More on Lyme Disease and Epstein-Barr Virus

Welcome to Season 3, Episode 15 of Winning Isn't Easy, the podcast that explores the intricacies of disability insurance claims. In this episode, we delve deeper into a topic of great significance: Lyme Disease and Epstein-Barr Virus.

Building upon our previous discussions on these complex illnesses, we continue to shed light on the challenges faced by individuals affected by Lyme Disease and Epstein-Barr Virus. These conditions can have profound impacts on one's health, daily life, and ability to work.

Join us as we explore the latest insights, research, and advancements in understanding these conditions. Our host, Nancy Cavey, will share her expertise as a disability attorney specializing in cases involving Lyme Disease and Epstein-Barr Virus. Nancy will discuss the unique challenges in obtaining a proper diagnosis, navigating the claims process, and advocating for the benefits individuals deserve.

In this episode, we'll also cover the various symptoms and complications associated with these diseases and how they can impact an individual's functional capacity. We'll provide practical advice on gathering medical evidence, understanding policy language, and effectively communicating your condition to insurance providers.

Whether you are personally affected by Lyme Disease or Epstein-Barr Virus, or seeking to deepen your knowledge of these conditions, this episode offers valuable information that can help you navigate the disability claims process with confidence.

Tune in to empower yourself with the knowledge and tools needed to overcome the challenges and secure the disability benefits you deserve.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals. 

Transcript

Disability Attorney Nancy L. Cavey: 0:11

Hey, I'm Nancy Cavey, national ERISA disability attorney and individual disability attorney. Welcome to this episode of Winning Isn't Easy. Before we get started, I have to give you this legal disclaimer. Now, this podcast is not legal advice. The Florida Bar tells me that I have to tell you that I'm not giving you legal advice. I've done that, but nothing will ever prevent me from giving you information about the ERISA disability claims process, an overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go with this week's episode. Now, in this week's episode, I'm gonna be talking about Lyme disease, Epstein Bar virus, and other chronic illnesses that cause fatigue. They're often difficult to manage. And when it comes to disability insurance claims, given the GE disability carriers general dislike of potentially subjective symptoms, the game that they're gonna play and what we need , uh, to do to help you win your case. So I'm gonna talk about a number of things in today's , uh, episode. First, I'm gonna talk about Epstein Barr disability insurance claims and what you need to know about limited disability benefit clauses that you might find in your own disability insurance policy or plan. Next, I'm gonna talk about how Epstein Barr virus can reactivate in long covid and your rights to long-term disability benefits for that. And then lastly, I'll talk about the mental nervous policy limitations and Lyme disease. Got it. We've got a lot to cover today, but I'm gonna take a quick break. See you in a minute.

Speaker 2: 1:51

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Disability Attorney Nancy L. Cavey: 2:10

Welcome back to Winning Isn't Easy. Let's first talk , talk about Epstein Barr disability insurance claims and what you need to know about limited disability benefit clauses. Now, many disability policies or plans have subjective medical condition limitations or limited disability benefit clauses. Generally, they will limit the payment of benefits to just 24 months. And there's really a fight often about the terms of these limited disability clauses and whether a particular medical condition actually falls within the limited disability benefit clause. And that's exactly what happened in the case of Tucker versus Express Scripts Health and Welfare benefits. This is a , uh, case , uh, out of Missouri. Mr. Tucker was covered under a disability plan that had a limited disability benefit clause. It limited the payment of disability benefits to just 24 months for certain conditions, including chronic fatigue syndrome. Now, when faced with such a policy limitations, there are generally two arguments that we Aris a disability lawyers make. One , uh, that the policy limitation is poorly written, and two, that the disability con disabling condition isn't one of those limited benefit conditions. Now, in Tucker's case, the benefits for chronic fatigue syndrome were limited to just 24 months. The disability plan found that Tucker was disabled by chronic fatigue syndrome and then denied the claim of for benefits in excess of the two years. Obviously, his case ends up in federal court, the I'm not disabled by chronic fatigue argument, I'm really disabled by postviral chronic fatigue syndrome, fibromyalgia and chronic Epstein bar infection gain . That's exactly what you try to do. You try to argue you're disabled based on medical conditions that aren't listed in that limited disability benefit clause. And now that can be tricky because first many disability policies or plans have a discretionary clause, and that discretionary clause is, you know, is it get outta jail free card for a disability carrier and a plan, the judge has to defer to the carrier plan's interpretation of the terms of the policy and the terms limited disability benefits unless it's unreasonable. And secondly, the judge is gonna review the carrier's medical analysis and conclusions about what medical conditions are the cause of the disability, and whether or not those medical conditions are excluded by that limited disability benefit clause. So in Tucker's case, he argued that his disabling diseases were the post-viral chronic fatigue syndrome, fibromyalgia and chronic Epstein bar infection. He argued that Epstein-Barr was not one of the limited benefit conditions, but the plan had determined that he was disabled because of chronic fatigue and not the chronic E B V infection. Tucker's physician and the plan's physician relied on the same medical article about the relationship between C F S and Epstein Barr , and they reached opposite conclusions about what it stood for . Under the Arisso case law, a disabling carrier or plan doesn't have to accept the opinion of a treating doctor over that of its own doctor. And so of course they did, and the court ultimately found it was not an abusive discretion for the carrier to accept the opinions of its physicians and its physicians' interpretation of the medical literature over that of Tucker's physician. And as a result, that denial was upheld. So regardless of the approach the disability policy holder plan beneficiary is taking, you've got the burden of proof. And if you don't meet that dur burden of proof, you are going to lose. But I don't want you to give up. Disability carriers are in the business of denying disability insurance claims, and you shouldn't give up. But what you should be doing is working with an experienced at a disability attorney. Now, unfortunately, the facts are what the facts were and Tucker's attorney worked with what he had. But I think that the fact that , um, there is a strategy here that we ERISA lawyers employ should encourage you. Again, we start out by looking at the terms of the policy of the plan to see exactly what it says in terms of disabling medical condition. Is that diagnosis that our client has one of the conditions that is under the limited pay provision? And if it is that condition goes out, we then ask, look, does our client have any other medical conditions that we could potentially argue are disabling? And we parse through those to see whether there are conditions and if so, whether or not they are disabling, certainly consistent with the medical records, then we're getting the physician involved to say, look, we want you to understand that chronic fatigue or Epstein Barr are excluded conditions, but according to the records our client has these other medical problems. Now treating doctor, do you think any of these conditions would prevent our client from working or would provide , uh, restrictions or limitations that would prevent them from doing the material and substantial duties of their occupation? Uh, yes. Well, good. Doctor, could you give me a report about the diagnosis, your opinion , uh, about restrictions, limitations, the objective basis of those restrictions and limitations, and comment on why you think the person might be disabling , uh, might be disabled. And then of course, that is information that the , uh, lawyer is going to be using in writing an appeal. They also may be , uh, taking , uh, a , the client to , um, uh, independent medical evaluation or a functional capacity evaluation to buttress the disabling nature of the ex, the non excluded condition. Uh, and then ultimately you wanna be tying it together with a vocational opinion. So you can see it takes teamwork , uh, to get disability benefits and to , uh, make the right arguments or arguments that resonate potentially with the court so that you get the disability benefits you deserve. No lawyer can guarantee the results, but you can see the strategy. Got it. Let's take a break. Welcome back to Winning Isn't Easy. I'm gonna talk about how Epstein Bar Virus can reactivate in long COVID cases and how that impacts your right to long-term disability benefits. Latent Epstein Barbar virus is a widespread human herpes virus. It's found in 90 to 95% of adults. It's been suspected that there might be a connection between long covid and reactive aided E B V , and I think research is now providing evidence of that connection. There's an article entitled Epstein Bar Virus Can Reactivate in Long Covid by Shanette , Susan Alex, and it reported on the results of a recent study reported in mid R X iv , and it showed that there was , uh, serological evidence of this interaction. And according to the study, long covid 19 symptoms of neurocognitive impairment and fatigue were linked to serological proof of recent E B V reactivation. And there's now thought that there is this relationship between the reactivation and of course , uh, the symptoms that can cause someone to become disabled that can include fatigue, the cognitive issues , uh, and other manifestations of of the disease and along covid . Now let's talk about this in conjunction with a long covid case. What a disability carrier is looking for in terms of your medical records is the diagnosis of Epstein Barr and potentially the , um, diagnosis of , uh, COVID. And that can be problematic, especially for those in the early days who had covid testing, which was negative, but went on to develop covid or those with Epstein Barr who have equivocal serological testing. The COVID 19 pandemic obviously turned the world upside down in a matter of weeks, but we're now only learning of the long-term complications of covid. And I think that it , it's important for those individuals who went on to develop long covid , uh, or to ha have reactivated Epstein-Barr to prove the underlying basis of the diagnosis and the complications. Neurological, cardiovascular, pulmonary problems , uh, are easy to prove based on objective testing. Um, and you know, that's sort of one form of proof because that can document not only the diagnosis, but the extent of nature of the damage caused by the Covid virus. In other words, one way to get around, if you will, the negative covid testing is to document the known , uh, Sequoia of long covid by body symptoms and by objective testing like neurological cardiological or pulmonary testing. So we can get around the lack of diagnosis , uh, if you will, in quotes and objective testing by going backwards if, if you will, into the affected organ system and document objectively that there has been , uh, damage. So that objective testing is really important. Now, what also is important obviously, is the reactivation of the E B V , uh, and , uh, you know, testing certainly can be used , um, from a serological standpoint. Um, but again, if that's negative or equivocal, that can be problematic also. But I think you can backdoor it , uh, just like you can backdoor the long , uh, covid , um, uh, type situation by , uh, going after body systems. Now, just because you have positive testing doesn't mean you're out of the woods because disability carriers are challenging the testing and the diagnosis. I think that we don't necessarily wanna get hung up with the diagnosis , um, but rather address the symptoms of neurocognitive impairment , um, fatigue , uh, and the other symptoms that we will see with a combination of both. These can be objectively confirmed by neurocognitive testing and cardiovascular pulmonary , uh, exercise testing known as CPE disability carriers dislike Epstein Bar and long covid cases that involve cognitive impairment and fatigue. And I think these two objective types of testing are really key to proving that you are in fact , uh, disabled. And I think that this recent study that I cited can help prove the connection with , uh, COVID 19 and eeb B in your case, in submitting my , uh, appeals, I am always bringing medical , uh, literature to the attention, not only of the disability carrier, but I also am providing this information to physicians so that they are educated , uh, and , um, can help us tie together this medical literature , uh, and , um, and the basis of the disability. Now I have to point out that the study I just cited is not a peer review report, but I think that, that it could help. I think that medical literature , um, uh, as researchers are studying the impact of long covid and Epstein Barr are really also going to be a crucial part of any appeal. So I'm actively , uh, looking for this literature. I catalog this literature, and so when I have a long covid case or I have an Epstein Barr case, I am using this medical literature as a supplement to show that there is scientific proof for what we're trying to prove here in terms of this relationship. But more importantly, as I said, I'm submitting objective testing to document the symptoms and the disabling nature of these symptoms because after all , remember you've got the burden to prove that you meet the standard of disability. Got it. Let's take a break.

Speaker 2: 14:26

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Disability Attorney Nancy L. Cavey: 15:00

Welcome back to Winning Isn't Easy. Let's talk about mental nervous disability policy limitations and Lyme disease . Lyme disease is a complex multi-system illness. It's difficult to diagnose and it is complicated to treat. What's important is developing the symptoms in your medical records, and those symptoms can include chest pain, palpitations, shortness of breath , gastrointestinal symptoms, joint pain, neurological symptoms, memory issues, and even psychological symptoms. The psychological symptoms are , uh, important to develop and they can include mood swings, irritability, anxiety, depression, and any of those symptoms can be problematic in a long-term disability , uh, claim. Why do I say that it's problematic? Well, there are mental nervous policy or plan limitations in many disability policies or plans, and the, they come in two flavors. Uh, the first flavor is if your , uh, disability has caused or contributed to, regardless of how small , uh, by a mental or nervous disorder, benefits are limited to just two years. It's the contributed two language, which is problematic. There are other version, of course, is that you have , uh, that you are disabled based on a psychological condition , um, and obviously we need to be parsing what the disability policy or plan terms are that you have because it will impact the strategy of the case. So let me give you an example . This is the case of Mateo versus Reliance Standard. It's a case out of New Jersey and Mateo suffered from Lyme disease, chronic pain, chronic fatigue syndrome, fibromyalgia, thyroid disorder, and of course, she also suffered from anxiety and depression. It's not uncommon to see those , uh, ex anxiety and depression caused by multiple physical problems. Now, ultimately, reliance terminated her long-term disability benefits after 12 months based on the plan's , uh, mental nervous policy limitation. Uh, and obviously she wasn't happy about that. But the language of the mental , uh, nervous , um, clause clearly stated that benefits are not payable for disability caused or contributed to by mental or nervous disorders. So the proper question in this case with this type of mental nervous limitation for reliance and the court is to determine whether Mateo remained totally disabled based on her physical limitations, or in other words, were her physical symptoms , uh, those symptoms that rendered her to be disabled regardless of her mental condition. Now, unfortunately for her, her medical records documented that her anxiety and depression contributed to her overall impairments, and as a result , uh, the evidence did not allow for this parsing and support a finding that her physical condition , uh, on their own rendered her to be totally disabled. The court obviously upheld the denial of the benefits based on the language of the mental nervous , uh, policy limitation. Uh , and that was not obviously a happy thing for Mateo . Now, what I think you have to do before you stop working apply for your benefits is to understand what your policy provides in terms of the definition of disability, occupation, and whether there are any , uh, limitations such as the subjective medical condition limitation or the mental nervous limitation, because that will drive, in my view, how the case is presented. Now , uh, obviously you wanna get a copy of your medical records and you wanna review them cover to cover to understand what your physician's opinions are about your diagnosis, whether your condition is disabling, and the extent to which , uh, any psychological problems are contributing to your overall disability. And it may be necessary to clarify through your physicians that while you may be suffering from a psychological problem like depression or anxiety, that they are not the cause of, nor are they contributing to your overall disability. And that obviously means that youve gotta do some work before you're applying for benefits. We wanna make sure that your medical records document that your physical problems, including your Lyme disease cause you to be totally disabled based on your physical limitations. The goal here obviously is, is to prevent the disability carrier from using the mental nervous policy limitations to deny your benefits after the 12 months or two years. So it obviously , uh, requires some coordination , uh, before you stop work and apply for benefits. Now, if you haven't followed that ABI advice and you've stopped working and you're now collecting benefits, you need to understand that at some point the disability carrier is or plan is gonna be looking at your medical records to see whether or not they can apply that mental nervous policy limitation or even a subjective medical condition limitation. As I've discussed in earlier episodes, if the policy language is caused or contributed to, I think that you need to determine whether or not in fact, your depression, anxiety, or your psychological problems are contributing to the disability and whether or not you would be disabled with or without the, those , um, mental or psychological problems. If those problems are there , uh, and you're getting treatment and they're not disabling, I think your medical records need to make that abundantly clear. Also, your medical records need to make it abundantly clear what your symptoms are from a physical standpoint and how those symptoms prevent you from doing , uh, your own occupational duties or the occupational duties of , uh, any other occupation because, you know, the disability carrier's gonna parse those medical records and look for reasons to deny the claim. So you need to start making sure that your medical records are accurately telling the story of your symptoms, how they're disabling you, why your psychological symptoms or problems are not contributing to your disability, and why your physical conditions, symptoms, manifestations of any disease, including Lyme disease, are in fact why you are disabled. You can see it takes a lot of work, and that's just one reason why you want to have an experienced ERISA disability attorney. If you've got a disease like Lyme Disease, Epstein var , chronic fatigue syndrome, disability carriers look very closely at these claims in an effort to either deny them or to terminate benefits , uh, based on the mental nervous policy limitation or subjective medical condition limitations. Got it. I hope you have enjoyed , uh, this week's episode of Winning Isn't Easy. I , uh, hope that you've enjoyed it and you've enjoyed it so much that you're gonna like our page, that you're gonna leave a review, you're gonna recommend it to your family and friends, and of course you're gonna subscribe. I look forward to talking with you in our next episode of Winning Isn't Easy. Thanks.