Suzanne Lee v. BellSouth Telecommunications, Inc.

318 F. App'x 829
CourtCourt of Appeals for the Eleventh Circuit
DecidedMarch 10, 2009
Docket07-14901
StatusUnpublished
Cited by15 cases

This text of 318 F. App'x 829 (Suzanne Lee v. BellSouth Telecommunications, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Suzanne Lee v. BellSouth Telecommunications, Inc., 318 F. App'x 829 (11th Cir. 2009).

Opinions

PER CURIAM:

At issue in this Employee Retirement Income Security Act of 1974 (“ERISA”) case is whether BellSouth Telecommunications, Inc. (“BellSouth”) improperly denied benefits to Suzanne Lee, a BellSouth employee who suffers from chronic pain syndrome, under both its Short Term Disability Plan (“SD Plan”) and Long Term Disability Plan (“LD Plan”). The district court granted summary judgment to Bell-South, determining that Lee was not eligible for disability benefits because she failed to submit “objective medical evidence” of her claimed medical condition as required by the terms of the SD Plan. After thorough review, we conclude that BellSouth acted arbitrarily and capriciously in denying Lee’s claim for SD Plan benefits since the undisputed record is filled with objective medical evidence of her disability and, therefore, that Lee was entitled to SD Plan benefits from January 25, 2005 through July 19, 2005. We also reverse the district court’s entry of summary judgment for BellSouth concerning its denial of Lee’s claim to SD Plan benefits after July 19, 2005, and its denial of Lee’s claim to LD Plan benefits, and remand for further proceedings consistent with this opinion.

I.

The lengthy medical history necessary to resolving this lawsuit includes these essential facts. BellSouth’s active employees are provided with disability benefits through the BellSouth Corporation Health Care Trust—Employees (the “Trust”), which is sponsored and contributed to by many BellSouth affiliate companies. Bell-South hired Broadspire Services, Inc. (“Broadspire”) to administer the Trust and, with respect to the SD Plan, specifically granted it “all discretionary authority and powers necessary to enable.it to carry out its duties and discharge its responsibilities under the Plan,” including deciding all [831]*831questions of benefit eligibility. (BellSouth SD Plan § 6.1).

Under the terms of the SD Plan, an employee is entitled to disability benefits if she suffers from “a medical condition supported by objective medical evidence, which (i) makes a Participant unable to perform any type of work as a result of a physical or mental illness or an accidental injury or (ii) results in a Participant receiving treatment that qualifies as a Chemical Dependency Confinement.” (BellSouth SD Plan § 2.10). The phrase “any type of work” means the participant’s regular job with or without accommodations, any other job at a participating company (regardless of availability) with or without accommodations, and temporarily modified duties. (Id.).

Under the Long Term Disability Plan, “disability” is defined as “a continuous physical or mental illness, whether work related or non-work related, which renders a Participant unable to perform any type of work other than one that pays less than half of his Annual Compensation at the time his benefits under the [SD] Plan began.” (BellSouth LD Plan § 2.12). A BellSouth employee would not be eligible for LD Plan benefits unless she has first exhausted all fifty-two available weeks of SD Plan benefits. (BellSouth LD Plan § 2.28).

Suzanne Lee was a BellSouth employee from July 5, 1994 until May 4, 2005; during most of that time she was employed in a management position. Lee was notified by letter on May 10, 2005 that her employment with BellSouth was terminated effective May 4, 2005, because she failed to return to work full-time after the period of medical leave BellSouth was required to give her under the Family and Medical Leave Act (“FMLA”), 29 U.S.C. § 2601 et seq., had expired.

Lee was first absent from work due to chronic pain on January 18, 2005. On January 24, 2005, she filed an SD Plan benefits claim related to that chronic pain, which would have become effective the following day if it were approved and would have excused her continuing absence from work. But on February 4, 2005, Broad-spire denied Lee’s SD Plan benefits claim saying that it had not received the information it had requested from Lee’s medical care providers. Then, on February 25, 2005, Broadspire informed Lee that its Appeals Review Committee (“ARC”) had received her medical records, but, without a formal appeal request from Lee, they would not be reviewed. On April 26, 2005, Lee’s FMLA medical leave expired, and she formally appealed the denial of her SD Plan benefits claim.

Along with her application for benefits and her appeal, Lee presented a variety of detailed statements and records from many treating physicians. First, Dr. Cheryl Goyne of the Birmingham Pain Center offered the following letter dated February 3, 2005:

I have been treating Ms. Suzanne Lee for her chronic pain syndrome since January 28, 2004. She suffers from chronic thoracic spine pain secondary to thoracic disc disease. Unfortunately, despite her treatment, she has persistent, intractable pain. It is my understanding that she is unable to sit for more than Vk hours at a time. She cannot stand for more than 15 minutes or walk for more than 10-15 minutes at a time. She is unable to work for more than 2-4 hours a day.

(Doc. 14 Ex. 1 at BRO193).

Next, an attending physician report completed for Suzanne Lee at the Birmingham Pain Center on February 7, 2005 summarized the results of a number of functional impairment tests administered [832]*832to Lee. (Doc. 14 Ex. 1 at BR0200). Among other things, this report observed that Lee could lift no more than 10 pounds, carry no more than 10 pounds, sit for no more than 15 minutes, and stand for no more than 10 minutes. Moreover, it opined that Lee could rarely bend or stoop, push or pull, complete repetitive motions, undertake fíne manipulation, or climb or traverse heights. Finally, it said that Lee could only occasionally walk or reach and that she could not drive a car or operate machinery.

Third, Dr. Wayne Grossman, another treating physician, submitted the following detailed statement in support of her claim on February 7, 2005:

Su[z]anne Lee has seen me on three occasions in the context of her treatment here at the Birmingham Pain center, first in August and November of 2004 and most recently January 20th, 2005..... It was apparent from the very beginning that, in addition to being very anxious and upset about her pain and physical limitations, she had very severe muscle spasm complicating her treatment. She was placed on Valium for the treatment of her anxiety and muscle spasm. She reported a remarkable improvement, at the cost of some element of sedation.... Currently, she obtains some element of relief, only at the cost of seriously limiting sedation....
More importantly, however, it became clear at our most recent appointment, that this lady seriously understates her difficulties.... She reported improvement ... and fought hard, but I think much of her reported improvement was wishful thinking.... At her most recent appointment, after her Valium had been decreased because of sedation, she was in extreme pain, splinting nearly every movement, and could hardly talk or breath smoothly because of the severity of the spasm. This was my first occasion to see her walk into my office.... I was so alarmed at how unsteady and limited her gait was; I almost got a nurse to assist. I did assist her myself. Asking details about this, I felt the need to discuss it with her boyfriend, both because of her difficulty breathing and my desire for another’s perspective. He related that she is this way most of the time....

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Knox v. United of Omaha Life Ins. Co.
357 F. Supp. 3d 1265 (M.D. Georgia, 2019)
Hassoun v. Reliastar Life Ins. Co.
288 F. Supp. 3d 1334 (S.D. Florida, 2018)
Dawson v. Cigna Corp.
261 F. Supp. 3d 1275 (S.D. Florida, 2017)
Graham v. Life Insurance Co. of North America
222 F. Supp. 3d 1129 (N.D. Georgia, 2016)
Metropolitan Life Insurance Co. v. Waddell
194 F. Supp. 3d 1340 (N.D. Georgia, 2016)
Raymond Shaw v. AT&T Umbrella Benefit Plan
795 F.3d 538 (Sixth Circuit, 2015)
James v. AT & T West Disability Benefits Program
41 F. Supp. 3d 849 (N.D. California, 2014)
May v. AT & T Integrated Disability
948 F. Supp. 2d 1302 (N.D. Alabama, 2013)
Howard v. Hartford Life & Accident Insurance
929 F. Supp. 2d 1264 (M.D. Florida, 2013)
Harvey v. Standard Insurance
850 F. Supp. 2d 1269 (N.D. Alabama, 2012)
Hunley v. Hartford Life and Accident Ins. Co.
712 F. Supp. 2d 1271 (M.D. Florida, 2010)
Perryman v. Provident Life and Accident Ins. Co.
690 F. Supp. 2d 917 (D. Arizona, 2010)
Herman v. Metropolitan Life Insurance
689 F. Supp. 2d 1316 (M.D. Florida, 2010)

Cite This Page — Counsel Stack

Bluebook (online)
318 F. App'x 829, Counsel Stack Legal Research, https://law.counselstack.com/opinion/suzanne-lee-v-bellsouth-telecommunications-inc-ca11-2009.