Bemis, Roach & Reed
Disability Case Examples

Bemis, Roach & Reed helps those who have been denied both Social Security and private Long-Term disability benefits.

Our vast experience, case preparation and knowledge of disability law enable us to be highly successful in winning claims at the hearing level. We have 5 attorneys and over 25 employees all solely dedicated to winning disability claims just like yours. Clients find our staff caring and easy to talk to; we understand how hard it can be being disabled and having to navigate the legal system that seems to be stacked against you. Clients rave about our customer service and communication skills, being easily accessible and keeping you informed on the status of your claim. Put Bemis, Roach & Reed in charge of your case and let us take the worry out of the process for you. We know how the process works and we know what it takes to win. Hiring us gives you the peace of mind that you have done everything possible to help yourself win your disability benefits.

We have handled claims for almost every disabling ailment possible.

We understand medical issues and how they can affect your ability maintain employment. These are just a few examples of the thousands of clients we have represented. Please give us a call, even if you don’t hire us, we love to help folks find the best solution for their own personal situation.

Cigna LTD Back Issues Claim

Continuing neck and back problems plagued one Grand Prairie, Texas client, followed by multiple surgeries.

After one of the surgeries, one of her treating physicians, a neurosurgeon, stated on Cigna’s attending physician statement that she was unable to work secondary to pain and weakness and that she would never be able to return to work. The client underwent a two-day FCE protocol after which a Board Certified Orthopedic Surgeon wrote that her results were “about the clearest-cut case of someone applying for long-term disability that deserves it that [that physician had] seen in 27 years of clinical practice as a spinal surgeon.” The doctor further indicated that client was not fit for employment and that this would be a lifetime condition.

Cigna LTD Degenerate Disc Claim

A Frisco, Texas client suffered from severe, intractable low-back pain. Imaging studies revealed multi-level degenerative disc disease of his lumbar spine.

Because of the extent of the degeneration, his orthopedic surgeon restricted him from bending, lifting anything exceeding ten pounds, and twisting. Even with these restrictions, his doctor stated that the client was unable to return to work due to continuous low back pain, that walking more than 100 feet was virtually impossible for him, and that he was unable to sleep for more than two hours at a time due to pain. Physical therapy only aggravated his condition. The doctor felt that he was unable to return to any type of meaningful occupation for the foreseeable future and that he should be considered persistently disabled until further notice.

SSDI Back Pain Claim

Another client of ours from The Woodlands suffered from back pain, depression and carpal tunnel syndrome.

He had undergone an attempted lumbar decompression and fusion between his fourth and fifth lumbar vertebrae. This failed and was followed by a second surgery that attempted to fuse the third through fifth lumbar vertebrae. The second surgery failed, too, and the client’s condition continued to degenerate. He was on constantly increasing pain medications. The Social Security Administration awarded him full disability benefits.

Aetna LTD Lumbar Radiculopathy Claim

Physicians had previously certified that our client from Streetman, Texas had a class 5 physical impairment and was totally disabled.

Aetna’s own file reviewer indicated that the client was unable to be employed as a Registered Nurse. The denial letter suggested that she could engage in other types of nursing. This analysis did not, however, take into account her current restrictions and limitations. She had a history of a lumbar fusion surgery as well as chronic and persistent lumbar radiculopathy with chronic pain syndrome. This resulted in a very poor sitting tolerance of approximately ten minutes. She was also noted to have a short walking tolerance and was unable to lift more than five or ten pounds. For these reasons, our client was incapable of working full time. She was awarded disability benefits from the Social Security Administration.

SSDI Migraines and Impaired Cognition Claim

We were hired by a Travis County resident who was suffering from a number of impairments including intracranial hypertension, migraines, and impaired cognition which prevented him from working.

The Social Security Administration originally determined the claimant to have no severe physical impairments and that the claimant could perform a range of light work, consequently he was denied disability benefits. At the hearing our attorney Daniel Messenger presented additional medical evidence and testimony that his client suffered from intercranial hypertension, causing migraine headaches and cannot sustain employment due to dizziness, lightheadedness, memory problems, and deficits in concentration associated with his medical condition.

SSDI Degenerative Disc Disease, Depressive Disorder, and PTSD Claim

A client from Central Texas had applied for disability for Degenerative Disc Disease,
Depressive Disorder, and PTSD and was denied benefits by the SSA who stated he was still able to maintain employment.

During the hearing before an Administrative Law Judge, Daniel Messenger represented the client and presented medical evidence concerning the client’s back pain as well as findings of PTSD and depression. Taking into account the client’s level of residual functioning capacity, we successfully demonstrated to the vocational expert that, considering the claimant’s age and work experience, there were no available job opportunities suitable for the claimant.

SSDI Radiculopathy, Chronic Pain Syndrome and Obesity Claim

We had a client from the Panhandle of Texas who suffered from disorders of the cervical spine,
extremity radiculopathy, chronic pain syndrome, degenerative joint disease, obesity, and hypertension.

The initial disability claim was denied; the SSA stating the claimant does not have an impairment or combination of impairments that meets or equals the severity of a listed impairment, and that the claimant can perform light work. Upon reconsideration, they found the claimant’s physical impairments to be non-severe once again. Our attorney Daniel Messenger gathered and presented medical evidence to prove the claimant is limited to light exertion work with a low maximum lifting amount. Our client’s limitations included ongoing issues involving degeneration of the cervical spine along with degenerative joint disease of the right upper and right lower extremities, compounded by morbid obesity and chronic pain syndrome.

SSDI Long-Covid-19 Claim

A client from East Texas hired us to appeal his disability denial.

Unfortunately, he was experiencing degenerative disc disease, post-viral Covid fatigue syndrome, sensorineural hearing loss, depression, and post-traumatic stress disorder (PTSD). In its denial the Social Security Administration stated that the claimant did not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments and that the claimant was capable of a light residual functional capacity. The claimant’s mental capacity was assessed by the psychological consultants of the SSA, who determined that the client possessed a semi-skilled capacity with moderate limitations in performing detailed tasks. Mr. Messenger presented significant medical and psychological evidence demonstrating that the client had a neurocognitive disorder due to Covid-19 and demonstrated a significant decline in mental functioning following his illness, as well as the development of memory issues.

SSDI Peripheral Neuropathy Claim

A man from the Rio Grande Valley of Texas had applied for disability benefits for peripheral polyneuropathy, diabetes mellitus, and obesity.

The Social Security Administration in their original assessment had declined him benefits; stating that the claimant did not have an impairment that meets the severity of one of the listed impairments and that the claimant had the residual functional capacity to perform sedentary work. They stated that the claimant could occasionally lift and carry 50 pounds, and frequently lift and carry 25 pounds. They found that the claimant could stand and walk for a total of about six hours in an eight-hour workday, and sit for about six hours in a workday and did not find any postural, manipulative, or environmental limitations.
Our attorney Daniel Messenger represented the client at his disability hearing. Occasionally lifting and carrying 50 pounds and frequently lifting and carrying 25 pounds are actually the exertional criteria for medium work. Daniel presented current medical evidence to prove that the client, due to his polyneuropathy and other neuropathy, in conjunction with his obesity, support a limitation to no more than sedentary work. We proved that the claimant’s ailments support a limitation that is more restrictive than that proposed by the original assessment.
In the hearing it was determined that the demands of the claimant’s past relevant work exceeded his residual functional capacity, which limits him to no more than sedentary exertion. The claimant’s acquired job skills were found to not transfer to other occupations given his limitations.

SSDI Migraine Headaches Claim

A client suffering from migraines headaches from the Central Texas area applied for disability benefits and was initially denied. She hired us to represent her at her disability hearing.

Initially the SSA found that the claimant did not have an impairment that meets or medically equals the severity of one of the listed impairments. The claimant was determined to have the residual functional capacity to engage in sedentary work, with the ability to occasionally lift or carry 10 pounds. Additionally, they can stand and walk for a total of 2 hours during an 8-hour work day, while being able to sit for a total of 6 hours during the same period. The client was said to have psychological limitations such that they can understand, remember, and carry out routine instructions and interact occasionally with the public.
Attorney Daniel Messenger presented significant medical documentation to demonstrate the extent of his client’s limitations. He proved that the claimant was more limited than the SSA previously assessed, and unable to sustain competitive work on a regular and continuing basis. Mr. Messenger proved that the claimant’s migraine symptoms negatively impaired her functioning and that the claimant was not able to hold any employment that requires reading of printed or digital text, presence in a nosy or bright environment, operation of a vehicle or other machinery, or manual labor.
According to the testimony of the vocational expert, the claimant would experience excessive off-task behavior and frequent absences, making it difficult for them to sustain employment in a competitive job.
The judge found that claimant’s acquired job skills do not transfer to other occupations within the
residual functional capacity defined, and considering the claimant’s age, education, work experience, and residual functional capacity, there were no jobs that exist in significant numbers in the national economy that the claimant could perform.

The Standard LTD Neuropathic Pain Claim

A Fort Worth client’s physician certified that she suffered from “constant neuropathic pain.”

The same physician also certified that her condition would impair her for the remainder for her life, that she had regressed, and that he never anticipated a fundamental or marked change in her condition. The doctor did not anticipate that the client would ever be able to return to work.

Prudential LTD Progressive Neurogenic Disease Claim

One client, in San Marcos, had a progressive neurogenic disease. This disease caused wasting syndrome of her left arm and deltoid triceps and biceps groups.

Our client also had EMG-confirmed neurogenic atrophy of her bilateral lower extremities and wasting in those extremities. She had a surgically inserted pain pump which dispensed a pain medication 100 times as powerful as morphine, and further required narcotic patches to attempt to control her pain. She required a wheelchair to move any significant distances and was eventually confined to an assisted living center. She was found to be totally disabled from any gainful activity by the Social Security Administration.

Unum LTD Ruptured Rotator Cuff Claim

A Round Rock Sales Support Analyst for a large computer company suffered a complete rupture of her rotator cuff and other injuries after a fall.She was awarded SSDI and was receiving LTD benefits.

The Hartford Degenerative Disc Disease Claim

Another Round Rock client suffered from degenerative disc disease for over 28 years.

She had undergone 18 surgeries to attempt to address her condition and was only able to function due to daily narcotic medication and a surgically implanted morphine pump. Both her orthopedic surgeon and pain management doctors had stated she was totally disabled. Based on her medical records, it does not appear that The Hartford consulted with an orthopedic surgeon or pain management specialist in making its benefit decision to deny her claim. The Social Security Administration had awarded her SSDI based on full disability. The Hartford attempted to settle the remainder of the client’s claim for a single lump-sum payment.

In October, Mr. Reed took on a Cedar Park client who had suffered a perforated ulcer in April of the previous year.

Before his disability, the client was a small business owner. Unfortunately, he lost his colon and part of his small intestines and now required a colostomy bag. In addition he suffered from high blood pressure and congestive heart failure. He had a difficult recovery and suffered complications that required further surgery a year later. His surgeon instructed that our client avoid lifting anything over 10 lbs. due to risk of additional injury to his abdomen. This restriction made it impossible for our client to continue running his business or, in fact, from continuing in his profession at all.

Another client, from Lockhart, came to us knowing how hard it is to achieve a favorable judgement when you first apply for social security disability.

The 60-year-old truck driver had been in an auto accident several years previously which had resulted in a back injury that led to degenerative disc disease. He continued working and subsequently broke his right ankle twice. Over time, these injuries led to debilitating back pain and leg problems. He was no longer able to perform his job duties.

One of our Cedar Park client’s treating physicians certified him as having a class 4 psychological functioning impairment.

He was advised to stop working due to “incapacitating anxiety”. When asked whether our client could return to work, this physician responded “No . . . currently his anxiety and depression are incapacitating and his treatment is just beginning.” Another physician stated that he suffered from Major Depression; recurrent, severe, Panic disorder with agoraphobia; and Dysthymic disorder. Accordingly, he was unable to perform daily chores, attend social functions, attend to legal needs, shop, or venture into the community and manage everyday financial affairs. Our client’s severe depression/anxiety interfered with his concentration, energy, self-confidence, decision making ability, and even his ability to leave the house.

A client from Round Rock was diagnosed with pancreatitis.

By 2009, he was on eight medications, including Hydrocodone and Fentanyl. He could not operate a motor vehicle in the course and scope of employment, as required by his occupation, while under the influence of the narcotics he needed to take.

An Austin client suffered from Bipolar disorder and took lithium and lexapro for this condition.

She was dysphoric and had cognitive deficits secondary to her Bipolar illness. She suffered from decreased memory, poor organizational skills, poor executive functioning, and low frustration and stress tolerance. According to her treating psychiatrist, she was totally disabled from this condition. She had been found totally disabled by the Social Security Administration. Furthermore, because of the significant mental impairments caused by her condition, the Administrative Law Judge who decided our client’s social security disability claim made a finding that the evidence suggested she was not capable of managing her own funds.

A client of ours from Round Rock had congestive heart failure, uncontrolled arrhythmias, and a surgically implanted pacemaker.

This previous heart condition was later complicated by a paralyzed diaphragm that caused chronic Pulmonary Insufficiency. The client was determined to have a Class 5 physical impairment by her treating physician, a Board Certified Cardiologist. She was similarly certified as suffering a Class 5 physical impairment by a Board Certified Pulmonologist. She satisfied Social Security’s criteria for total disability under at least three separate sections. Her pathology was demonstrated by multiple, objective tests and she had been certified as totally disabled by a cardiologist and a pulmonologist.

The former president of a company in Houston had been receiving disability benefits, and then was denied.

The Social Security Administration concurred with his physicians that he was disabled from any gainful activity, much less his former occupation as president of a multi-national corporation. At the time of denial, over ten years after the initial disability determination, he was placed on a heart transplant list. The physician on whom Hartford allegedly relied to deny benefits stated that the client could not work at any occupation.

Bemis Roach and Reed has successfully handled many ERS claims.

A college professor in north Texas contacted Bemis, Roach & Reed to assist in challenging the denial of long term disability (LTD) benefits through Fort Dearborn Life Insurance Company.

At the time we were contacted, the client had already initiated an appeal of the Fort Dearborn denial by requesting a review from the Employee Retirement System of Texas (ERS). The claim was set for hearing before an administrative law judge (ALJ) with the State Office of Administrative Hearings in Austin, Texas. The college professor suffered from fibromyalgia. The disease had progressed to the point that work was no longer possible due to constant pain and fatigue. Fort Dearborn denied the claim when it was filed.
Bemis, Roach & Reed accepted the representation and began to litigate the case.

A Dickinson client of ours was denied Short Term Disability by Cigna.

She underwent a neuropsychological evaluation which found cognitive impairments. At the suggestion of the neuropsychologist, she then underwent a Functional Capacity Evaluation which found physical limitations. Both of the tests, which are considered the “gold standard” for making disability determinations, found our client incapable of full-time employment. Her doctor described her limitations so as to include two hours of rest with every one hour of activity. These restrictions were indefinite. Although she could perform some functions, she was limited to part-time work and could not earn 80% of her indexed pre-disability earnings unless she could work at least 80% of a full-time schedule. There was no evidence in the record that she could do so.

Lonnie had a client who was a field sales representative living in Paige, Texas.

He suffered a branch retinal arterial occlusion (stroke) in his right eye, permanently impairing his field of view. Both his treating physician and Aetna’s reviewing physician agreed that he should not be employed in a position that required driving. Because his occupation required extensive driving, the client was forced to stop working and apply for long term disability benefits.

Originally approved for disability benefits under the Mental Illness clause of his Halliburton policy, our Spring Branch client’s benefits were terminated initially because of the two-year mental/nervous limitation in his policy.

Upon review however, the plan administrator found that his condition had been improperly classified as a mental/nervous condition and then properly classified it as Post Concussive Syndrome with Attention Deficit Disorder and Organic Brain Syndrome, a physical condition; benefits were reinstated. It remained classified this way for the next 18 years, until the time of denial. The client had organic brain damage for over 20 years. During that time, The Hartford, or its predecessor, recognized that the client’s organic brain injury rendered him totally disabled from any occupation under the terms of the plan. Since there is no treatment or cure for organic brain damage, the medical evidence of his condition had no expiration date.

Our client, from Euless, had long term disability insurance with Lincoln Financial.

He was diagnosed with Severe Legg-Perthes disease and chronic pain. He could not sit for more than 15 minutes before experiencing severe pain and could not walk for more than five minutes before his pain increased. He had exhausted all surgical options and was on long-term pain management.

A Hutto client had a right rotator cuff rupture followed by a right bicep tendon rupture.

She experienced significant limitation of motion, weakness and pain. Her physician determined that she could not return to her occupation. She continued to have significant restrictions to her right upper extremity, including no lifting over five pounds, no repetitive motion, no reaching above the horizontal position, and no lifting above the level of the waist with the right arm. She was expected to require repeat surgery after conservative treatment options were exhausted.

The denial letter for a Taylor client listed a variety of cardiac issues and concluded that the client was not precluded from performing sedentary labor due to those issues.

Her claim for disability was not based on a cardiac condition, however. After her cardiac surgery, she suffered an intracerebral hemorrhage which led to massive bleeding in her brain. According to her neurosurgeon, the client suffered from a class 4-severe physical impairment as well as a class 4-severe mental impairment. She suffered from an inability to use and understand spoken language and short term memory loss. This was due to brain damage which had been objectively documented by MRI and CT scans. Although she attempted to return to work, she was terminated because her cognitive deficits rendered her unable to perform her job. As a result of her brain injury, she was determined to be totally disabled by the Social Security Administration.

A resident of Montgomery worked in the healthcare industry before becoming disabled.

She underwent a Functional Capacity Evaluation that demonstrated that she only retained sedentary capacity for activity performed above the waist and less than sedentary capacity for activity below the waist. Additionally, she could not sit, stand, or walk for any extended period. This residual, physical capacity was below that required to perform any occupation. She had been adjudged totally disabled by the Social Security Administration and awarded SSDI and required significant narcotic pain medication due to her objectively documented condition.

A Floresville client had been found totally disabled by the Social Security Administration (SSA).

The SSA found that she had a medically determinable impairment, fibromyalgia, which met the criteria set out in Social Security’s Guidelines.

One client from Manor suffered from severe migraines over several years.

She also experienced migratory polyarthralgia and intolerable back and bilateral leg pain that wasn’t responsive to conservative care. Though on many medications, including morphine, a narcotic patch, and Valium, any activity requiring concentration, like work or hobbies, triggered severe migraines. The Social Security Administration declared her disabled. She saw several specialists across the country but was never provided with a successful, long-term treatment option. Her daily narcotic medications left her cognitively impaired and caused her to sleep 12-14 hours each day, making it impossible for her to perform her work duties.

Another one of Lonnie’s clients suffered from medical conditions Northwestern Mutual had previously found to be disabling, including chronic fatigue with severe fatigue, widespread muscle/joint pain, recurrent infections, insomnia, irritable bowel syndrome, headaches, sore throat, cognitive dysfunction, and tender points (fibromyalgia).

She had also been diagnosed with Lyme disease. NW Mutual Life denied her claim, saying there was no medical support for a disabling condition that did not fall under the Mental Disorder provision contained in the group policy. The medical, as opposed to psychological, nature of the client’s condition was well supported by her treating physicians, and she had been awarded SSDI benefits.

The Hartford did not dispute that our Austin client suffered from Systemic Lupus Erythematosus, a significant chronic disease, as well as Fibromyalgia and Polyarticular Inflammatory Arthritis.

According to the record, she suffered near constant oral ulcerations, frequent nasal ulcerations, alopecia (hair loss), fevers, sicca symptoms (dryness of the mouth and eyes), myalgias, Raynaud’s Syndrome, fatigue, and polyarticular inflammatory arthritis. The client’s treating physician stated that the client had been ill since the time she first saw her in April of 2005. The Hartford determined that, since there were no restrictions in the client’s ability to sit, stand, walk, or drive, she was functionally able to perform her job duties. However, her treating physician emphatically stated that she did not have the physical ability to return to her previous job or any similar job.

A Dale, Texas client suffered from pseudotumor cerebri, which causes intractable headaches.

The headaches, in conjunction with pulsatile tinnitus, awoke the client at night and prevented sleep, which caused her to develop symptoms of depression. Her doctor wrote that she was unable to perform the material duties of her occupation or a qualified alternative. A board certified neurologist stated that she was totally disabled due to her multiple conditions which included chronic, daily headaches.

The only medical justification referenced in the denial letter for Prudential’s determination that another client’s disability was due to mental illness, and thus limited to 24 months of benefits under her policy, was a Medical Evaluation by a reviewing physician.

This doctor clearly stated that our client was totally disabled but felt she was possibly in a psychotic state on the day of the examination. This doctor also offered that “this may very well be related to lupus or some sort of arthritis.” This, of course is possible. Systemic Lupus Erythematosus is well known to cause Lupus Psychosis. Lupus Psychosis is not, however, a mental illness. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, it is a “psychosis due to a general medical disorder.” Our client suffered from numerous other documented, serious health conditions for which her treating physician had certified her as being totally disabled.

Our client came to us for help with a Long Term Disability claim that had been denied.

I noticed that the client likely qualified for Social Security Disability (SSDI) and put her in contact with my partner Greg Reed to help with that claim. The Social Security claim ultimately went to an administrative hearing in which we prevailed. In the meantime, my client’s Long Term Disability appeal had been denied and we were preparing to file a lawsuit. After winning the SSDI claim, however, we changed course and filed another appeal of the Long Term Disability denial including our newly won, fully favorable decision from Social Security. Even though the Long Term Disability appeal period had ended, the carrier reviewed the appeal again and granted it.

Author: Attorney Lloyd Bemis has been practicing law for over 35 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Bemis obtained dual board certifications from the Texas Board of Legal Specialization. Lloyd is admitted to practice in the United States District Court - all Texas Districts and has argued before the U.S. Court of Appeals, Fifth Circuit. Mr. Bemis is a member of the Travis County Bar Association. He has been active in the American Association for Justice and is a past Director of the Capital Area Trial Lawyers Association. Mr. Bemis and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.