Articles Tagged with “Lyme Disease”

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A former employee of Mid America Clinical Laboratories hired O’Ryan Law Firm after Lincoln National wrongfully terminated her short term disability benefits and then refused to pay any long term disability benefits.  The client initially applied for short term disability benefits that were offered through her employee benefit plan, although the employee paid all of the premiums herself for the disability coverage.  Lincoln National was the disability insurance company who accepted all of her premiums and agreed to pay her monthly disability benefits in the event she became unable to work due to a serious illness or injury.

The employee suffered from the severe symptoms of Lyme disease including muscle and joint pain, headaches, and disabling fatigue.  The employee treated with one of the best Lyme disease specialists in Indiana, Dr. Kimberly Lentz, whose office is located in Zionsville.  Dr. Lentz reported to Lincoln that the employee had the classic symptoms of Lyme disease and was unable to continue working because of the debilitating consequences of contracting Lyme disease.  Lincoln paid her short term disability benefits for a month but then terminated the claim after they hired a record reviewing doctor to review the records.  After the short term disability was terminated, the employee hired O’Ryan Law Firm to appeal the premature termination of her short term benefits and to assist her with applying for long term disability benefits.

Prior to her serious medical conditions, the employee worked as a medical technician with Mid America Clinical Laboratories for two years.  Her job required her to analyze blood and body fluids, operate sophisticated laboratory equipment and computerized instruments, log data from medical tests, discuss lab findings with physicians, and supervise and train other medical lab technicians.  An extensive amount of concentration and focus was necessary to perform the duties of her position and any mistakes could lead to serious consequences. Mid America is the largest clinical laboratory in Indiana. They complete over 4.5 million tests per year. Mid America is not only located in Indianapolis, but also has over 30 Patient Service Centers throughout central Indiana.

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Cigna, headquartered in Bloomfield, Connecticut, is a global health services organization and its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. CIGNA is one of the top health insurers in North America, with medical plans covering nearly 12 million people. Cigna operates in 30 countries, has approximately 40,000 employees and manages around $54 billion in assets.

CIGNA is the parent company of Life Insurance Company of North America. Life Insurance Company of North America (“LINA”) offers group life, accident, and disability insurance to employers. LINA was formed in 1956 by Insurance Company of North America (INA), a CIGNA predecessor company. LINA provides group disability insurance to many employers across Indiana including Toyota, the University of Notre Dame, State Farm, Sony Electronics, Covance and many others. Employees of these companies are provided short and long term disability benefits if they become unable to work due to injury or illness. LINA is responsible for processing the claims and making monthly benefit payments if the claimant proves that they are disabled and unable to return to their own occupation.

During the claims process, LINA will have a Nurse Case Manager review the medical records to determine whether an individual meets the definition of Disabled under the terms of the policy. If necessary, the Nurse Case Manager will escalate the review to a Cigna Medical Director who is an employee of Cigna. The Medical Director will also review the medical records and reports to determine whether the restrictions and limitations listed by the claimant’s treating physician are supported by the medical records. It is not uncommon for the Nurse Case Manager and Cigna Medical Director to disagree with the treating physician and to find that the claimant is able to return to work despite the medical evidence supporting the claim.
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The Center for Disease Control (www.CDC.gov) reported 17,730 cases of Lyme Disease in the year 2000 and as of 2012, over 100,000 cases have been reported. Lyme Disease is a growing epidemic in America and was first recognized in 1975 in Lyme, Connecticut, where the first outbreak occurred. Lyme Disease is the illness that results from the bite of an infected tick and it is the most common tick-born infectious disease in the United States.

Several related species of Borrelia cause Lyme Disease (Lyme Borrelia). Virtually all patients in the United States are infected with a single species called Borrelia burgdorferi, the spirochete that infects the deer tick and causes Lyme Disease. Worldwide, there are about 850 tick species and 30 major tick-borne diseases.

The infection usually starts with a painless, spreading “bull’s eye” rash where the tick had attached itself to the skin. If you notice your tick bite right away and you are treated with antibiotics, this infection can be cleared fairly easily. If the cause is not found until later, people with Lyme Disease are more likely to feel fatigued, suffer from poor sleep, and muscle and joint pain, even after treatment. Other symptoms might be an acute fever, rash, Bells’ palsy (paralysis of the face), headache, and joint and muscle pain. Some patients may complain of sensory symptoms such as burning, shooting pain or numbness. Your doctor may administer blood tests to determine if Lyme Disease is causing your symptoms and to rule out other diagnoses.
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