OLD vs. NEW Definition of
Chronic Lyme Disease
May 14, 2017- I just reviewed a court case involving a patient who is living near Lyme, CT. Out of the blue one day she began feeling sick with many flu-like symptoms. As time progressed she developed more seemingly not related symptoms.
The patient continued feeling ill and was treated for a couple of her symptoms, including depression. She was eventually was forced to stop working due to her ongoing illness.
She received some part time disability compensation for a few months, however, when the allotted time was up and she had not recovered, she was wrongfully denied long term disability.
OLD DEFINITION OF LYME DISEASE
NOTE- Names and dates (year) excluded to protect patient's privacy. Changed the name of the patient to "Ruth".
Quote- "Additionally, Dr. XXX (Consults for Insurance Company) based his conclusion on the absence of evidence of (i) exposure history or a tick bite, (ii) a rash (i.e., erythema migrans) associated with Lyme disease that typically lasts for weeks,5 (iii) serology tests with positive results, and (iv) specific physical findings such as acute arthritis, cardiac complications, or neurological abnormalities such as cranial neuritis, lymphocytic meningitis or encephalomyelitis."
NOTE- These are the only symptoms listed by the IDSA/CDC that can be related to Lyme disease. The patient and her symptoms didn't fit into that limited description.
In his report, Dr. XXX (Consulted For Insurance Company) noted that because the disablingsymptoms Ruth complained of were similar to those Ruth had experienced while being treated for depression by Dr. AAA during the exclusion period, the plaintiff appeared to be suffering from depression rather than from Lyme disease.
On May 11, xxxx, Insurance Agent wrote to Ruth and informed her that her claim had been denied. Insurance Agent gave the following explanation:
[W]ith regard to your diagnosis of Lyme Disease, as stated in our telephone conversation of April 19, xxxx, your medical records on each occasion of Lyme Disease Testing (November 24, xxxx, May 8, xxxx and December 29, xxxx) yielded a negative serology.
NOTE- The Insurer relied on the CDC's description of Lyme disease which was supplied to them by the IDSA.
Continuing from legal papers... The Center for Disease Control (CDC) has established the criteria for diagnosing Lyme Disease. The University of Connecticut Hospital, where you were tested for Lyme Disease, was contacted by our physician consultant. Our physician consultant was informed, by the Director of Serology at the University of Connecticut Hospital, that they adhere to the CDC criteria for the diagnosis of Lyme Disease and that your Lyme Disease test results were negative.
Also, the other 2 tests listed in your file[,] the MRI and the Speck Test, although abnormal, did not support or offer any specific diagnosis. Our physician consultant concluded that he was unable to identify a physical illness that would prevent you from performing your occupation.
Our conclusion is that the medical evidence in your file does not currently support a diagnosis of Lyme Disease. However, even if you had Lyme Disease, your claim would still be denied, due to the preexisting condition exclusion as you were seen and treated consistently from about July of xxxx through the present for many of the same physical and psychiatric complaints for which you are claiming disability."
It continues... "... and that she saw Dr. LLMD in November of xxxx “because of red marks on [her] lower back and extreme numbness in [her] face, arms and legs and back.”
Another Insurance Agent stated that although Ruth’s physician had diagnosed her as having Lyme disease, The Insurers Physician consultant had found that the laboratory tests contradicted that diagnosis.
She stated further that although the actual diagnosis of Lyme disease had not been made during the exclusion period, Ruth was being treated during the exclusion period for the same set of symptoms which eventually led her physician to make a diagnosis of Lyme disease. In other words, the “set of symptoms for which she received treatment [had] beenexistent since July xxxx.”
Insurance Company determination that Ruth’s disability was caused or contributed to by apre-existing condition was based on a consideration of relevant factors. Those factors were as follows:
1. The negative results of the three laboratory tests for Lyme disease.
2. The fact that, although Dr. LLMD's reading of the tests apparently was contradicted by Dr. LLMD, Dr. LLMD had consulted with the director of the laboratory where the tests were conducted and obtained an explanation as to why the laboratory concluded the tests were negative for Lyme disease.
3. The absence of any notation at all by Dr. LLMD in her treatment notes concerning a complaint of a rash in November xxxx, when the plaintiff claims her complaint was a red rash on her back, and the fact that there was never any record of the type of unusual rash that is typical of Lyme disease.
4. Dr. LLMDs conclusion that the MRI and SPECT scan results were “nonspecific” for a diagnosis of Lyme disease; and
5. The fact that a review of the treatment notes of Ruth’s visits with Dr. Insurance Company and with Dr. LLMD showed that there was a general similarity of the plaintiff’s symptoms (including depression and related symptoms) during and after the exclusion period.
Thus, the individuals involved in the decision-making process at Insurance Company had before them evidence that a reasonable mind might accept as adequate when they concluded that Ruth did not have Lyme disease and that she had been treated for the same impairing condition during and after the exclusion period.
Moreover, in view of the totality of the relevant factors, adding as a factor a conflict of interest on the part of Dr. LLMD would not change the court’s conclusion that there was no abuse of discretion by Insurance Company here.
The Lyme patient lost her case.
NEW DEFINITION OF CHRONIC LYME DISEASE
Utilizing the new definition of chronic Lyme disease the patient would have won her case. Every symptom she had that was documented in her charts, including the reasoning behind the negative tests, can be found in the this new chronic Lyme disease definition.
The New Definition- Chronic Lyme Disease