Important Message from ProHealth Founder, Rich Carson

Disability Insurance for Lyme Disease


By Karen Lee Richards*

Social Security Disability Insurance

If you are no longer able to continue working, you may qualify for Social Security Disability benefits. Going through the process of applying for SSD is generally not a simple task. Therefore, it’s important to learn all you can about the process before you begin in order to maximize your chances of being approved. The following information and especially the suggested articles can help you navigate the system as smoothly as possible.

There are two types of disability benefits available through the Social Security Administration (SSA):

  • Social Security Disability Insurance (SSDI) – Pays benefits if you have worked long enough and have paid Social Security taxes within the past five years.
  • Supplemental Security Income (SSI) – Pays benefits based on your financial need.

If you’re unsure which program best fits your situation, use the Benefits Eligibility Screening Tool to see which you may be eligible for. The information here applies only to SSDI. For more information about applying for SSI, see: Supplemental Security Income Home Page

In determining whether or not you are disabled, SSA asks five questions:

  1. Are you working? If you are working and earning an average of more than $980 a month, they do not consider you disabled.
  2. Is your condition “severe”? Your condition must interfere with basic work-related activities.
  3. Is your condition found in the list of disabling conditions? The SSA has a list of conditions they consider so severe, they automatically mean you are disabled. If your condition is not on the list, they have to decide if it is equal in severity to another condition on the list. To check the SSA list of disabling conditions, see: Listing of Impairments. If your condition is not on the list or equal in severity, they then move to question 4.
  4. Can you do the work you did previously? If the SSA determines that your condition does not interfere with the work you previously did, your claim will be denied. If it does interfere, they then proceed to question 5.
  5. Can you do any other type of work? It’s not enough just to be unable to do your previous job. They also look at your medical conditions, age, education, past work experience and transferable skills to determine if you could adjust to doing other types of jobs.

For answers to frequently asked questions about how the SSA determines the answers to questions four and five, see: Work and Education Information the SSA Needs

These articles will provide you with additional in-depth information about applying for SSDI, particularly in relation to Lyme disease:

Social Security Disability (SSDI & SSI) for Lyme Disease

Can You Get Disability Benefits for Lyme Disease?

Facts About Lyme Disease and Filing for Disability

Social Security Disability for Lyme Disease: A How-To Guide


Long-Term Disability Insurance

If you have long-term disability insurance through your employer, you may be able to receive benefits – at least for a period of time – when you are no longer able to work due to chronic Lyme disease. Be aware, though, that you will likely meet with substantial resistance from your insurance company. Long-term disability (LTD) insurance companies routinely deny or limit claims for diseases like chronic Lyme because the symptoms are “self-reported” (e.g., pain, fatigue, headaches).

Be sure to read your policy carefully to find out whether and for how long you may be able to receive benefits for chronic Lyme disease. The following paragraph is a sample of typical language that may be used in an LTD policy to limit eligibility.

Benefits will be terminated after 24 months for those with disabilities which are based primarily on self-reported symptoms, and disabilities due to alcoholism, drug abuse, or mental illness. Self-reported symptoms include manifestations of your condition that are not able to be verified using tests, procedures, or examinations commonly accepted in the practice of medicine, including headaches, pain, fatigue, soreness, numbness, dizziness, ringing in the ears, and loss of energy.

Another tactic employed by LTD insurance companies to limit eligibility involves chronic Lyme disease patients who also have depression, anxiety or any other “mental impairment” in addition to their physical illness. Many policies restrict benefits to a maximum of two years if the mental impairment “contributes to” the overall disability and inability to work. In order to prevent the insurance company from taking advantage of the mental impairment clause, the patient, their doctor and attorneys must document that the depression or anxiety does not contribute to the disability caused by chronic Lyme disease.

These articles will provide you with additional in-depth information about applying for LDI, particularly in relation to chronic Lyme disease:

Update for patients with CFS/CFIDS/ME, fibromyalgia and Lyme Disease on important issues affecting Long-term Disability Insurance and Social Security Disability

Disability Insurance Q&A – Attorney Team Answers Your Questions

VIDEO: Top 5 Reasons for Long-Term Disability Insurance Denials

When You Can’t Manage a Full Workload – Partial Disability May Be an Option

Last Updated: 5/5/15

* Karen Lee Richards is ProHealth’s Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE, the very first full-color, glossy magazine devoted to FM and other invisible illnesses.  After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times website About.com, and then for eight years as the Chronic Pain Health Guide for The HealthCentral Network.


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