Dabdoub Law’s appeal on behalf of a client suffering from Lyme Disease and CoInfections resulted in a recent reversal of CIGNA’s decision to terminate long-term disability benefits. The client was paid long-term disability benefits for two years. CIGNA sent him to an Independent Medical Examination (IME) performed by its paid doctor and used the doctor’s report to terminate benefits. CIGNA claimed that while the client may have been disabled from his prior job as a manager, it did not find him disabled from any occupation.
What is Lyme Disease & CoInfections?
Lyme disease is a bacterial infection that is caused by a tick bite. Symptoms of this disease can vary but include extreme tiredness, severe pain, memory loss, attention issues, heart disease, anxiety, panic attacks and delusions.Even worse, symptoms of Lyme disease are similar to those of other physical and mental conditions. People suffering from Lyme disease have good and bad seasons of symptoms. This makes the medical condition difficult to diagnose. It is not uncommon for victims to see two or three dozen doctors before being accurately diagnosed with Lyme disease.
Test usually used to diagnose Lyme antibodies, ELISA and the Western blot, only have a 60 percent accuracy in detecting the presence of the disease. Several factors can affect the incidence of antibodies. This results in many infected patients being turned away due to false negatives. Even more, one in four people who contract Lyme disease do not develop the most common sign of the infection - a rash.
CIGNA’s Claims Review
Like most disability insurance companies, CIGNA terminated the client when the definition of disability changed under the insurance policy’s terms. Generally, most disability insurance policies have an own occupation and any occupation period. In order to receive disability benefits during the own occupation period, a person must be unable to perform the material and substantial duties of the job he or she was doing at the time disability began. This time period is typically 24 months long. After 24 months a person must be unable to perform any occupation in order to continue receiving disability payments.
During the any occupation review a disability insurance company may send your file to a paid consulting physician for review. As in the case of our client, the insurance company may have you examined by one of its paid doctors. It may have you undergo a Functional Capacity Evaluation (FCE). Some insurance companies conduct video surveillance and a social media investigation. They try to build up a case against you and gather evidence to terminate or deny your disability claim.
Disability Claim Help
Our long-term disability attorneys understand Lyme disease and how it can cause severe limitations if not diagnosed and treated right away. We have helped several people suffering from Lyme disease with their long-term disability claims. Our experienced attorneys are familiar with arguments used by CIGNA and other insurance companies to deny or terminate benefits. Contact us today to discuss the next steps available to you under the law.
Resources on Lyme Disease: