While musculoskeletal disorders such as back pain and arthritis remain the leading year-round causes of long-term disability (LTD), there is a noticeable increase in Lyme disease long-term disability insurance claims, particularly in the Northeast.
Lyme Disease is a clinically recognized mental health condition that typically worsens during late fall and winter months. Despite its legitimacy, disability claims based on Lyme disease face significant resistance from long-term disability insurance companies.
What Is Lyme Disease?
Lyme disease, caused by Borrelia burgdorferi and transmitted by ticks, can affect multiple organ systems. When the bacteria disseminate beyond the initial infection site, they can invade the central and peripheral nervous systems, joints, heart, and other tissues.
Neurologic complications often emerge during early disseminated Lyme disease, including:
- Facial nerve palsy (unilateral or bilateral)
- Radiculopathy causing numbness, tingling, “shooting pains,” or limb weakness
- Fever, stiff neck, severe headache, and light sensitivity
- Research shows that Lyme disease—especially post-treatment Lyme disease (PTLD)—can cause measurable brain changes
- Alterations in frontal lobe activity involved in memory and concentration
- Abnormal white matter physiology, including axonal leakage and changes in water diffusion, revealed through advanced imaging (fMRI, DTI)
- Reduced cerebral blood flow and disrupted neurotransmitter function contributing to cognitive slowing (“Lyme brain”)
- Short-term memory loss and working-memory deficits (average 20% decline in testing)
- Slowed processing speed and executive dysfunction (attention, planning, organization)
- Brain fog that fluctuates with inflammation levels
- Sleep disturbances and mood changes (irritability, depression)
- Joint pain and swelling (often migratory)
- Muscle aches and fatigue
Persistent immune activation, even after eradication of the bacteria, may drive long-term symptoms in some patients, as suggested by white matter changes and inflammatory markers
While less common, Lyme carditis may cause heart rhythm disturbances or palpitations
These symptoms are common in both early and long-term Lyme disease and can persist even after antibiotic treatment
Why Long-Term Disability Claims for Lyme Are Commonly Challenged
Lyme Disease is a serious health illness, with significant manifestations. Yet, long-term disability insurance companies routinely challenge LTD claims based on Lyme Disease, even when short-term disability benefits have been approved.
Mental/Nervous Disorder Limitations
Lyme disease claims, even when accepted by an insurance company, often are argued to fall within the broad reach of some policies’ mental/nervous disorder category. Most long-term disability policies limit benefits for mental or nervous conditions—including depression, anxiety, PTSD, and bipolar disorder—to 24 months, regardless of severity.
But where Lyme is a neurological disease, how does that get ensnared by a long term disability insurance company? They argue the symptoms of anxiety or depression (typically secondary to the Lyme) is contributing to the disability and seek to apply a limited benefit period.
Can You Obtain LTD Benefits for Lyme Disease?
Yes—but success depends on the strength and consistency of the medical evidence. Lyme Disease disability insurance claims are scrutinized carefully due to their frequently subjective nature – even if someone has diagnostic support for the diagnosis (bloodwork or other diagnostics).
Unlike many other physical impairments, Lyme Disease, even with blood work, does not have functional deficits revealed via objective evidence typically.
To prevail, a claimant must be under the care and treatment of a provider, and must demonstrate that they are functionally unable to perform the material duties of their own occupation resulting from their condition, and other policy definitions.
Building a Strong Disability Insurance claim through medical record
Many Lyme disease patients recall the onset, while others do not, and have suffered symptoms without recognition, making treatment ever more challenging. Medical documentation for Lyme disease claims differs from that required for physical disabilities. Insurance companies focus on treatment history, clinical observations, and functional limitations.
Documenting Manifestations of Lyme Disease
Treatment is periodic, but it is important for the documentation to note the symptoms and issues of significance. Treating providers should document both subjective complaints and clinical observations, including how and/or why the array of symptoms interfere with daily functioning and occupational demands.
Bridging the symptoms and their impact with the requirements of one’s work is critical to success – and with Lyme disease claims that carry both physical and cognitive challenges, it is precarious to leave to chance that the medical records will be supportive. Without supportive medicals, a claim will not succeed.
The Importance of Consistent Treatment
Consistency with treatment is critical in supporting a disability insurance claim. Infrequent therapy or sporadic treatment often results in denial of these claims. It serves to support an argument against the severity of the condition.
Maintain a symptom journal to note how you feel
A detailed daily journal can be powerful corroborating evidence for a Lyme disease claim. It serves to fill in the blanks of the medical records, and should track:
- Pain levels on a scale – need not be 1-10, but can use characterizations
- Hours and quality of sleep
- Level of fatigue/exhaustion/lethargy (all different)
- Appetite changes
- Focus/concentration difficulties
- Impacts of medications
When combined with provider records, these journals help establish functional impairment over time. They will buttress the medical records, as they show rich information that covers a span of time.
Surveillance and Social Media Risks in Mental Health Claims
Disability insurance companies engage in aggressive surveillance practices – and invest money in an effort to save money by undercutting claims of disability. Investigators frequently conduct video surveillance and monitor social media activity. Insurers often miscast the extent of surveillance, and seek to argue that getting one’s mail, attending medical appointments, or doing an errand proves work capacity. It is unfortunate for claimants, but this occurs, despite the fact that this argument focuses on isolated events, and is routinely used to deny or terminate benefits.
Practical Steps to Strengthen a Lyme Disease Disability Claim
Newfield Law Group advises clients to take proactive steps to support their claims for Lyme Disease.
Document Occupational Impairment
Occupational demands are central to disability determinations. Jobs requiring executive functioning, complex analysis, sustained concentration, or client interaction become untenable for individuals suffering from the pain, fatigue and focus and concentration challenges associated with Lyme disease.
Why can’t I work?
- Reduced Cognitive work capacity
- Decreased physical work capacity
- Appearance at work with regularity
- Physical exhaustion and lack of endurance
This is a large array of issues and often will cover a wide swath of occupations. Often, we further support our claims with written statements from spouses, co-workers, or friends, who may further illuminate the claimant’s functional deficits from anecdotes or firsthand observations, buttressing the arguments to support the inability to function at work.
Why Experienced Legal Representation Matters in Lyme disease Claims
Lyme disease disability insurance claims are challenging for the reasons outlined above. Success on such claims is frequently aided by the guidance of an experienced long-term disability insurance attorney. Experienced legal guidance can help level the playing field, counter insurer tactics, and provide the advocacy for claimants to secure their benefits.
Having seen these issues over nearly 30 years, we are prepared to guide claimants effectively through this complex process.
