AT&T employee with back injury sues Sedgwick Claim Management Services, Inc. for denial of short term disability benefits
Disability Lawyer Sues Sedgwick Claim Management Services
In the case of Richard Shane Burnett Vs Sedgwick Claim Management Services, Inc. D/B/A AT&T Integrated Disability Service Center, filed at the District Court for the Middle District of Florida, the plaintiff Richard Shane Burnett alleged that he is eligible for short term disability (STD) benefits under an employee benefit plan provided by his employer.
The Alleged Facts Of Sedgwick Disability Denial
The plaintiff was a former employee of the BellSouth Advertising and Publishing Corporation that operated under the name “AT&T Real Yellow Pages” at Tampa, Florida. He alleged that he was at all times a participant in a STD Plan called “the AT&T Umbrella Plan No. 1″ under the BellSouth Short Term Disability Plan for Non-Salaried Employees program. Sedgwick Claim Management Services, Inc (SEDGWICK) acted as the Claims Administrator and operated under the name of “AT&T INTEGRATED DISABILITY SERVICE CENTER”. Accordingly, the plaintiff to the best of his knowledge and belief stated that the above mentioned plan was not insured and is funded from one or more of AT&T affiliated companies.
Following back injuries that he sustained at work, the plaintiff filed a claim for STD benefits on January 13th 2010. The plaintiff alleged that these injuries had resulted in several physical restrictions and limitations that prevented the plaintiff for performing the duties of his occupation or any other occupation.
The Claim for Benefits and Appeals to the Denial of Benefits
SEDGWICK, while operating under the name of or on behalf AT&T INTEGRATED DISABILITY SERVICE CENTER, evaluated the plaintiff’s claim for benefits and formally denied the plaintiff’s claim on February 5th 2010. An appeal was made to SEDGWICK regarding the February 5th 2010 denial but was also denied.
The plaintiff made a second appeal to SEDGWICK which was again denied by SEDGWICK on December 30th 2010. According to the lawsuit, SEDGWICK had denied the plaintiff’s claim for benefits on the grounds that he did not fulfill the Plan’s definition of disability at the time of its initial decision and the two subsequent appeals.
Legal Remedies Sought By The Plaintiff In The Lawsuit
The plaintiff alleged that he had exhausted all his administrative remedies as required under the Plan and as informed by SEDGWICK. The plaintiff argued that he was not provided or was deprived access to a copy of the STD plan. The plaintiff alleged that a request to the Plan Administrator to provide the copy of the Plan documents or Summary Plan description had yielded no result. As such, the plaintiff contended that he is unable to state the precise amount of benefits that he is entitled to under the STD plan.
The plaintiff asserted in the lawsuit that he is entitled to the benefits mentioned above because:
- The plaintiff has met the definition of disability under the plan.
- The plaintiff has met all the conditions for benefits eligibility.
- The plaintiff has not waived or relinquished his rights to the benefits.
As such the plaintiff is seeking the following relief from the Court:
- A declaration that the plaintiff is entitled to STD benefits from January 14th 2010 and continuing (or for other such period as permitted under the STD Plan).
- An accounting of benefits owned to the plaintiff with SEDGWICK to produce the factors and figures necessary to render such accounting.
- An award of benefits plus interest at the legal rate from the date it became due until the date it is paid.
- An award of reasonable attorney fees and costs incurred.
- For such other and further relief as this Court deems just and proper, including but not limited to:
- A declaration that the plaintiff’s claim continue after the last date of benefits awarded without the requirement by the plaintiff to file a new claim for benefits.
- Remand the plaintiff’s claim to the Plan Administrator for further action to address continuing benefits under the STD Plan and for purpose of processing a claim for Long Term Disability benefits for the period following the expiration of the plaintiff’s eligibility for STD benefits.
- An order to SEDGWICK to inform the plaintiff’s former employer or any other necessary entity that benefits in this action were properly paid through the date of this Court’s Order for the purpose of coordinating or reinstating any ancillary benefits which should properly be paid or for which coverage should be awarded as a result of the plaintiff’s receipt of disability benefits under the Plan.
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I have been going over the case against AT&T intergraded services known as Sedgwick Claims Management for I’m going through for my second time with this company denying my claims. First time, two years ago, I had a seizure disorder. Unable to work, they denied 29 claims submitted by my doctor. I could not drive and now I have stage four COPD and having problems breathing and on a machine most of the day, because my doctor is not saying what they feel is right. They denied me. I feel so upset for this condition already makes me have fatigue. They are not going by state and federal law per the labor board and per looking at suits filed. How do they stay in business?
Patricia,
Sedgwick is notorious for denying disability claims. I probably receive a phone call 5 days a week for a Sedgwick Disability Claim Denial. Don’t give up. Sedgwick stays in business because they are getting paid their fees regardless of whether you get paid your disability benefits. AT&T employees are stuck with Sedgwick. Everyday there are AT&T employees that are forced to deal with the Sedgwick. If you need assistance with your Sedgwick disability denial, then please call our office at 800-828-7583 for a free consultation.
My husband was injured on 1/11 and is an bargained labor AT&T employee. He was denied STD pay for 101 days. While married, we keep our accounts separate. I, as his wife, had to sell many assets as well as exhaust my personal accounts to keep from going into foreclosure. After the first appeal, the disapproved disability was changed to an approved disability and was given 10 days of spent leave. After that decision, it was explained that AT&T had to pay my husband for the 91 days. That did not happen. Filed second appeal and, per Sedgwick’s rules, time frames were defined. Husband was to get a response by Sedgwick letter by 12/31/11 or by voice mail1/2/12. We have nothing to date. Does that mean he wins his appeal by default?
Lana,
You do not win by default during an ERISA appeal, but you may be able to file a lawsuit now due to their failure to respond timely.
My husband has a workman’s comp. claim with Sedgwick and twice they have stopped sending his checks. The first time he was told his payments had all been paid out that was in December 2008. He had a letter that said his checks would continue until about January 2013 so they said they made a mistake and began sending his checks again. All went well until January 2012, last check sent from them was 1-31-12. Called the same claim rep he had the first time and she said she wasn’t handling his case anymore and gave him a number to talk to someone else. The new rep told him the same thing he heard the first time. His claim had been all paid out. He told her of his letter and she said she didn’t have the letter, but would get back to him. She called, and also said our mistake, we will be sending you a check right away. What I’m concerned about is other people that may not no or remember when their claims should end. Is this company cheating people out of their money?
Dee Dee,
Sedgwick is a large company and in my opinion they seem to be very disorganized. I cannot say that they do these things intentionally, but we clearly see a pattern of activities similar to the ones you have described. Sedgwick originally handled Worker Comp. claims and now they handle disability insurance claims. We don’t handle Worker Comp. claims, but Sedgwick treats disability insurance claims as if they are worker compensation claims. We also think that Sedgwick hires employees that are not qualified to administer claims. Thank you for sharing your experience.
I got into a wreck after ring told we could not leave early due to bad weather. When I started on my 25 minute drive home on the interstate, my truck hit the ice on a bridge and plunged over it thirty feet down. I have severe back pain from herniated disk in the lower lumbar part in my back and will need surgery eventually. Sedgwick has denied my claim for the second time because they say pain can’t be measured and not being able to walk on both legs due too numbness is not good enough. If my appeal for denial is not approved, I will lose my job because of the way our point system works. Please tell me what should I do ?
Anna,
If your appeal is denied, then your only remaining legal option will be to file a lawsuit. Since you cannot work, you should also apply for social security disability benefits.