Our client, a 32 year old, highly successful professional, was diagnosed with Lyme disease, as well as chronic fatigue syndrome, Epstein Barr virus, Barbonella and babesia. As a result of her disease, she suffered from cognitive impairment, chronic pain and extreme fatigue. In late 2013, she could no longer endure the rigors of her occupation. She submitted a claim for long term disability to her insurer, Prudential Insurance Company of America (Prudential).
Lyme disease, in particular, can be a severely debilitating illness. It can affect any organ of the body, including the brain and nervous system, muscles, joints, and the heart. If detected early, lyme disease is highly treatable and curable, however the symptoms, such as a fever, chills, sweats, muscle aches, fatigue, nausea and joint pain often make it difficult for a patient to detect and it is regularly mistaken as a flu. Less than 10% of people have a “classic bullseye” rash and often the rash appears and fades and then reappears later. Its symptoms mimic other diseases so much so that Lyme disease is called “The Great Imitator.”
If Lyme disease is not diagnosed and treated early, the Lyme spirochetes can spread and may go into hiding in your body. Weeks, months or even years later, symptoms may appear including headaches, light and sound sensitivity, cognitive impairment, sleep disturbance, depression, anxiety, arthritis, fatigue, abdominal pain, diarrhea, chest palpitations, shortness of breath, burning or shooting pains and reproductive system complications.
Early in 2014, Prudential denied our client's claim for long term disability benefits concluding that she was not disabled from her regular occupation. On her behalf, Kantor & Kantor appealed this decision. We submitted a comprehensive written appeal accompanied by medical records, medical opinions, and Lyme disease research and statistics. Just recently, Prudential overturned the denial, and benefits were reinstated.
This case was yet another example of an insurance company not taking the time to consider the medical records submitted by their insured, understand the nature of the illness, or comprehend the complications associated with the illness and the impact it has on a person’s life.
We are thrilled that this denial was rightly overturned and that the intervention of the court system was not required.
If you or someone close to you is suffering from Lyme disease, or any other illness, and your are being denied benefits by your insurer, please call Kantor & Kantor for a free consultation at 888-569-6013. We can help!