By Joel Zelkowitz, Esq.

The spring 2026 tick season has been alarming across New York, New Jersey, Connecticut, and the surrounding northeast region.

For those of us who work with disability insurance claims, the concern is not only that more people may become sick. It is that many people with serious Lyme disease and tick-borne illness symptoms may eventually find themselves facing a disability insurance system that still does not handle these claims well.

Lyme disease disability claims have always been challenging. Many people experience fatigue, joint pain, neurological symptoms, cognitive problems, dizziness, headaches, weakness, post-exertional worsening, and other symptoms that can interfere with full-time work.

Yet disability insurers often focus on what is “objective,” what appears normal on exam, or whether a reviewing doctor believes the person can still perform a job on paper.

That disconnect is not new.

What feels newer, and more concerning, is the sharp rise in disability policies that contain infectious disease limitations. In our view, this trend appears to have accelerated after COVID, as insurers looked for ways to limit exposure for long COVID and other post-infectious conditions.

But the practical effect may reach far beyond long COVID. These limitations can also affect people with Lyme disease and other tick-borne illnesses.

That should concern every Lyme patient, every treating provider, and every advocate helping patients prepare for disability claims.

Why Lyme disability claims are already hard

Even without such a limitation, Lyme disability claims can be difficult to prove.

Insurers may accept that a person has been diagnosed with Lyme disease but still deny the claim because they do not believe the medical evidence proves functional impairment. In other words, they may say: you have a diagnosis, but you have not proven that you cannot work.

That is why these claims often turn on function, not just diagnosis.

A disability claim should explain how symptoms affect the person’s ability to perform the actual duties of their job. For example:

A lawyer with cognitive fatigue may struggle to analyze complex records, meet deadlines, write briefs, or sustain attention through a full workday.

A teacher with severe fatigue and pain may not be able to stand, speak, supervise students, or maintain pace across a school day.

A finance executive with brain fog may not be able to process data, make decisions quickly, participate in long meetings, or handle pressure consistently.

A healthcare worker with dizziness, neuropathy, pain, or post-exertional worsening may not be able to safely and reliably perform patient-facing duties.

The problem is that insurers often reduce the issue to a much narrower question: Can this person sit? Can this person walk? Were their basic neurological findings normal? Did lab testing confirm active infection? Did the records use strong enough language?

That approach misses the real question: Can the person perform full-time work reliably, safely, and consistently?

For many Lyme patients, the answer is no.

The new concern: infectious disease limitations

Before filing a disability claim for Lyme disease, patients should carefully review the policy for any infectious disease limitation.

This is important because some policies now contain language that may limit benefits for disabilities caused by, contributed to by, or resulting from an infectious disease. The exact wording matters.

Some provisions may refer directly to “infectious disease.” Others may use related language such as:

• “communicable disease”
• “viral or bacterial illness”
• “pandemic-related illness”
• “post-viral syndrome”
• “environmental exposure”
• “self-reported symptoms”
• “chronic fatigue conditions”
• “subjective symptoms”
• “limited duration conditions”
• “pre-existing condition limitations”

A policy may not say “Lyme disease” by name and still create a major problem for a Lyme-related claim.

That is why patients should not assume they are covered simply because they have disability insurance. The policy language needs to be reviewed before the claim is filed.

Tips for reviewing the policy before filing

Get the full policy, not just a benefits summary

Many employees only have access to a short benefits summary or enrollment brochure. That is not enough.

Before filing a claim, request the full disability policy, certificate of coverage, summary plan description, and any amendments or riders. These documents may contain limitations that do not appear in the shorter benefits materials.

This matters because a one-page benefits summary may say you have long term disability coverage, while the full policy may contain limitations that change how the insurer evaluates the claim.

Do not rely only on HR’s description of the coverage. HR may be trying to help, but they may not know how the insurer will interpret the policy.

Search the policy for limitation language

Once you have the documents, search for words such as:

• “infectious”
• “infection”
• “communicable”
• “bacterial”
• “viral”
• “pandemic”
• “COVID”
• “post-viral”
• “Lyme”
• “tick”
• “fatigue”
• “self-reported”
• “subjective”
• “limited”
• “pre-existing”
• “exclusion”
• “limitation”
• “not covered”

Some policies place limitations and exclusions in obvious sections. Others bury important language in definitions, riders, amendments, or benefit limitation sections.

Do not stop reading after the main benefits section. The limitations and/or exclusions sections may matter more.

Look for “caused by or contributed to by” language

One of the most important phrases to look for is “caused by or contributed to by.”

That language can make a limitation broader.

For example, a policy may not only limit benefits payable for a disability caused entirely by infectious disease. It may also attempt to limit disability benefits where infectious disease contributed to the impairment.

That can become a serious issue for Lyme patients who have overlapping conditions, including autoimmune disease, chronic fatigue syndrome, dysautonomia, migraine, neuropathy, depression, anxiety, pain disorders, or co-infections such as Babesia or Bartonella.

If the policy uses broad causation language, the claim strategy needs to address it carefully from the beginning.

Identify whether the provision is an exclusion or a limitation

An exclusion and a limitation are not the same.

An exclusion may allow the insurer to deny benefits entirely for a certain category of disability.

A limitation may allow benefits but only for a restricted period, such as 12 or 24 months.

Both can be serious, but they require different planning.

If your policy contains an infectious disease exclusion, the claim may need to explain why the exclusion does not apply or why the disabling impairment should not be treated as excluded under the policy.

If your policy contains a limitation, the claim may need to address whether the insurer can cap benefits and whether the medical evidence supports disability from conditions outside the limitation.

This is not a minor technical issue. It can determine whether benefits are paid at all.

Do not frame the claim too narrowly

Lyme patients often describe their disability as “Lyme disease,” because that is the diagnosis that changed their lives.

That may be medically accurate. But from a disability claim perspective, it may not always be the most complete framing.

The claim should focus on the full medical picture and the specific functional impairments preventing work. That may include:

• cognitive impairment
• fatigue
• post-exertional worsening
• pain
• neuropathy
• vestibular symptoms
• headaches
• sleep disruption
• autonomic dysfunction
• co-infections
• immune complications
• medication side effects
• other overlapping diagnoses

The goal is not to avoid the truth. The goal is to avoid giving the insurer an overly narrow label that lets it ignore the full scope of impairment or invoke a policy limitation without considering the entire medical picture.

Build functional evidence early

For many Lyme patients, standard medical records do not tell the full story.

Office notes may document symptoms but fail to explain why the person cannot work. A doctor may write “fatigue” or “brain fog” without explaining how often symptoms occur, how severe they are, how long they last, or how they affect job duties.

That gives insurers room to minimize the claim.

Depending on the symptoms, helpful evidence may include:

• neuropsychological testing for cognitive impairment
• functional capacity evaluation for physical limitations
• cardiopulmonary exercise testing for exertional intolerance
• vestibular testing for dizziness or balance problems
• autonomic testing for dysautonomia or POTS-like symptoms
• detailed treating physician narratives
• symptom logs showing frequency, severity, and duration
• statements from family members or coworkers
• a clear occupational analysis explaining the demands of the job

The strongest claims usually do not rely on diagnosis alone. They explain what the person can and cannot do in functional, work-related terms.

Ask treating doctors to explain reliability, not just symptoms

Many Lyme patients can do some activities on some days. Insurers often misuse that fact.

They may point to a medical appointment, a short walk, a trip to the store, or a single good day and argue that the person has the functional capacity to work.

But work requires consistency. Most jobs require attendance, pace, focus, stamina, and reliability over a full day and full week.

Treating doctors should be asked to address issues such as:

• How long can the patient sustain concentration?
• How often would symptoms interfere with productivity?
• Would the patient need unscheduled breaks?
• Would the patient likely miss work?
• Do symptoms worsen after exertion?
• Can the patient maintain a reliable schedule?
• Can the patient perform cognitively demanding tasks safely and accurately?

For Lyme claims, reliability is often the central issue.

Be careful before filing without reviewing the policy

Many people file disability claims quickly because they are sick, overwhelmed, and financially stressed. That is understandable.

But filing before reviewing the policy can create problems.

If the policy contains an infectious disease exclusion or limitation, the initial claim forms, attending physician statements, and claimant narrative may become very important. The way the disability is described at the beginning of the claim process can affect how the insurer categorizes the claim.

Before filing, patients should understand:

• what the policy requires
• how disability is defined
• whether the claim is in the “own occupation” or “any occupation” period
• what exclusions or limitations apply
• whether infectious disease language exists
• whether subjective symptom limitations exist
• whether mental health limitations could be raised
• what medical evidence is already available
• what additional evidence should be developed

A rushed claim can give the insurer an advantage.

Why this matters now

The 2026 tick surge should force a broader conversation about how disability insurers handle Lyme disease and tick-borne illness claims.

More tick exposure means more people may develop symptoms that affect their ability to work. Some will recover quickly. Others will not. Those with persistent symptoms may find themselves in a disability claim process that was not built to understand fluctuating, multi-system illness.

At the same time, policy language appears to be moving in a more restrictive direction. If infectious disease exclusions become more common, Lyme patients may face an additional barrier before the insurer even reaches the functional evidence.

That is a serious problem.

People buy disability insurance because they believe it will protect them if illness prevents them from working. If broad infectious disease exclusions are used to deny claims involving Lyme disease, long COVID, or other post-infectious conditions, many policyholders may discover too late that their coverage is narrower than they previously understood.

Final thought

Lyme disease disability claims require careful preparation. In 2026, that preparation should include not only medical evidence, but a close review of policy language before the claim is filed.

Patients should know whether their policy contains an infectious disease exclusion, a limited benefit provision, a subjective symptom limitation, or other language the insurer may use to restrict benefits.

The best time to find those issues is before filing, not after a denial.

Lyme patients deserve a fair review based on the full reality of their illness, their symptoms, their job duties, and their ability to sustain work. As tick-borne illness continues to rise in our region, disability insurers need to keep up with the medical and functional reality of these claims.

Until they do, patients must be prepare

This article is for informational purposes only. It is not legal advice and does not create an attorney-client relationship. Disability insurance policies vary, and anyone dealing with a claim should consider seeking guidance based on their specific policy, medical condition, occupation, and claim history.

Joel Zelkowitz is a Partner at Riemer Hess LLC, a New York City law firm representing clients nationwide in disability insurance claims. For more educational information about proving Lyme disability insurance claims, visit their educational FAQ Center page, Is Lyme Disease a Disability?, and their prior LymeDisease.org opinion piece, Why Was Your Long Term Disability Claim Denied?