Lyme disease is yet another medical impairment disability insurers are reluctant to pay benefits for. Reasons given by insurers are: 1) lack of diagnostic identification of a rash at the location and time of the bite; 2) absence of positive (not near positives) objective test data such as Western Blot or CD-57; and 3) patient records documenting only “self-reported symptoms without further proof and etiology of symptoms.
For many years disability insurers have had a field day denying Lyme claims brought about by doctors themselves who disagreed on medical diagnostic data and whether patients really had Lyme or something else. Ten years ago many renowned Lyme physicians still claimed patients could have Lyme with negative test results and having been bitten by ticks more than 10 years in the past. (Late Onset Lyme) The failure of short-term antibiotics led to the administration of IV-antibiotics which caused serious liver consequences for some patients placing them near death.
IV-antibiotic treatments for Lyme clinically diagnosed by physicians led to approximately 50% of the medical community reporting the other 50% of Lyme physicians to their medical boards for malpractice. There are some physicians who actually lost their licenses because of prescribed IV-antibiotics long-term for unproven Lyme. Of course, disability insurers took immediate advantage of the medical disagreement among physicians and became denying large numbers of unsubstantiated Lyme disability claims.
The problem is that early administration of antibiotics can lead to negative test results, or, negative test results can be evident when one of several Lyme bacteria can be present in the body. Symptoms attributable to Lyme disease are many, but most describe joint and arthritic pain in addition to sweats, headache, stiffness, etc. Physicians may test for arthritis, but again test results are inconclusive and often negative. Some physicians really do have problems with peers who prescribe antibiotics for Lyme bacterial infection which is unproven by lab results. And, disability insurers have problems with the theory of IV-antibiotic treatments for subjective symptoms.
In addition to uncertain objective evidence to support Lyme disease diagnoses, symptoms reported by patients could easily be identified as something else. Although late stage Lyme disease can produce the same white brain lesions as MS, there are still some physicians who diagnose Lyme when all other causes have been ruled out. In other words, Lyme can be turned into a diagnosis of exclusion.
Still, disability insureds and claimants continue to report they “think” they were bitten by a tick on that camping trip several years ago, but can’t remember seeing any rash. Again, disability insurers are more likely to pay a fibromyalgia claim than one for Lyme simply because Lyme is now seen as the “catch-all” diagnosis when everything else has been ruled out. My own personal physician once told me that very few tick bites came from Lyme ticks carrying the dangerous bacteria.
Currently, the Center for Disease Control sets standards for Lyme identification such as visible bullet rash, positive Western Blot and/or CD-57 within 6 months of symptoms. Treatment for Lyme is 12 weeks with oral antibiotics. According to at least 50% of physicians after one or two trials of antibiotics, patients no longer have Lyme.
So, where does this leave Lyme insureds with disability claims? A disability filed for Lyme disease may get approved with positive Western Blot test results within 6 months of filing a disability claim. However, STD benefits will be probably be paid for a 12-week trial of antibiotics and not longer. Most insurers no longer consider Lyme as permanently disabling once treatment has been administered. Occasionally, insureds may continue with approved claims during IV-antibiotic trials, but then claims are denied on the basis insureds no longer have Lyme when the treatment is finished. Re-testing in the lab at this point generally produces negative results and again, insurers won’t pay Lyme claims.
I know there might be quite a few readers who contact me with, “I KNOW I have Lyme and so does my doctor!” I’m not disputing that. But, in reality will insurers continue to pay for Lyme claims indefinitely if at all? Lyme disease disability is often a hard sell to insurance companies who use the criteria of the CDC and continue to take advantage of disagreements among doctors who continue to treat Lyme or not.
After the hype of trying to remove medical licenses from physicians still prescribing IV-antibiotics, some well-known Lyme physicians changed their treatments to herbal medicine such as reichi mushrooms, and various other herbs, Insurers do not buy naturopathic medical treatment for Lyme and claims were denied for this reason alone. It’s my impression that although some die-hard physicians continue to prescribe IV-antibiotics, others continue to disagree with the practice.
Those who continue to suffer with identifiable Lyme symptoms have a hard time getting disability claims paid long-term. Unfortunately, as long as physicians and the medical community remain on the fence of uncertainty, disability insurers will continue to take advantage and not pay long-term disability for Lyme.