By Jennifer Hess

Lyme disease long-term disability claims are often more complicated than people expect.

Many individuals move forward with serious symptoms, supportive doctors, and a clear understanding that they can no longer work, only to receive a denial that feels confusing and difficult to reconcile.

That experience can be frustrating and, at times, discouraging. It is important to understand that a denial does not mean your condition is not real or that your limitations are not significant.

In many cases, it reflects how the claim was evaluated and how the evidence was presented.

Looking at how these claims unfold in practice, along with common patterns that appear across many cases, can help make the process easier to understand.

A case study

Consider Jane Doe, a senior marketing executive in her late 40s who began experiencing persistent fatigue, joint pain, and cognitive difficulties. At first, she continued working, adjusting her schedule where possible and pushing through symptoms. Over time, her ability to focus, process information, and maintain a consistent pace declined.

Her role required sustained concentration, strategic thinking, and the ability to manage multiple projects under tight deadlines. Tasks that once felt routine began to take significantly longer, and mistakes became more frequent.

After months of ongoing issues, she was diagnosed with Lyme disease. Her treating physician supported the diagnosis and began treatment. Despite this, her symptoms continued to interfere with her ability to perform her job.

She ultimately stopped working and filed a long-term disability claim.

The claim was denied.

The insurance company cited several reasons. They pointed to a lack of objective evidence supporting functional impairment. They noted that certain exam findings were normal. They characterized her fatigue and cognitive complaints as subjective. They relied on a reviewing doctor who concluded she could still perform her occupation.

From her perspective, this outcome was difficult to understand. Her symptoms were real, consistent, and documented in her medical records.

What the insurance company focused on

A closer look at the denial shows several issues that come up frequently in Lyme disability claims.

1. Lack of objective evidence

Although Lyme disease is often diagnosed based on clinical presentation, insurance companies tend to place significant weight on testing that measures functional limitations.

In this case, there was no neuropsychological testing to evaluate cognitive functioning. There was no functional capacity evaluation to assess physical ability. There was no cardiopulmonary exercise testing to measure fatigue or exertional tolerance.

Without these types of assessments, the insurer framed the symptoms as insufficiently supported, even though they were repeatedly documented.

2. Generalized physician support

The treating physician supported the claim but did so in broad terms. The medical records referenced fatigue, pain, and cognitive difficulty, but did not clearly outline specific restrictions or limitations.

For example, there was no detailed explanation of how long the claimant could sit, stand, or concentrate. There was no discussion of whether she could sustain work activity over the course of a full day or week.

Insurance companies often look for this level of detail. When it is missing, they may discount the opinion.

3. Limited connection between symptoms and job duties

The claim described the symptoms, but it did not clearly explain how those symptoms interfered with the specific demands of the occupation.

Cognitive fatigue was noted, but not tied to the need for sustained attention and decision making. Physical symptoms were described, but not connected to productivity, endurance, or reliability.

This gap allows insurers to argue that a person may still be able to work in some capacity.

4. Reliance on file reviews

The insurer relied on a reviewing doctor who did not examine the claimant. That reviewer focused on selected portions of the record and emphasized normal findings while minimizing ongoing symptoms.

This approach is common, particularly in conditions where symptoms fluctuate or are not easily measured through standard testing.

Common patterns in Lyme disability insurance claims

The issues in this case are not unique. Many Lyme disability claims follow similar patterns.

1. Symptoms are labeled as subjective

Fatigue, pain, and cognitive issues are often described as subjective, even when they are consistent and documented over time. Without testing that evaluates function, insurers may question the severity or impact of these symptoms.

2. Fluctuating symptoms are misunderstood

Many individuals with Lyme disease experience variability in their symptoms. Some days may be more manageable than others.

Insurance companies may focus on periods of higher functioning and use them to suggest that the person is capable of working. This overlooks the importance of consistency and reliability, which are essential for maintaining employment.

3. Evidence is not fully developed early on

Initial claims are often submitted with standard forms and basic medical records. While this may seem sufficient, Lyme claims often require more detailed and targeted evidence.

Without it, important aspects of the condition may not be fully captured.

4. Occupational demands are oversimplified

Insurers may categorize a job based on general physical requirements while overlooking cognitive demands, pace, and the need for sustained performance.

This can lead to an incomplete assessment of whether a person can realistically perform their role.

5. The claim is evaluated in pieces

Rather than considering the combined impact of multiple symptoms, insurers may evaluate each issue separately. This can minimize the overall level of impairment.

In reality, it is often the combination of fatigue, pain, and cognitive difficulty that prevents a person from working.

6. Overlapping conditions and co‑infections are often overlooked

Many individuals with Lyme disease are not dealing with Lyme alone. Co‑infections such as Babesia or Bartonella can contribute to the severity and variability of symptoms. In addition, other conditions such as autoimmune disorders, chronic fatigue, or neurological issues may also be present.

In our experience, these overlapping conditions are not always fully accounted for in how disability claims are evaluated. Insurers often review each diagnosis separately rather than considering how they interact.

This can lead to an incomplete understanding of what a person is actually experiencing. Fatigue may be more severe and less predictable. Cognitive issues may be more pronounced. The overall ability to function consistently can be significantly affected.

Looking at the full picture, rather than any single diagnosis, is often critical in understanding the true level of impairment.

Strengthening the claim

In cases like Jane Doe’s, the issue is often not the absence of a real condition, but gaps in how the limitations are documented and explained. When the claim is revisited, the focus is typically on developing more targeted, functional evidence.

For example, where cognitive symptoms such as brain fog, slowed processing, or memory issues are present, a neuropsychological evaluation can provide objective data showing how those impairments affect attention, concentration, and executive functioning.

Where physical symptoms such as fatigue, joint pain, or reduced endurance are limiting, a functional capacity evaluation can assess the ability to perform work‑related activities such as sitting, standing, lifting, and maintaining activity over time.

In cases involving significant fatigue or exertional intolerance, cardiopulmonary exercise testing may also be considered to evaluate how the body responds to physical exertion.

Equally important is the role of the treating physician. A supportive opinion is helpful, but what often carries more weight is a detailed narrative that explains specific restrictions and limitations and clearly connects those limitations to the demands of the person’s occupation.

For example, rather than noting general fatigue, a more developed report might explain an inability to sustain concentration for extended periods, difficulty maintaining pace, or the need for rest breaks that would interfere with a normal work schedule.

Finally, a clear explanation of how symptoms affect the actual duties of the job can be critical. When that connection is well developed, it becomes easier to evaluate whether full‑time, reliable work is realistic.

Many Lyme disability insurance claims that are initially denied can be strengthened in this way.

My final thoughts

Lyme disease claims can be challenging because the symptoms do not always fit neatly into the frameworks used by insurance companies. A diagnosis alone is often not enough.

What matters is demonstrating how the condition affects day‑to‑day functioning and the ability to sustain work activity over time.

A denial is not the end of the process. In many cases, it is the beginning of a more focused effort to present the full picture of what you are experiencing.

This article is for informational purposes only and should not be construed as legal advice.

Jennifer L. Hess is a partner at Riemer Hess LLC, a New York City headquartered law firm representing clients nationwide in disability insurance claims. For more educational information about proving Lyme disability insurance claims, visit their FAQ Center page: Is Lyme Disease a Disability?” and her prior LymeDisease.org post 10 tips for Lyme disease disability insurance claims.