Hartford Admits Decision to Deny LTD Benefits to Claimant with Chronic Lyme Disease Was Wrong
Author: Attorney Rachel Alters
Dell & Schaefer filed an appeal with Hartford for a 36 year-old claimant seeking total disability benefits due to Lyme disease and its related physical and cognitive symptoms, such as severe pain, post-infectious autoimmune neuropathy and dysautonomia. As a result of his tick-borne illness and related symptoms the claimant has been unable to perform one or more of the essential duties of his occupation as an Information Security and Business Continuity Manager. “There are very few lawyer across the country that have as much knowledge as Attorney Rachel Alters regarding lyme disease and she did an amazing job to prove our client was disabled,” stated Gregory Dell, managing partner.
Disability Companies Challenger If Chronic Lyme Disease Exist
The ongoing controversy in the medical community regarding chronic Lyme gives insurance companies ammunition to deny LTD claims based on the chronic form of the illness as some physicians do not believe it exists.
Unfortunately, patients stricken with chronic Lyme suffer very serious physical and cognitive issues that have little or no other explanation other than resulting from Lyme disease. There is a vast amount of literature supporting chronic Lyme and the treatment of the same.
Lyme disease is a bacterial illness caused by bacterium called “spirochete.” Certain ticks found on deer harbor the bacterium in their stomachs. Lyme disease is spread by these ticks when they bite the skin, which permits the bacterium to infect the body.
There is currently a controversy about whether Lyme disease can survive antibiotics and become a chronic illness. About 30,000 Americans contract Lyme each year. If the disease is caught early, it is usually cured with a dose of antibiotics. If not caught early, the tick-borne illness can cause a number of problems ranging from rashes to fatigue, migratory joint pain, cardiac issues and neurologic disorders. Patients who continue to have symptoms of Lyme after receiving antibiotic treatment find it very difficult to find physicians to treat their symptoms as well as insurance companies to cover the cost of treatment. If an individual is stricken with Lyme disease and suffering from long-term effects of the illness, it is important to seek out medical treatment from physicians who believe that chronic Lyme does exist.
Often times the laboratory data used to test for Lyme disease is also unclear and inconsistent. It is possible to test negative for Lyme in its early stages as there could be an insufficient number of IgG bands to prove a positive result. In certain situations, a positive IgM test alone, without a positive IgG test does not support a diagnosis of Lyme and would not make the patient a candidate for antibiotic treatment.
In our case, Hartford based its denial of our client’s long-term disability benefits on its incorrect assertion that he did not have chronic Lyme disease, was not disabled and able to perform one or more of the essential duties of his occupation. According to our client’s treating physicians, his laboratory tests, and supporting medical literature, there was no question that he was suffering from the chronic and debilitating effects of Lyme disease as well as the debilitating effects of Syringomyelia (syrinx), post – infectious autoimmune neuropathy and dysautonomia.
Claimant Treated With World Renown Lyme Disease Specialist
Our client treated with a Board Certified Internist with additional training in Pathology and Critical Care Medicine, practicing in Pawling, New York. His physician has been actively involved in diagnosis and treatment of Lyme disease and related disorders since 1988, and has cared for many persons seriously ill with chronic and neurologic Lyme disease. He has published articles on Lyme disease in peer-reviewed scientific journals and has presented poster abstracts and talks at national and international conferences on Lyme disease and other tick-borne diseases. His work has focused on the serious morbidity and (occasional) mortality that can eventuate from this aspect of the illness.
The claimant’s treating doctor’s medical opinion was that he was unable to perform the essential duties of his occupation or any occupation due to several physical and cognitive complications secondary to his diagnosis of Lyme disease. Hartford made a final decision to deny benefits based exclusively on the speculative opinions of their hired physicians, who merely conducted paper reviews of our client’s medical records and failed to examine him in order to determine whether he was indeed disabled. Had Hartford’s physicians examined him, they would have surely realized that he was not malingering and his tick borne illness was in fact debilitating.
Claimant Underwent Neuropsychological Evaluation Demonstrating Cognitive Impairments Due to Chromic Lyme Disease
Hartford failed to consider and even blatantly ignored the vast amount of medical evidence supporting our client’s disability. Hartford also ignored his complex job description as well as his physicians’ opinions that due to pain, tremors, numbness and tingling in his extremities, difficulty ambulating and severe cognitive impairment, there is absolutely no way he could perform the essential duties of his regular occupation. Our client is so ill that at times he is unable to get out of bed for an entire day.
In order to prove the neurological effects of Lyme disease, our client underwent a neuropsychological examination. According to the neuropsychologist, the Claimant was diagnosed with Lyme Disease in 2/2011 and testing was positive for numerous tick-borne diseases; he underwent a course of IV antibiotics for his medical condition. He also had a history of cervical spine disc disease secondary to an accident with C5/6 cervical fusion. According to the neuropsychologist, the testing results found variable orientation with poor mental control. Visual and verbal auditory memory was moderately to severely impaired and overall Performance IQ was in the borderline range. He demonstrated difficulty with functional calculation ability and basis writing and spelling. Self report found he was moderately to severely depressed and there was no indication of attempts to exaggerate or malinger responses. Based on the above-described impairments, and within a reasonable degree of neuropsychological certainly, these deficits were causally related to a combination of physical and psychological deficits associated with Chronic Lyme Disease, as well as Chronic Pain secondary to cervical injury. In his professional opinion, our client was not capable of return to full-time competitive employment as an Information Security and Business Continuity manager, based on his current level of cognitive impairment.
After reviewing the objective evidence provided by attorney Alters of Dell & Schaefer in support of our client’s disability, Hartford reversed its decision to deny his LTD benefits, paid his past benefits and reinstated his monthly benefits. Attorney Alters will continue to manage his claim in order to help prevent future claim denial.