Has your Lyme disease diagnosis kept you out of work? You may be eligible to receive Lyme disease disability benefits.

Common Reasons Why Lyme Disease Disability Insurance Claims Are Denied

Despite being diagnosed with the disease, claimants are often surprised to receive a Lyme disease disability claim denial.

For insurers, the issue isn’t that a person has the condition. It’s that it affects each person differently, and the symptoms and severity can vary widely depending on the individual.

In order for an insurer to award Lyme disease disability benefits, the claimant must show sufficient proof that the condition prevents or limits their ability to work.

That said, there are several reasons that Lyme disease disability insurance claims are denied.

Lack of Objective Medical Evidence

Insurers base a great deal of their decision on medical evidence. However, many insurers routinely challenge Lyme disease insurance claims because common symptoms like fatigue, pain, and cognitive difficulty are not easy to quantify. Insurers often argue that there is not enough objective evidence to consider a claimant disabled from work.

Insurer Disputes the Severity of the Symptoms

Similarly, insurers often acknowledge that the claimant carries Lyme disease, but they argue that the symptoms are not significant enough to prevent the claimant from working.

Inconsistent Medical Records

When medical records do not consistently document a patient’s symptoms, limitations, and treatments, insurers are more likely to deny a Lyme disease disability claim.

Disagreement Among Medical Providers

Insurers often use their own affiliated doctors and specialists to review a claimant’s case file. Even though your primary treating physician may believe you are medically unable to work, the insurer’s medical team may argue otherwise.

Social Media Surveillance

Increasingly, insurers are surveilling their claimants’ social media accounts for evidence that contradicts your disability claim. For example, photos or videos that you post enjoying a day at an amusement park can be seen as proof that you are capable of working normally.

With most Lyme disease Long term Disability claims, insurers are asking basic questions like can the claimant maintain concentration, sit for extended periods of time, work a given schedule, or interact with coworkers or customers appropriately. If they have any reason to believe that you meet these conditions, they are likely to deny your claim.

How a Lyme Disease Disability Attorney Can Help Your Insurance Claim

The core of a Lyme disease disability claim is being able to prove that your condition prevents you from working.

Fields Law can help you do that.

It starts with reviewing your insurance policy. Your policy contains specific definitions of what the insurer considers to be a disability. It also includes deadlines, limitations, and requirements for proving a disability. We start by helping our clients identify what is needed to prove their case.

We work to obtain medical records, physician statements, and vocational evaluations that don’t simply prove you have Lyme disease; they paint a picture of how the symptoms of the disease strip away your work capacity.

Our team presents evidence that shows how your condition affects everything from your attendance at work to your productivity, job duties, and cognitive and physical performance.

Many Long Term Disability policies also include strict deadlines for filing a claim or appealing a denial. Working with a Lyme disease disability attorney ensures that your documentation is professionally prepared, free of errors, and submitted within appropriate time frames.

As nationwide disability attorneys, Fields Law is familiar with the tactics that many insurers use to deny claims. They minimize symptoms, seek unfavorable medical reviews, and interpret evidence in ways that favor a denial result.

Our attorneys have the experience and the knowledge to counter these tactics and advocate for the rights of our clients.

How to Respond to a Lyme Disease Disability Claim Denial

Having your Lyme disease disability insurance claim denied can be shocking. You expect the insurer to honor their end of the policy when you need help the most. But as we’ve seen, insurers often use a variety of tactics to deny the very claims you expect them to honor.

The important thing to remember is that a denial does not necessarily mean your claim is over. Lyme disease disability insurance claims are often denied initially, but in many cases, claimants have options to appeal the insurer’s decision.

Many employer-sponsored Long Term Disability policies are governed by the Employee Retirement Income Security Act (ERISA). This federal law provides most with an opportunity to appeal a disability denial.

However, there is a strict deadline to file an appeal under ERISA. In most ERISA-governed plans, there is a window of at least 180 days to appeal disability claims, counted from the day a denial letter is received.

Fields Law’s Lyme disease disability lawyers can help you understand the reasons for your denial, build a strong case for appeal, and file an appeal within the appropriate deadline.

We can help you:

• Gather additional medical evidence
• Collect detailed statements from your treating physicians
• Obtain a written statement from your doctors that explains how your specific Lyme disease symptoms restrict your work capacity
• Work with vocational experts to further document how your condition affects your work duties
• File an appeal within ERISA deadlines

Our attorneys can also help you communicate with your insurance company, address the reason for your claim denial, and advocate for the full extent of benefits available under your policy.