treated?

Lyme Disease is treated with antibiotics. Often, antibiotic treatment results in a fairly rapid and complete recovery. The most common drugs used to treat Lyme Disease are:

  • Doxycycline
  • Cefuroxime axetil
  • Amoxicillin

There are options for those intolerant to the antibiotics listed above, such as: azithromycin, clarithromycin, or erythromycin. These treatments usually have lower efficacy, and the patient should be monitored closely to ensure symptoms are improving.16

Patients with early-stage localized symptoms, such as an EM rash, are usually treated with a 10-day antibiotic regimen. Patients with mid-stage Lyme disease are usually treated with a 14-day dose of antibiotics. The duration of treatment for severely immunocompromised patients is much longer, usually totaling 6 weeks or more.17

What is the impact on daily life for a person with Lyme Disease?

Lyme disease has the potential to: make a person feel extremely ill with flu-like symptoms, produce widespread muscle pain, impair cognitive function, and even develop arthritis in some patients. About half of people diagnosed with Lyme disease will get a form of arthritis.18 It is also quite common for those suffering from Lyme disease to experience extreme fatigue, resulting in severe headaches, impaired memory, and trouble concentrating. The effects of Lyme Disease can make it difficult for a person to continue working throughout the course of treatment, and sometimes long after treatment is completed.

Those suffering from long-term residual symptoms of Lyme Disease may develop a condition known as Post Treatment Lyme Disease Syndrome (PTLDS). Approximately 1 in 10 people diagnosed with Lyme Disease experience lingering symptoms. Those with PTLDS most commonly experience residual symptoms such as muscle aches, sleep disruption, fatigue, neurocognitive dysfunction, and headaches that can last for months, or more, after treatment. PTLDS cannot be improved by extending antibiotic treatment. Time is the only factor currently known to reduce symptoms of PTLDS. Depression and anxiety can also arise when dealing with persistent symptoms over a long period of time.

A range of functional domains can be impaired by Lyme Disease’s residual symptoms, and can pose great difficulty to anyone trying to remain in the workforce.19,20

CCK understands Lyme Disease disability claims

Long-term, debilitating symptoms often manifest within those suffering from Lyme Disease, and can affect people both physically and cognitively. Symptoms of Lyme Disease are not easily ignored, and can greatly impact a person’s ability to continue working.

Your insurer may not understand that the symptoms associated with Lyme Disease can be long-lasting and very troublesome, even after treatment. Recovery time for Lyme Disease can vary greatly from person to person. If you are suffering from PTLDS, we will help you prove that your residual symptoms prevent you from working, warranting a longer recovery time.

How can CCK help you with your LTD appeal?

The knowledgeable attorneys at Chisholm Chisholm & Kilpatrick LTD will integrate years of cumulative experience into your appeal. Insurance companies have a lot of resources at their disposal, and will not make your disability benefits available to you without a fight.

Finding insurance company errors

In order to detect errors made by your insurer, we make sure to gather any and all documents pertaining to your LTD claim. These documents include: your denial letter, your policy documents, the insurance company’s claim file, and any other plan-governing documents. We will put our vast knowledge of ERISA law, the U.S. Department of Labor, and insurance policies to work for you in order to identify any errors the insurance company may have made.

Communication with doctors during the appeal process

A steady flow of communication between you, your doctor, and the insurer is essential to winning your appeal. Unfortunately, sometimes this is not easy to do; doctors can be too busy in their day-to-day medical practices to adequately report detailed medical information to your insurer. This is why we teach you how to most effectually communicate with your doctor about your condition, and facilitate the flow of information between your doctor and insurer so that nothing is left out or overlooked.

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
  • Medical records
  • 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 policy’s definition of disabled.

Call Chisholm Chisholm & Kilpatrick today

If you need assistance appealing your long-term disability claim denial, our office may be able to help. Contact us today for a free consultation: 401-331-6300.

  1. Lyme Disease. (n.d.). Retrieved January 30, 2018, from http://www.aldf.com/lyme-disease/
  2. Lyme Disease. (2015, September 30). Retrieved January 30, 2018, from https://www.cdc.gov/lyme/stats/humancases.html
  3. Lyme Disease. (2017, November 13). Retrieved January 30, 2018, from https://www.cdc.gov/lyme/stats/index.html
  4. What Causes Lyme Disease? (n.d.). Retrieved January 30, 2018, from https://www.bayarealyme.org/about-lyme/what-causes-lyme-disease/
  5. Lyme disease. (2016, April 03). Retrieved January 30, 2018, from https://www.mayoclinic.org/diseases-conditions/lyme-disease/symptoms-causes/syc-20374651
  6. Lyme Disease. (2016, October 26). Retrieved January 30, 2018, from https://www.cdc.gov/lyme/signs_symptoms/index.html
  7. What Is Bell’s Palsy? (n.d.). Retrieved January 30, 2018, from https://www.webmd.com/brain/understanding-bells-palsy-basics
  8. Lyme Disease. (n.d.). Retrieved January 30, 2018, from http://www.aldf.com/lyme-disease/
  9. Lyme Disease Diagnosis. (n.d.). Retrieved January 30, 2018, from http://www.childrenslymenetwork.org/children-lyme/lyme-disease-diagnosis/
  10. Understanding the EIA Test. (2015, March 04). Retrieved January 30, 2018, from https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/eia/index.html
  11. Understanding the Immunoblot Test. (2015, March 04). Retrieved January 30, 2018, from https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/westernblot/index.html
  12. Lyme Disease Diagnosis. (n.d.). Retrieved January 30, 2018, from http://www.childrenslymenetwork.org/children-lyme/lyme-disease-diagnosis/
  13. Lyme Disease. (n.d.). Retrieved January 30, 2018, from http://www.aldf.com/lyme-disease/
  14. Lyme Disease Diagnosis. (n.d.). Retrieved January 30, 2018, from http://www.childrenslymenetwork.org/children-lyme/lyme-disease-diagnosis/
  15. How Do I Know If I have Lyme Disease? (n.d.). Retrieved January 30, 2018, from https://www.webmd.com/arthritis/do-i-have-lyme-disease#2
  16. Lyme Disease. (2017, December 01). Retrieved January 30, 2018, from https://www.cdc.gov/lyme/treatment/index.html
  17. Sanchez, E., Vannier, E., Wormser, G. P., & Hu, L. T. (2016, April 26). Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review. Retrieved January 30, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/27115378
  18. Chronic Lyme Disease — Complications. (n.d.). Retrieved January 30, 2018, from https://www.webmd.com/arthritis/chronic-lyme-disease-complications
  19. Chronic Lyme Disease — Complications. (n.d.). Retrieved January 30, 2018, from https://www.webmd.com/arthritis/chronic-lyme-disease-complications
  20. Aucott, J. N., Rebman, A. W., Crowder, L. A., & Kortte, K. B. (2013, February). Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here? Retrieved January 30, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548099/

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