Disability company ignores evidence of disabling back pain and Federal Court reverses disability benefit denial

Once again we look at one of those cases that prove how important it can be to appeal the decision of a District Court. Suzanne Lee had been an employee of BellSouth for almost 10 years. She was diagnosed with chronic pain in October 2003 after she was diagnosed with degenerative disc disease in her back. She continued to work until January 18, 2005, when her pain became so severe that she could no longer sit for longer than 1-1/2 hours at a time, and could not stand or walk for more than 15 minutes.

She applied for short-term disability benefits under the plan that she participated in as a BellSouth employee. BellSouth employed Broadspire Services, Inc. to evaluate her claim. Despite the fact that she provided documentation from over five physicians supporting the existence of her condition and her disability from it, after sending her file to two separate physicians for a peer review, Broadspire determined that she was ineligible for benefits. For a pre-lawsuit history of this case please read our article Seven pieces of medical evidence and disability company still denies claim for lack of “objective evidence”.

After her ERISA appeal of the decision was unsuccessful, Lee filed an ERISA lawsuit against BellSouth for wrongful denial of short-term and long-term disability benefits. The District Court upheld BellSouth’s denial of benefits under the arbitrary and capricious standard of review. It determined that BellSouth had reached a reasonable conclusion based upon the evidence and the wording of the BellSouth Short-Term Disability Plan.

Disability Lawyer Represents Client in Appeal of District Court Decision

Because BellSouth plainly granted Broadspire discretion to determine whether Lee was eligible for short-term disability benefits, the Court of Appeals agreed that the standard of review chosen by the District Court was the correct one. This meant that the question to be answered was “Did Broadspire reached a reasonable decision in light of the evidence in the administrative record.”

The short-term disability plan stated that Lee would be entitled to disability benefits if she suffered from “a medical condition supported by objective medical evidence, which” made her “unable to perform any type of work as a result of a physical or mental illness or an accidental injury.”

Reading the terms of the plan as any ordinary plan participant would understand them, the court concluded that “any type of work” referred to not only her regular job with or without accommodations but any other jobs, regardless of availability, with or without accommodations or temporary modification of duties.

The court understood the plain reading of the plan to require proof that a medical condition existed, but that it did not require “objective medical evidence” that Lee was disabled. Rather, the Court understood the plan to require Lee to support her medical condition by objective medical evidence. If Lee had done this, only then would it be appropriate to consider whether the objective evidence supported her disability.

Court Gives Definition Of Objective Medical Evidence

The Courts have long recognized laboratory test results, MRIs, CAT scans and functional impairment tests as objective medical evidence. Lee’s medical records contained examples of any of these objective medical tests. The court recognized that there is a “subjective” aspect of pain which cannot be measured quantifiably. Frequently the only evidence available is the “subjective” opinion of a physician as he/she interacts with the patient.

In Mitchell v. Eastman Kodak Co., the Court recognized that there are no laboratory tests for chronic fatigue syndrome, yet the disease is almost universally recognized as a severe disability. Because there is no etiology to explain the syndrome, the court recognized that requiring a claimant with CFS to show clinical evidence in order to prove its existence would defeat the legitimate expectation of a plan participant that disability benefits could be collected for this diagnosis.

The Court of Appeals noted that this condition is usually diagnosed through long-term clinical observation. Lee’s medical record reflect the long-term clinical observations of numerous treating physicians. In Oliver, the Court found that the disability insurance plan had acted arbitrarily and capriciously when it refused to recognize the only medical evidence that Oliver was capable of producing, reports from multiple physicians stating that his reports of pain were consistent with their diagnosis as well as EMGs, nerve conduction tests and an MRI.

Court Finds More Than Sufficient Medical Evidence in File

In Lee’s case, she had submitted more than enough evidence to support her claims. Her file contained reports from five treating physicians, all confirming the presence of debilitating chronic thoracic back pain. Her physicians noted that she required so much pain medication that she functioned in a state of “seriously limiting sedation.”

The Court found that there was no wording in the short-term disability plan that excluded pain related disabilities from coverage. At the same time, the Court has recognized the right of disability plans to require objective evidence to support the purported limitations created by pain syndromes. In this case, Lee had presented considerable evidence to support her inability to perform in a sedentary position. She had been unable to complete a functional impairment test in January 2004. Her “[f]unctional motions were insufficient to assess lifting” and her “[g]ait was aberrant and appeared more as a shuffle as opposed to attempt to reduce stance on either side” according to the tester.

Lee’s case was similar to Oliver. The disability insurance plan had provided no evidence to dispute the physician’s observations and evaluations of the tests which have been performed. And the disability insurance plan had failed to provide clear guidance as to what additional testing Lee needed to undergo to provide the additional “objective” evidence the disability plan was looking for.

Court Finds That Peer Reviews Were Faulty

BellSouth had relied on peer reviews which chose to discredit the opinions of physicians who had seen Lee over the space of several years. It was arbitrary on the part of the physician to determine that information in the doctor’s statements and reports were merely a recital of information supplied by Lee. Rather much of the information provided by her treating physicians clearly reflected objective observations.

For example, one physician had been extremely alarmed when he saw his patient. He noted that she could hardly talk or breathe smoothly because the muscle spasms she was experiencing were so severe. He observed that she could barely walk and was so unsteady that he personally assisted her into the office, and almost called his nurse to assist in as well. This was clearly an objective observation.

These flawed peer reviews led BellSouth to conclude that Lee’s medical condition did not render her “unable to perform any type of work.” Yet, neither of the two physicians Broadspire sent her file to addressed the fact that she could not sit for more than 1-1/2 hours. Nor did they consider that she could only do this when she was under heavy sedation. They also fail to recognize that mental fog caused by her heavy medication would also make it very difficult to perform a job. They also fail to address the fact that Lee’s physicians had observed that she was unable to move, speak, or breathe freely.

Court Finds Claimant Clearly Proved Disability

The court found that after reviewing the medical evidence provided by Lee and her treating physicians, she was clearly disabled under the short-term disability plan, because her medical condition made it impossible for her to perform “any type of work” as defined by the plan.

Lee had been eligible for short-term disability benefits from the time of her application on January 25, 2005. Despite the fact that the last peer reviewer had concluded that Lee met the short-term disability plans definition of disability between May 16, 2005 and July 19, 2005, the day he reviewed her file, Lee had never received any benefits, because the plan required her to be a current employee of BellSouth and she had been laid off on May 4, 2005 for failing to return to work after she exhausted her Family and Medical Leave benefit.

The Court found that Lee had been wrongfully denied short-term disability benefits, thus she was also wrongfully terminated for her position at BellSouth. The SD Plan benefits excused absence from work for up to fifty-two weeks “as long as the Participant remains continually Disabled and otherwise meets the terms and conditions for Benefit payment.”

Court Finds BellSouth Decision Arbitrary and Capricious

The three Federal appellate judges reviewing this case found that BellSouth’s decision was not reasonable in light of the evidence. Summary judgment for BellSouth needed to be reversed in its entirety and the case shall be sent back to the District Court for reevaluation.

While the court of appeals had clearly found that she was entitled to benefits from January 25, 2005 through July 19, 2005, the District Court needed to evaluate whether Lee was also entitled to short-term disability benefits from July 19, 2005 through the end of the short-term disability term on January 25, 2006. The District Court would also have to consider whether Lee would then be entitled to the long-term disability benefits that would have begun a January 26, 2006.

This case once again highlights the value of pursuing an appeal when a district court makes a decision favorable to the disability insurance plan. So often, three judges are better than only one. The three perspectives this gives to interpreting the evidence increases the odds that a correct and favorable decision for the disability claimant will be achieved.

Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Broadspire Appeal Package

We work with you, your doctors, and other experts to submit a very strong Broadspire appeal.

Learn more

Sue Broadspire

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Broadspire.

Learn more

Protect Your Benefits
Get Your Broadspire Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Broadspire Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Broadspire Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Broadspire Reviews

Policy Holder Rating

0 out of 5
Read 0 reviews
0would recommend
Timely Payments
0.0out of 5
Handling Claim
0.0out of 5
Customer Service
0.0out of 5
0.0out of 5
0.0out of 5
Showing 8 of 642 Reviews

AT&T Was Great and Sedgwick Horrible

Reviewed by From a great job to a complete nightmare on March 20th 2024   Verified Policyholder | March 2024 date of disability
My Physician recommended that I take some time from a toxic environment after several deaths in my family coupled with AT&T trying to run tenured employees out of the door... read more >
New York Life

Keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting

Reviewed by M.T. on February 15th 2024   Verified Policyholder | May 2023 date of disability
I have been appealing a claim for LTD for 8 months! New York Life keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting ... read more >
Reliance Standard

Staff Lie

Reviewed by Tanya on February 12th 2024   Verified Policyholder | August 2021 date of disability
I had my disability cut off the day I was scheduled to find out whether I should have surgery. The claims examiner was aware that I had an appointment on that date and sai... read more >
Sent on February 12th 2024 by Attorney Gregory Dell

I am sorry to hear about your experience. It’s crazy that Reliance Standard would deny your disability benefits when you are suffering so badly that you need surgery.... read more >


Former Hartford employee has had life insurance and accidental death policy's revoked for one late premium payment

Reviewed by Becky H. THOMAS on February 12th 2024   Verified Policyholder | February 2024 date of disability
Dislike how they are constantly interrupting the lives of their disabled EE's whom are entitled to benefit which they paid into out of there pay check every pay period onl... read more >
Sent on February 12th 2024 by Attorney Gregory Dell

Thank you for your review of Hartford and we appreciate you sharing.  It’s sad they don’t take care of their own employees.

Lincoln Financial

Never received benefits my entire leave - or help with them

Reviewed by Anna on December 19th 2023   Verified Policyholder | November 2023 date of disability
I used my short term disability insurance for maternity leave and started the process beforehand knowing when I would be out (scheduled induction.) It took a little over a... read more >
Sun Life

Unscrupulous Tactics

Reviewed by Misseekayy on December 19th 2023   Verified Policyholder | May 2023 date of disability
Sunlife uses unscrupulous tactics in order to prevent payment of claims. They wait until it is close to the 30 day mark and then they ask for another form of information o... read more >


Reviewed by Dennis T. on December 11th 2023   Verified Policyholder | March 2022 date of disability
My experience with Sedgwick and personell is as follows: Unhelpful, unprofessional and an overall unpleasant experience.

Low payments

Reviewed by Dorothy on November 30th 2023   Verified Policyholder | November 2023 date of disability
I was injured at work. I did house keeping in a hospital. I tore just about everything imaginable in my knee. I was let go from my job, because I was no longer able to do ... read more >
Answered Questions by Our Lawyers
Helpful Videos
Showing 12 of 888 Videos
Disability Benefit Tips
Showing 8 of 331 Benefit Tips

Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your long term disability benefits, it's vitally important that you... Read More >

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concern... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability benefits under a long term disability policy, your medical rec... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many long term disability claimants don't know about (or expect) from the claims re... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves th... Read More >

Disability Denial Reason #1 – Paper Review & IME

At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny lon... Read More >

How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial

At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few thi... Read More >
Dell Disability Cases
Showing 8 of 375 Dell Disability Cases

Seven Surgeries and The Standard Still Denies Long Term Disability Benefits

Our client was employed with the State of Oregon as a Technical Support Representative. She ... Read More >

Sun Life Wrongfully Denies Disability After Paying For 23 Months

We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for ma... Read More >

Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal

Unum unjustly terminated our client’s long term disability claim after it had approved and... Read More >

Engineer With Depression Wins Prudential LTD Appeal

The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was force... Read More >

New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis

Our client, a former elementary school teacher suffering from Multiple Sclerosis, contacted our office after New York Life terminated her clai... Read More >
Disability Lawsuit Stories
Showing 8 of 765 Lawsuit Stories

Cytec Industries and Broadspire Services discontinue disability insurance benefits for army veteran suffering from PTSD

An Appeals Court recently upheld the decision by Cytec Industries and Broadspire Services to discontinue short-term disability benefits for an... Read More >

Broadspire Services terminate long-term disability benefits after paying for 8 years

A Federal Appellate Court recently upheld the decision by Eaton Corporation and Broadspire Services to discontinue the long-term disability be... Read More >

Disability company ignores evidence of disabling back pain and Federal Court reverses disability benefit denial

Once again we look at one of those cases that prove how important it can be to appeal the decision of a District Court. Suzanne Lee had been a... Read More >

Seven pieces of medical evidence and disability company still denies claim for lack of "objective evidence"

When Suzanne Lee first had to miss work on January 18, 2005 for chronic back pain, she had been a manager at BellSouth for almost 10 years. Sh... Read More >

Disability battle against Verizon and Broadspire long-term disability plan lingers in courts for years

Lisa Pakovich and her former employer's long-term disability plan had been in and out of court for almost five years when Judge Michael Reagan... Read More >

Broadspire ordered to pay disability insurance benefits but not attorney fees

If Judge Michael J. Reagan is beginning to tire of considering the case between Lisa Pakovich and her former employer's long-term disability p... Read More >

HM Life and Broadspire wrongfully deny disability insurance benefits to a receptionist and 9th Circuit Court of Appeals reverses claim denial

When Barbara Sterio's disability attorney presented arguments on February 11, 2010 before the Ninth Circuit United States Court of Appeals, he... Read More >

Systems support specialist wins disability benefits case against Coca-Cola and Broadspire

Theron Oliver was a Systems Support Specialist working for Coca-Cola, which provided long-term disability benefits to its employees. In Octobe... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our lawyers for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability lawyers have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance lawyers that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We welcome you to contact any of our attorneys for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, GoToMeeting sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.