Skip to content

Helping Disabled Claimants Nationwide "Whatever It Takes" to Get Your Disability Benefits Paid

Facebook Twitter Get Updates

Free Phone Consultation Nationwide
CALL (800) 682-8331
Click to be called now

We offer no fee or cost unless you get paid

Attorneys for Sedgwick Disability Claims


Related Videos

Sedgwick Ignores Medical Records and Denies Disability Benefits Video
Sedgwick Claims Management Services Disability Benefit Claims Video
Third Party Administrator Role in Disability Insurance Claims

Does Sedgwick Approve Any Claims For Disability Benefits?

Sedgwick Claims Management Services (Sedgwick) is often a nightmare for disability insurance claimants to deal with.

On almost a daily basis we are contacted about an unreasonable Sedgwick disability denial. A simple review of the public comments posted on our website gives you a very quick understanding about the unreasonable manner in which Sedgwick can operate. You should also watch our Sedgwick videos and read some of the articles listed below to learn more about their conduct.

Our law firm has handled numerous Sedgwick disability Appeals and lawsuits throughout the USA. Contact us to discuss your options if your Sedgwick short term or long term disability claim has been denied. We never charge any fees or costs unless we recover disability benefits for you.

Is Sedgwick Claims Management A Disability Insurance Company?

Sedgwick is a third party administrator that manages short term and long term disability insurance claims on behalf of employers and insurance companies.

As a third party administrator Sedgwick may have the authority to approve or deny a disability insurance claim, but the money to actually fund the disability benefit is not paid by Sedgwick. For example, Sedgwick is the claims administrator for the AT&T disability plan, but the money to pay benefits, if approved by Sedgwick, comes from AT&T.

Sedgwick claims to have more than 6,400 employees in more than 150 offices throughout the US and Canada. Sedgwick prides themselves on providing cost effective claims management, which usually means they use special techniques to help employers or insurance companies reduce the amount of financial exposure due to paying disability benefits. Additional information about Sedgwick and their philosophy for handling disability insurance claims can be reviewed here.

From our law firm’s experience, Sedgwick appears to be overwhelmed with disability claims and they do not hire qualified people to administer claims. Sedgwick claims examiners function like robots and in most cases it seems as if they are programmed to deny disability benefits.

Sedgwick has all of the resources necessary to attempt to prove a claimant is not disabled. For example, Sedgwick purchased a company called Factual Photo. Factual Photo was purchased so that Sedgwick could have their own in-house resources in order to obtain video surveillance and photos of disability insurance claimants.

Share Your Thoughts With Us And Other Disability Claimants Nationwide

We encourage you to post your complaints, comments, or share your experience about dealing with Sedgwick.

It is our goal that your online posting will help educate other claimants across the country that must deal with Sedgwick.

We also recommend you review our short articles summarizing lawsuits and court decisions involving Sedgwick.

Please contact us privately if you would like assistance with your claim.

There are 342 opinions so far. Add your comment or complaint now.

Jane:

Sedgwick, or better know as Sedgthug, is out for the best interest of the employer, not you. If you work for a self insured company such as Frito Lay, like I do, expect to be screwed. My claim was actually a workman’s comp. claim and Sedgthugs worked closely with Frito Lay to find doctors that they could pay to claim that it was a non work injury ($2,000.00 to one doctor). Guy did a brief (and I do mean brief) exam, asked a couple of questions and sent me on my way. Disgusting little company out to screw over the hard working Americans. Way to go Sedgthugs!

Karl Redd:

I have been on short term dissability with Qualcom sedwick CMS and they have not paid me in 1 month. This is my only income and they dont even care. It is there faught because of there new system they say. There manager Ms Jenny Marathow dosnt even return calls if she exist at all. They say its payroll Qualcom’s problem and payroll Qualcom says its CMS issue. I don’t know what to do. I requested to speak to a higher Dept and CMS says they dont know who that is, stating they dont have a complaint dept WOW I cant believe that no one is running the Office. I feel Qualcom benefits dept should get involved to watch over ther employees so they want be abused like this. After this treatment who would ever want to work for Qualcom because of the treatment from a CMS. I was a good employee for 3 years and I am dissabled now trying to recover from foot surgery and this is the treatment i get.

April:

i was at at green mountain coffee roasters and was injured feb of 2011 as of yet i have recieved nothing. doctors havent been paid for visits or my surgery. i have hired an attorney because being decent and honest with Sedwick proved to be a costly mistake. Thanks for this blog. more people need to find out about the way things are handled. We all are not a bunch of “bumber chasers”. we are just people trying to be treated fair.

M. I. Rob:

I have had 2 claims with Sedgwick. The first one was OK, I guess. Not the best, but I do feel that they pay off doctors. My impairment rating was fixed, I’m sure of it, seeing that I went to another doctor and he said that my impairment should have been WAY higher. But the 2nd one is the one I’m having the most trouble with. I basically injured the same thing. My surgery failed from the first claim and they don’t want to pay for it. The only thing is, if I dont have this surgery I will lose my hand. I’m seriously about to get an attorney on this one… if I can afford it. It’s just a never ending battle with this company. I’m really disappointed that my employer would hire such a crappy company!

Pam Wolfe:

Husband works for 3M. They realized husband is disabled at this time and shouldn’t be at work but Sedgwick don’t care, they are insisting he return to work with out doctor’s release, even though the functionality test says not able to return to work ’till after treatment, which he just started. Looking into an attorney now. Tired of harassing phone calls every other day.

Attorney Greg Dell:

Pam,

As you are aware, Sedgwick can be a very difficult company to deal with. Please contact us privately to discuss how we may be able to assist your husband.

Paperworked Out:

First time I tried to claim, they used every paperwork not filled out by doctor, paperwork not submitted etc. etc. excuse. Doctor said can not work, employer agreed, but Sedgwick says not enough. Employer has me collect unemployment until I can come back to work (Frito-Lay). I was without income for four months and collected unemployment the last two.

Second time I have a serious condition that prevents me from performing my job. Doctor puts me off work and Sedgwick for over a month now keeps finding faults with my paperwork and closes 3 cases in a month that I had to keep refiling for. No matter what you send them it’s not done to their satisfaction or not enough.

I think I am going to need an attorney.

Kim Roberts:

I work for 3M. I was in a car accident, not my fault, with broken ribs and several other bruises. My paperwork didn’t have enough information and I was out of the guidelines for missing work because of my broken ribs. My doctor sends me back to work for light duty, with restrictions on bending, twisting, and reaching above my head, my paperwork is faxed to Sedgewick, and later that afternoon I get a phone call from Lisa notifying me that their doctor talked to my doctor and my restrictions have been lifted. Evidently, with that one phone call I am now pain free and can do what I haven’t been able to do with one month of physical therapy. All I have is an email to my employer about a verbal consultation with my doctor that I was not a part of. Either my doctor is spineless or Sedgewick can preform miracles. If I am injured further at work because of my “lifted restrictions” who will be responsible? We didn’t want to get a lawyer because of the accident but may need one now because of Sedgewick.

Attorney Greg Dell:

Kim,

You have a few different issues going on.

1) You need to contact your doctor and clarify your restrictions and limitations. If you are unable to work, then you need to discuss this with your doctor and have your doctor clarify your limitations.

2) You may need to speak with a car accident attorney regardless of what Sedgwick does. Sedgwick may try to offset any auto accident recovery you obtain.

3) If you are injured at work, then you would have a worker’s compensation claim, which would once again offset any of your disability insurance benefits obtained.

Alan Smith:

At what point does someone do something about Sedgwick CMS? They are really being difficult at the wrong time. I just recently had back surgery and shouldn’t be going through what I am with them. I can’t call my claim adjuster because I have a lawyer. But they disregard their phone calls as well. Is there any way that I can make this a government issue, expose them and bring justice to myself and the thousands of others that have the same or much worse cases? Seriously, how am I supposed to make it to my therapy sessions and doctors appointments without financial means?

Attorney Greg Dell:

Alan,

Sedgwick should not be ignoring your attorney. You should discuss with your attorney filing a complaint with your State of Department of Insurance.

Michael L. Snodgrass:

I am in a typical “Catch 22″ with my employer AT&T. I have appealed my short term disability denied claim and Sedgwick now has until January 19, 2012 to make their final decision. However, I am out of FMLA time so AT&T has mandated my return to work or I have abandoned my job. How can I utilize what is contractually at my disposal, the appeal process, and AT&T present employment reprisals at the same time? So, in the meantime I return work while claiming I am unable to? That is ridiculous! As of 10 a.m. today I am considered unemployed by a company I have worked very hard for since October, 1999.

Attorney Greg Dell:

Michael,

You are in the typical strong arm technique used by Sedgwick. If you can’t work then you cannot return. You may be able to return one day and then leave again and file another claim. Sedgwick AT&T usually requires two appeals.

Sandra Crowell:

I have been looking at the internet to find out about Sedgwick because my brother, who injured his back after working at California State Polytechnic University in Pomona California for over 30 years, has had claims denied contiuially by Sedgwick!

He just had back surgery no more than 3-4 weeks ago and they denied his claims for pain medications. They are a nightmare to work with. They have him jumping through hoops going from doctor to doctor and still not getting what he needs. Although the doctors are prescribing the pain medication Sedgwick adjustors are denying the claims. He has not had a penny in his pocket for over 3 years. My disabled mother who is in total kidney failure with heart trouble is trying to help him financially and it is placing a strain on her finances.

Our family didn’t get it? Until now looking at your web site and other web sites who have had the same thing happen to them. I e-mailed 2 senators to place my complaints regarding Sedgwick and others in the governmental arena to try to shed light into what this company is doing to our injured workers. Asking them for help! I don’t know how these poor disabiled people are surviving?

Sonia E. Harden Lemke:

Dear Gentlepersons,

Do you represent clients in California? I have two, possibly three, claims against SCMS and Kroger and I need help. Please contact me to discuss details.

Thanks,
Sonia E. Harden Lemke

Attorney Greg Dell:

Sonia,

We represent clients nationwide. Please contact us via our free consultation form or telephone to discuss your claims.

Shelley Carter:

I work for AA in Memphis, TN. I was out of work for two months this past summer (2011) with a back injury. Now I didn’t file it under workman’s comp. because I could not give an actual date, flight, time and bag that caused the injury. It has been a gradual 23 years of repetitive motion. And when working at the gate, it is impossible to use proper bag lifting technique because we only have 25 mins to turn a flight, and when you have 50 people and 30 carry-on bags, you just can’t do it… and NO manager can do it either. Anyway, I re-injured my back within the first two weeks of coming back to work. My last day was the 14 Nov. and I have waited and waited and waited for Sedgwick to send me to a doctor. I had to allow them access to all my previous medical records (MRI, chiropractor and ortho assessments). So I recieved a call from my GM yesterday 13 Jan. 2012 and he advised me that they denied the claim… Well, NO ONE from Sedgwick has called me to tell me, but they tell my boss…. What kind of crap is that? And then to make me wait 12 freakin’ weeks?

Attorney Greg Dell:

Shelley,

Sedgwick’s conduct you describe is not unusual. You need to appeal their denial immediately.

Alexander:

Who gets paid on a Monday? No one. Monday are holidays, banks are closed. I worked for AA and have been out with a full knee replacement back in 2010 to present as I am still having problems with the knee and also corporal tunnel injury to both left and and right arm. I need to pay my bills on time. Spoke to rep. at Sedgwick about checks arriving on Mondays that have been prepared on Thursdays and mailed out of their office on either Fridays or Saturdays and gets to me on either Mondays or Tuesdays. For the last two Mondays, Jan. 2 was celebrated for New Year’s Day, Monday Jan. 16 Martin Luther King’s Day, so no check until the Wednesday if I am lucky.

Rep. tells me check is a courtesy to be mailed out before the actual pay day. When SRS was handling the insurance I was religiously paid on Thursdays and never late. Rep. tells me check was hand made, which was a lie. All I want is my check that I am entitled to through workers comp.

What the rep. at Sedgwick is telling me is to go to hell in a very diplomatic way and will pay you as we see fit. There has to be a mandatory law forcing these insurance companies who have to pay people who are sick or on disability to handle these people who have been hurt on the job with a lot of courtesy because one day they may be on the other side of the fence and not to find everything negative in the book to handle them with. People don’t go to work to get hurt or killed on the job.

Aly:

Hello people who will read this. My mom has been dealing with Sedgesh*t. They cannot get their act together, and they are screwing with her. My mom has had to call the doctor and Sedgesh*t repeatedly, being the messenger. It personally ticks me the h*ll off. She is supposed to be let off of work for 8 weeks instructed by the doctor (I was there). They say she cannot be let off that long because she has had to have multiple surgeries regarding the same problem. She has been dealing with it for 2 years now and it was just a stress fracture and in my eyes it might as well have gotten worse with all the stress they are putting on her and my family. Screw Sedgesh*t.

Rick Hughes:

I have worked for the phone company in FL for 39 years. It was called Southern Bell, then Bell South and now it is A.T.&T. Every time I have had to go in for some kind of surgery I have filed short term disability and have not been paid for several weeks at a time because of the decision makers at Sedgwick. Their people say that my doctors do not follow guidelines to their standards and Sedgwick refuses to pay me for the time it takes to heal. Most recent is open heart surgery with 3 way bypass with removal of veins in both legs on top of being the carrier of 6 stints at this time. Two of which were installed three days before my open heart.

At this time I am required to return to work Jan. 30, 2012, after only 30 days recovery and discharge from ICU Cardiac Surgery, or not get paid. The Dr. has already given me instruction not to return to work until March 12,2012. I have to return in order to get paid because I am still trying to catch up from 14 months ago in which an accident caused me to break eight ribs on my left side and could not return when Sedgwick told me to, and did not get paid.

Attorney Greg Dell:

Rick,

We currently represent several AT&T employees that have had the same experience as you. It seems that Sedgwick has a business model of unreasonably denying disability claims and forcing disabled people to return to work. Sedgwick is probably the most difficult and unreasonable third party administrator of any disability administrator we deal with. Every day we are contacted by people around the country that have been denied by Sedgwick. You have rights and you should fight them if you can.

Mark Peppard:

My claim was denied on the basis that I waited too long to receive medical attention. So on the one side, even though I had reported the incident to my employer and wanted to wait and see if my injury would heal and not create a recordable for my employer I was then told by “saidslick” I took too long and thought it was not caused by the initial injury. In other words they think I’m lying even though I kept in verbal contact at all times with my employer. What this will create for employers in the future is more unnecessary recordables than usual. I’m just lucky my injury was not more extreme but I will never take the chance again if I am injured in the slightest way.

D:

Using Sh*twick now, I was injured in a tractor trailer accident, neck and back, on 10/27. Days after the accident sent in writing my injuries, Sh*twick forgot to tell Dr. about my back, then when they did they only discussed my lumbar and neck. It took 3 months to get approval of X-Ray mid-back, now it shows a fracture to go along with herniations in neck and back. Who can hold Sh*twick responsible for malpractice?

Steve:

I went out on disability Oct. 1 2011, on Oct. 31 I went back to work for 1 day and then went back out on disability. I have been out till 1-1-2012 when I resigned my position. I was told that for Oct. 1-31 I will be denied because I didn’t go to an MD, I went to nurse practitioner who I normally see. Then I was denied in Dec. for the time since Nov. 1. This time I did see a MD. When Sedgwick called to tell me this they did not have half of the doctor’s notes, they did not know I was on a sleeping pill for 3 months, they did not know that I was on 3 depression medicines at 6 different strengths, then they said now it’s also because I didn’t go to a psychiatrist. I explained I had an appointment for Jan. and it takes that long to get in. I really feel that no matter what, Sedgwick only knows one word: DENY. I was called today 2-2-2012 and told that my appeal was approved for 9 days, 11-1-2011 to 11-9-2011 but the rest of the time was denied. When they called my doctor, he offered to send them the doctor notes they were missing but they were not interested. I think Sedgewick is a joke.

Attorney Greg Dell:

Steve,

It is scary how often we hear the same story from disability claimants about Sedgwick.

Marie:

My husband works for one of the big three automakers. He was diagnosed with a sleeping disorder which enables him from handling heavy machinery, and also diagnosed with sarcoidosis. He filed a claim with Sedgwick over two months ago, and has submitted all test results, doctor notes, chart notes, and also proof of physical therapy. No matter what he does they continue to deny paying him!

They repeatedly tell him either “we have not received it”, and ignore his Doctors’ phone calls. He is not well, and should not be burdened with this! His union is not doing much for him either. I am beside myself with anger and frustration, as I am having chronic health issues.

What can be done to stop this company from doing this to hard working individuals, who have paid into a system that if in the event of illness or injury, they can still live? How many denials can be appealed? Is there a statute of limitations? If so, what is it?. I have followed the chain of command, however, since the union is not assisting at all, should I resort to taking legal action? Our utilities are due for disconnection, and our automobile is in jeopardy of repossession. Please advise.

Attorney Greg Dell:

Marie,

Sedgwick has been out of control lately. Either they are extremely disorganized, overwhelmed with claims, or hire incompetent employees to manage claims. You need to persistent and call them or write them everyday until you get a response. If you have been denied, then you must file an appeal in a timely manner. If you would like legal assistance, please contact us.

Deb:

I broke my foot on December 23rd and to this day I have not been able to get an answer from the CMS at Sedgwick as to whether or not they are going to cover the claim. My doctor put me off work due to the location of the fracture trying to keep me from having surgery. I call and leave messages on the CMS’s voicemail and she doesn’t return them. At one point I had to call her supervisor and threaten an attorney because it had been 10 days. She claims she has not received the medical records from the hospital. Also she stated she needed me to sign a form which she delayed two weeks post injury in sending me, then sent it to my old address which is not the address on my claim or the one the company has on file for me. She then tells me she will email it to me which she does and the attachment is blank, then next attachment I can not get open and and finally when I do there are no forms to sign as she mentioned only a letter. She then resends it to my correct address without enough postage. I feel like it is not my responsibility to have to pay for it since I don’t have the income from the company that is causing all this plus they didn’t even pay me for my holiday pay (Christmas and New Year’s) which I normally get paid for.

Attorney Greg Dell:

Deb,

The situation you describe is the typical games we see played by Sedgwick on a daily basis. I am still trying to figure out if Sedgwick does things intentionally to make life miserable for claimants or are they just really so disorganized that they have very little idea what they are doing. Sedgwick’s claims handlers seem to be some of the most inexperienced claims people that we deal with on a daily basis.

Attorney Greg Dell:

An AT&T employee recently shared her experience about dealing with Sedgwick for a short term disability claim. This story is a routine situation for people that are forced to deal with Sedgwick for the handling of their disability insurance claim. Read it here: Sedgwick continues to deny disability benefits to AT&T employee.

Kofi Dixon:

I work for Greyhound Lines who recently switched to Sedgwick. I have been placed out of work by Concentra, the company that Greyhound uses for workman’s comp. So far I have not received a letter or any other notification from Sedgwick or my employer. I only know that they have my case because the last claims company sent me a letter. I have spoken to the Rep. handling my case about three times. But I have a relationship with her voicemail that tells you she will return your call in one business day but then she takes a week to call you back. She then tells me she is still trying to verify the information that I gave her. They have not approved the tests that the doctor has ordered or approved a check and I definitely haven’t received any money. The Rep. also told me that she is waiting on my company to verify my statement. Wasn’t it my company who filed with them? Because I sure didn’t choose this company! I have followed all of the rules, when you see your child hungry or going without then you start to go crazy. My desirous certainly don’t want to hear that I’m having problems getting my money from workman’s comp claim services Sedgwick CMS.

Bill:

To say Sedgwick is incompetent would be a gross understatement. In my mind, they are criminally negligent. I filed a short term disability claim through my employer – United Healthcare. One month and five days later, still no check. My landlord wants me to move out because I’m late on the rent and Sedgwick keeps telling me the check is “in the mail.” From day one the claim has been a nightmare, made all the more difficult by Sedgwick’s incompetence and soul killing indifference.

Attorney Greg Dell:

Bill,

Thanks for sharing your comments about Sedgwick. It is shocking that employers continue to use Sedgwick to handle disability claims. You should see all of the other complaints about Sedgwick on our Facebook page. You need to continue to contact Sedgwick daily until they pay you. You should also notify your employer about the way in which Sedgwick has handled your claim.

Paula:

Sedgwick took over our medical leave management Jan. 1, 2012 and they are pathetic. They have denied my medical disability which is a benefit from my employer after I had 2 major critical surgeries in November and am not released to work yet by my doctors. They are a scam company who seem to simply deny claims vs. allowing employees to use a benefit we pay for from our paychecks. I am not healed from my wound yet and am in need of my disability pay. I need help.

Kevin:

So why can’t someone do something about Sedgwick? I am dealing with them currently. First they got my pay wrong, then it took over 5 weeks to get it right (after many phone calls with the adjuster) it got sorted out. Somehow in the process I gained a case worker from Corvel that handles most of the process with doctor appointments and picking the doctor and everything but I am pretty sure she the doctor and Sedgwick are all working together.

I have been out for a brain injury and I feel NO better at all. No one is listening to what I have to say, I gave the doctor a list of symptoms he just ignores. He gives me the sobriety test everytime I go in there and doesn’t address the ringing in my ears or the what I guess is vertigo? I can’t do my job as manager of dominos pizza and my employer doesn’t want me to return until I am 100%. The doctor saids he doesn’t know how to treat me and the corvel case worker tells me all the symptoms are from me “getting old” (I am only 36).

Somewhere someone must have told Sedgwick I am back to work cause they havent paid me in over 4 weeks and they just say “I can no longer help you with benefits”. The Corvel case worker yelled at me when I asked her about it and said its not her problem and the last I heard from my doctor was he wanted me to see someone else for another opinion. So now, because of Sedgwick or someone it looks as though I will lose my apartment because I have no money coming in from anyone at all.

If we all know Sedgwick is so bad why can’t anyone do something about them? I am sure they are all incompetent and they try to screw injured people purposely.

M.L. Snodgrass:

I am writing again about AT&T being true creeps just like Sedgwick, only because they can get away with. The AT&T human resource person I spoke to this morning said they pay Sedgwick, so of course Sedgwick works for them not you, the employee. I thought Sedgwick was a neutral 3rd party solely involved in what was medically true or false for me, the employee. I am now told an extension decision will not be made until the 16th of March at the latest. Suddenly my case is complex, they claim. I’d like to see how long AT&T would remain quiet if their source of income was suddenly removed. My CWA union is in bed with AT&T just as much as Sedgwick as they are doing nothing for me.

David Adams:

My AT&T/Sedgwick “relationship” began with an at work slip and fall in January 2007. I began having severe back pain and used my own doctor with receiving referrals to pain management, Orthopedic and Neuro surgeons. Despite having a Sedgwick WC case open, AT&T asked me to pay OOP and stipulating that my PM doctors was my primary treating physician. AT&T did reimburse for the first year, but then it stopped.

Sedgwick requested that I start going to a doctor in their MPN network. I picked one told my lawyer but never received the appointment, even after making several threats and filing for hearings. A large mass in my back was found during the MRI’s I had and so a biopsy was performed in October 2007. For several weeks after I had intense, unbearable pain which ended up being a large effusion in my right lung. 1000cc of fluid was removed at which time I had immediate relief. Despite all the treating doctor’s extensive notes, I was repeatedly threatened to return to work or I would lose my job. I did return too early and was on light duty for a week before returning to STD for two weeks.

In July 2008, my lawyer sent me to an AME for my rating which I feel was conservative, but OK. While Sedgwick paid for my pain meds they refused to reimburse me for doctor care that was stipulated in my settlement. So much for lifetime medical.

Now to the good part. My current manager has well documented issues with disabled techs. On 7/12/11 I had a new WC injury that was opened. I worked a short time after the injury because of my ongoing PM. Finally could no longer work due to severe headaches, back and knee injuries. On 8/2/11 the disability case was open and denied though my PM doctor show me temp total disability. I immediately hired a new lawyer. This time I went to an MPN network doctor, you know the ones AT&T and Sedgwick hand picks. He took me out of work as well. From August to today it’s been the same thing. Because I have two WC cases and the disability case all the paperwork gets filed incorrectly. My lawyer has made hundreds of calls never returned by Sedgwick. Even though mt WC case is approved the disability is denied. No money since day one. All benefits lost. My wife has a life threatening illness that needs prompt care. My MPN has asked for an injection therapy since 10/14. I visit my MPN doctor every month. I’m on company initiated leave that will last only so long. My lawyer applied for california SDI which I was receiving from 8/9/11 until 2/15/12 then Sedgwick WC adjust or called SDI and lied, telling them they would start paying benefits. No pay again. I’m losing my house of 15 years and everything else.

The Sedgwick disability adjuster finally called me for first final denial. I asked for an explanation. They said well now we can approve you but if even one day isn’t approved AT&T says we have to deny the whole thing. I filed and appeal right away. My MPN Ortho and Psychologist as well as my lawyer have faxed each doc dozens of times but they don’t seem to ever have my paperwork. I called my Sedgwick appeals adjuster and refaxed each document. Started at 2pm and finished at 9:20pm. The next day I had her read each doc and they had 15 of the 86 pages missing so I refaxed. Every facet of Sedgwick’s entire system is designed to fail.

My lawyer had to call AT&T’s defense attorney, something I guess that not done, to get the Sedgwick WC adjuster on the line. I had my procedure approved in 24hrs. Still no pay. A hearing has been filed. Fortunately the law office is a few stories above the court. Only a 30 day wait for hearing. To Sedgwick and AT&T, all laws and employee well being is ignored.

I guess Sedgwick CMS level of fraudulent activity was too much for AT&T as I received a letter stating that as of 1/1/12 AT&T has a new CMS. Too bad, as that doesn’t help me. I’m stuck with Sedgwick. My lawyers and MPN doctors are dumbfounded by Sedgwick. ERISA means nothing to them. I have eight fellows at work, all with the same issues.

Attorney Greg Dell:

David,

Your Sedgwick experience is unfortunately consistent with the stories we hear everyday about Sedgwick claimants. Since you reside in California you should file a complaint with the California Department of Insurance and the US Department of Labor. I cannot understand why AT&T continues to retain Sedgwick unless AT&T’s goal is to force people back to work by relying on Sedgwick to mismanage and unreasonably deny claims?

Andrea Fontaine:

Hi there,

I am an United Healthcare employee who filed a disability claim with Sedgwick that was paid at first (albeit grudgingly), then has been denied as of 11/19. I have been consistently having treatments and surgeries up till the end of January, and was ordered to lay up six weeks after my last surgery. I am since back at work and Segewick sent me a letter stating that they wanted another 45 days in addition to the first 45 from the appeal I filed in order to make the decision. At this point they owe me over $3k. The time is up 4/8 – which is a Sunday. Any way to hurry them along?

Jerry Webb:

Mike, I have been off since August 2011 for a mental illness that I have. Sedgwick has been handling my claim however I haven’t been paid since December because of a Denial in my short term. I did file an appeal however was just advised Friday the 23rd of March that a decision was made that they made a final denial. Just last week I was advised by social security that I was approved for disability. Sedgwick made their decision based on their thoughts because they said they were unable to contact my doctors, however they didn’t refer me to any of theirs. I have been with AT&T since 1998 and have already had to step down from a manager to an assistant manager because of my disability. I been having the same letters as in other post of job abandonment.

Attorney Greg Dell:

Andrea,

Sedgwick beats to their own drum. The best way to push them along is to consistently send them letters demanding a response. They are like robots and they are forced to respond to letters. They can ignore phone calls.

Attorney Greg Dell:

Jerry,

Please contact us to discuss your denial by Sedgwick. We will need to immediately review the denial letter your received. It is amazing how many AT&T employees are denied benefits by Sedgwick on a daily basis.

Sabrina M.:

Hello,

I have been dealing with the Sedgwick CMS crap from July 2010 when my company changed to them. I still have claims that have not been paid by my former STD company Standard and this deadbeat company who took 9 months to pay for an urinary tract infection with kidney stones. I am well over $3K in back STD wages, even with the payment of approx. $1.5K. I have proven record of violations of the HIPPA privacy act three times now and last just today.

This company, based on my own experiences, does not tell the truth. They go out of their way to delay and when confronted on delays they have no idea why someone gave me this information. I have turned them into health and human services and will again tomorrow for another violation of my privacy. I even have a letter from department of labor advising they can not use the ERISA law it strictly for retirement act and it doesn’t apply here. It is bad when you fax them a copy of this and yet this still try to delay.

I have repeatedly asked to have this current claim examiner removed from my cased when I caught in on suppose to be a recorded call not telling the truth. I brought this to the supervisor in charge of my company and she advised lying is a willful act and she doesn’t see this representative willfully doing this. I advised pulling the recorded call and she advised this is quality and training purpose and not for legal purpose of calls. I advised had I known this I would record this call myself and then play back the lies that were given to me. I am OK if I need to be a land mark case on my history to have it where they never do this another person for any company they service. Now when I call today and the rep read the notes that the claim examiner put in a supervisor advised they are not allow to release this information and it can only come from claims examiner which is another contradiction from his supervisor.

I am telling I have never seen a game played and no accountability as this company does.

Attorney Greg Dell:

Sabrina,

Thanks for sharing your experience. Every day we battle Sedgwick in an effort to stop their wrongful conduct. You should also take a look at our Facebook page to see the discussions about Sedgwick and their unreasonable claims handling actions.

Rob Delsman:

Dear Dell & Schaefer,

I can’t express my personal gratitude enough, for your efforts in the constant battle against the injustices perpetrated by Sedgwick Claims Management Services against America’s Sick, Injured and Disabled workers. I have been doing all that I can (with limited success) to expose these despicable deeds and to assist where possible. It is my sincere hope that your firm will not only continue to assist injured workers, but also use your influence to thrust these issues to the highest levels of government. Remember, Sedgwick provides claims management services for agencies that are funded with tax payer dollars and as such should be held accountable under state and federal laws.

Thank You!

Alan Smith:

Is it possible to file a civil lawsuit as a group against Sedgwick? With all these numerous claims of inappropriate actions by them, I’m surprised that a lawsuit has not been brought against them.

M. R.:

My wife has been on total and permanent disability from Delphi/GM managed by Sedgwick. Sedgwick is now offering a buyout of the claim which would remove her disability payment and health insurance. Can this be legal?

Attorney Greg Dell:

Alan,

The only way to file a lawsuit as a group is through a class action. The class action laws are very complicated and make it difficult to get a class certified. All of the claimants in a class action need to be “imilarly situated”. For example, multiple employees of AT&T with Sedgwick disability insurance claims could join together and file a class action lawsuit. We are currently in the process of researching a class action against Sedgwick.

Attorney Greg Dell:

M. R..,

Any company can offer a buyout of a claim. Acceptance of a buyout is voluntary and you are free to reject it if it does not interest you. To learn more about buyouts, please see this page on our site.

Karen:

I have been on appeal with Sedgwick CMS for 20 months! My pension provider told me that Sedgwick sat on my claim for six months without doing anything. Now that I am denied by pension provider said that they had another disability provider reviewed my file and they still denied me. I am so stressed out and my physical and emotional issues are so overwhelming that my hair is falling out and I am showing signs of Cushing Syndrome because of the increased cortisol caused by the stress. I was approved for Social Security but they say that they have higher standards and that was why I was denied. I do not trust any insurance companies!

Attorney Greg Dell:

Karen,

Your experience with Sedgwick is unfortunately typical. Keep fighting Sedgwick. You can probably sue them now since they have delayed making a decision on your claim. Please contact us if you would like us to review your potential lawsuit.

Steve:

I have been a retail manager for over 25 years. On Dec. 2010 I lost sight in the right eye due to an accident. Sedgwick approved Short Term Disability for 2 weeks for surgery. During 2011 I continued to work, had 6 surgeries in hopes to restore eyesight. On 12/2 I was told my sight could not be restored. Now being treated for depression and diabetes. Went out on disability on 12/18/2012 after a knee injury due to my vision impairment. Sedgwick approved my FMLA due to “a serious health condition that makes you unable to perform the essential functions of your job.” Yet they denied STD based on the condition had not worsened which suggest a lack of severity of condition. Blind is Blind. Filed the appeal and denied again. Attending Physician Statement states I am not able to return to work. Doctor complete Medical Report Form from employer stating I was not able to return to work and that I pose an imminent and substantial degree of risk to my own health and safety if I returned to work. Do not have a release to return to work from my doctor, yet my employer, based on Sedgwick’s process, expects me to return to work on 5/1. I do not feel I can return. My disability backpay is now over $29K. What steps should I consider to appeal Sedgwick’s 2nd denial? CIGNA is handling my Long Term Disability. I have failed the claim. Should I expect the same complications with CIGNA?

Attorney Greg Dell:

Steve,

Sedgwick is out of control. Please contact us so we can review your denial letter and discuss your options for presenting a strong appeal. CIGNA is not as bad as Sedgwick, but they are a close second. You need to be prepared to deal with these insurance companies as they don’t like to pay. If you would like assistance, let us know.

R.:

Yet another AT&T employee dealing with Sedgwick.

My short-term disability was approved initially, but when my doctor extended my leave, the extension was denied due to insufficient justification of not being able to return to work.

Following Sedgwick’s appeal process, I had that doctor as well as another doctor I am seeing (several doctors are treating me) conduct medical reviews with Sedgwick. Result of the consultations: Denied again.

Sedgwick rep. told me I can appeal the denial, which I will do, but I don’t understand how they can ignore the recommendations of two separate medical providers. I offered to see a doctor of Sedgwick’s choosing, and was told they don’t employ doctors and they don’t operate that way.

If i’m denied again I’m going to ask my state attorney general about appealing through the state’s employee protection law.

I’m also eager to hear about that class action law suit.

Thomas:

Sedgwick has really done a number on me 30 days after total knee replacement surgery they put me in “Administrative Denial” status even though my surgeon clearly stated I was taking heavy narcotic medicine, required a walking device and could not sit for any period of time. So they sent notice two days before an IME exam. I called and told them law required at least 7 days written notice. Two weeks later I got another letter regarding an IME exam. I checked the doctor’s license and other information – he has not performed orthopedic surgery in years, has no hospital affiliations and no faculty association. He just does IME work. So I called MCN about my concerns about his qualifications. Samuel told me “we can reschedule with an active surgeon”. Sedgwick then advised me I was in denial status for a missed appointment despite MCN sending a request to reschedule a new appointment. The AT&T/Sedgwick abuse is hurting my mental health.

Attorney Greg Dell:

R,

You must appeal again as Sedgwick requires AT&T employees to appeal twice. They will probably deny you again as Sedgwick only listens to their own hired doctors. If you get denied, please contact us and we can review your claim to see if we can assist you.

Charles:

Mr. Dell, a major concern for all Sedgwick/AT&T short term disability claimants I’ve talked to is regarding Independent Medical Examinations. Where in law findings can one find minimum requirements for physicians performing these exams? I know multiple times where Sedgwick has chosen doctors who don’t even practice in the area of concern. For example, orthropedic surgeons who have licenses but have ceased surgical practice for years, have no hospital credentials or teaching/faculty relationships. Basically, they are retired and strictly do independent medical exam work. I would hope this is addressed somewhere in law (outside of workman’s compensation). What are your thoughts on this abuse and where are any resources for us?

Attorney Greg Dell:

Charles,

The laws for IME exams are different in every state. As long as a doctor is licensed, then they can do an IME exam in most states. ERISA regulated policies require a doctor with the appropriate specialty to conduct the IME Exam. So if a person has a cardiac disability, then they should be examined by a cardiologist.

Tera:

I have worked for eBay for the last 6 years. I am a excellent employee, who is dedicated to my job. With that said, I filed a STD claim with Sedgwick 12/11/11 because my feet were swelling and I had pain all over my body that progressively got worse. I literally had to call Sedgwick daily. They played the oh we didn’t get the paperwork you sent us, oh we never got the doctor’s paperwork, etc. I would have to call my doctor’s and ask them to fax again, then call Sedgwick back frequently. Then they would tell me oh it takes 7-10 business days to review. They approved some of my time, but they were always behind, causing me to have to call into work every night. In March the doctor’s finally figured out that I had fibromyalgia. Since the pain was so severe I had stopped moving around and stayed in bed a good portion of days which then led to diabetes. I became severely depressed and anxious. My therapist said I needed to destress and my regular doctor and rhuematologist said it would take time to get the meds right. Sedgwick approved my time until 4/1/12, however they then required me to see a 3rd party therapist and refused to pay me until they decided. I saw the 3rd party therapist even though my family doctor and my therapist said I can’t work yet. I called Sedgwick. Heather, my caseworker, told me that she sent her recommendation to her supervisor which was to deny my claim. I asked why and she said because the therapist said I could work. I had an anxiety attack which is pretty normal after talking to Sedgwick. If I am constantly in pain, can’t sit or stand for long periods of time, have physical therapy 3 times a week, have massive anxiety attacks, and have crying spells, how am I supposed to go to work? The denial leads to no back pay or future pay, no job, and no medical insurance. How am I gonna get my medications, see doctors, and get treatment? Sedgwick doesn’t care. They told me I should have thought about that before I filed my claim. Now I am even more depressed and anxious.

Attorney Greg Dell:

Tera,

You have only received one person’s opinion at Sedgwick and you need to appeal their decision in a timely manner. It is surprising Sedgwick even paid you for a few months. You need to request a claim file from Sedgwick and ask your doctors to comments on the opinions rendered by Sedgwick. Contact us if you would like assistance.

Rose Yelvington:

I just got denied for short term disablity from Sedgwick, but my FMLA was approved due to my diabetes and vertigo. Sedgwick told me if I was going to be out longer than 1 week I had to file for STD. I have been out since 4/26/2012 from work. Just got note today that it was denied, they said because inconstancy with medical records. Records were faxed, they didn’t say how much records needed to be faxed. That is 3 weeks of pay I was denied due to an illness that I couldn’t control, good thing I return to work next week.

Attorney Greg Dell:

Rose,

You still need to file an appeal if you want to try to recover your 3 weeks of pay. We don’t handle short term disability appeals seeking 3 weeks of benefits, but you should try to get what is owed to you.

Tom Schardan:

I was working on the Music City Center in Nashville, TN on loan to another steel erection company. There was no service elevators to take employees, equipment to the 8th floor. There was only a series of stairs with 2 landing between floors. I had to climb & descend these stairs numerous time per day. I calculate about 24 flight up and 24 down, each landing turning 180 degrees, while carrying a 25# survey instrument like a suitcase in my left hand. On the fifth day at the site I turn and heard a popping sound in my left knee. It swelled to the size of a softball. The following day they sent me to Concentra Urgent Care. The date of injury was 12-05-2011. After maybe 2 months they finally approved my MRI. My MRI results showed at least 4 tears to my ligaments. So I hobbled around until my surgery was scheduled, which was 4-09-2012, so I had to live on pain medications all that time up to surgery. I have been in PT for 4 weeks and have 5 to go. Today is 5-31-12 and I have had no contact with Angela of Sedgwick for a month now. I used all my vacation to recover and avoid a lost time injury, for whom I really don’t even know. I think its time to talk to someone legally. My claim had been approved since 12-05-2012, yet I have no idea what’s to happen now.

Mike Johns:

I am posting this in behalf of my wife who simply cannot sit long enough to complete the task. She contacted what is know as Necretizing Fachistis know as flesh eating strep. You probably heard of the young lady that lost her leg. Well, my wife lost her complete left buttock and almost her leg and life. It required being in the hospital over one month in a wound center, over 100 bags of of antibiotics and a wound pump for two months. She needs to have reconstructive surgery done so she can walk again. The surgery was six months ago and the wound still has not closed. The experience with Sedgwick has been a nightmare. We are almost at the 90 day mark and they still have not responded to our calls. A Terri Eriwin is her case manager, she tried to make us believe she had a grip with medical terminology only to discover she had no command of medical issues. They continue to post a note on their web site that they are trying to reach her doctor, and we might want to call the doctor’s office to help. This is the fourth time this has happened with Sedgwick, we have called and left several messages, my wife has four doctors and we do not know what doctors they are requesting information from. We have called all the doctor’s office staff and they have had no calls that are requests from Sedgwick. They continue to claim they have 90 days to respond, claimed they had to read 45 pages, on half page of this report sends doctors flinching, it takes very little. I was laid off my job after a number of years with one company, I went through chemo and radiation treatments for over a year because of lung cancer, by the grace of God I am in remission. But I just turned 62 and just received my first social security check, and work 35 hours a week at a disgusting call center. If we had not received help from family services at the last minute the eviction notice would have gone into effect. As it stands we lost our home because of my cancer and ended up in a trailer park. I am playing catch up on bills with what little money I have, but if we do not get a check from Sedgwick soon we will be on the street, i am already behind.

Attorney Greg Dell:

Mike,

Please contact us privately. If your wife is seeking disability payments from Sedgwick, then you should be receiving written correspondence from Sedgwick?

Mike Johns:

Thanks for taking my call, the information provided was appreciated. However after days of faxing and leaving voice messages, Sedgwick one again comes up with another delay tactic and act of stupidity. They posted a notice on their web site, that they were trying to reach my wife’s doctors for additional information. In response my wife left several voice messages that she needed to know what doctors they were trying to reach and the information needed.

I faxed request everyday for four days and finally got a response. You need to know we have already spent alot of money on co-pays, back in March and April, providing them with a heavy amount of responses. One staff became so upset with Sedgwick they faxed almost every thing they had.

Sedgwick came back with a request with a complete list of all the doctors, they wanted information from all four, but they did not inform us what kind of information they were in need of. They informed us that if they did not get this unknown information in 19 days they would denied the claim.

My response was simply accusing them of losing all the previous faxes, and it would help if they picked up the phone and take our calls so we would know want was needed. I simply said that the next 19 days was in their ball park,
we can’t give them information nor the doctors if they don’t responded to our request, pick up the phone and return our calls.

I wrote a full page length fax covering several issues and noted their unknown request for information, I told them that we would fax this request everyday for the next 19 days, until they either denied the claim or contacted us as a professional service should and provide us with their request.

I also informed them that from the CNN talk site that is covering the young girl that was suffering from the strip eating virus, I have been involved in exchanging information on the topic. I have taken the opportunity to mention Sedgwick name and issues, surrounding their failures to provide proper professional services. I am now receiving emails from around the country and intend to share with my wife’s Human Resource Dept, which is the state of Arizona.

Mark A. Forrette:

Sedgwick has strung me out for almost 20 Months! I’m supposed to be getting to settlement soon but my attorney wasn’t specific (I thought it would be finalized as of June 30th). A nightmare to deal with, I have to drive Six Hours Each Way on Sunday-Mondyay July 8 & 9 in order to get an OK for Pain Medications for my Back Injury. They STINK!

Attorney Greg Dell:

Mark,

We are sorry to hear about your experience. Good luck with your claim.

Christine Armes:

I am a 49 year old female and diagnosed 2 years ago with end stage renal disease. I am currently do home dialysis which is approx. 10 hours 7 days a week. When first diagnosed I decided that since I still was able to function I wanted to continue to work until it became too difficult for me to function. 2 weeks ago after suffering from chronic nausea, constant fatigue, and continually swelling legs my doctor agreed that I should go out on disability. He filled out the paper work and I faxed it to Sedgwick who stated they would call me back when they received it. 2 weeks later after no response I called them and was told by a supervisor that there was no documentation that supported me being off from work. He stated if I did it for 2 years I should still be able to do it. I tried to explain that the longe you are on dialysis the harder it gets however he hung up on me. Sedgwick uses bullying tactics.

Attorney Greg Dell:

Christine,

It saddens me to hear your story. You have tried so hard to work through your condition yet Sedgwick makes a mockery out of your efforts. Sedgwick should have sent you a denial letter via mail. You need to appeal their denial in a timely manner and have your doctor write a strong letter of support for you. It will also help to have your employer write a letter explaining why you are unable to do your job or any other job. You should also apply for SSDI benefits. Contact us if you would like assistance.

Eric J.:

I have worked for AT&T for 15 years. In those years I haven’t given as much trouble as I have gotten from Sedgwick. I have had 3 back surgeries in 12 months, the last being a l4,l5,s1 fusion. At first everything was fine but after I reached the 90 day mark I have been denied. I haven’t been paid since July. Sedgwick sends faxes to to my neurosurgeon for recent medical and they send all that is requested only to find out that it want enough. They request more and it’s sent only to find out there is more needed. Sedgwick went as far as to tell my Dr. that all they need is for him to fill out a survey on my condition to get the approval process underway. He did it and guess what? It wasn’t enough. So now they told my Dr. to send them a letter to them explaining why I can not return to work. My Dr. will do it but I can almost bet you my house that they will say its not enough. I will file an appeal. I am going to send a certified letter requesting all my documentation and policies be sent to me from AT&T and from Sedgwick. And I will be waiting to hear back from Dell & Schaefer as to if they can help me. I am losing sleep worrying about paying my bills and keeping my home and I am sure the additional stress isn’t helping my current condition.

Attorney Greg Dell:

Eric,

With the large amount of people that contact us on a daily basis from Sedgwick, I wonder if the Sedgwick employees are worried about losing their jobs if they approve an AT&T employee for disability benefits following their initial application. It is rare that we see an AT&T employee that is approved for benefits following an initial application. We will review your claim and let you now ASAP if we can assist you.

R:

Update on my May 2012 post “Yet another AT&T employee dealing with Sedgwick“:

I have just received notice from Sedgwick that my final appeal for short-term disability benefits has been denied. My disability was initially approved for two weeks, but the subsequent extension requested by my doctor was denied. My condition had not improved, however, and my doctor said there was no logical reason for Sedgwick to treat the second disability period differently from the initial period that it had approved.

After repeated appeals and medical peer reviews – all denied – I submitted my final appeal. At the urging of my health insurance company (which had assigned a caseworker to monitor my health progress) I included a letter in the final appeal, detailing:

– work responsibilities, to help Sedgwick understand the specific functions that I was no longer able to perform

– the potential damage to AT&T if I produced any work that was not perfect

– feedback from my human resources partners and my colleagues urging me to take time away from work until I felt well enough to do my job.

Sedgwick’s final denial letter was comical – it found no physical reason I could not perform my “sedentary job function.” Despite the documentation, interviews, test results – the FACTS, in other words – Sedgwick’s denial was based on whether I was capable of sitting at a desk!

I am lucky – I was able to survive on unpaid leave until my health improved. My heart goes out to all the AT&T employees who have not been able so fortunate. There must be a special place in hell for Sedgwick and its masters at AT&T.

Attorney Greg Dell:

R,

It’s horrible that AT&T refuses to do anything about Sedgwick. Since your plan is self-funded, which means that AT&T pays the disability benefits, it almost seems like AT&T expects Sedgwick to deny a high percentage of the people that apply for coverage. I can not verify, but I recently heard that in the recent Union negotiation in the southeast that the definition of disability for short term disability is going to be changed to “own occupation”. This could be a great thing for most AT&T employees that need to file a claim in the future. I spoke with several people at the AT&T Union and I think they were able to get this done. Check with your Union for accuracy of my thoughts.

Becky S.:

I work for the “Daughters of Charity” Ascension Health/ Seton Healthcare. How ironic that I have been a stellar nurse since 1987 that now, in my time of need I am denied (by Sedgwick) the short term disability benefit that I long ago elected to pay for every two weeks. This is not a workmen’s comp claim. I suffered a traumatic brain injury elsewhere. I have been denied monies for September. I cannot continue to pay the co-pays to attend all the required therapies, so this will in fact hamper my recovery. My friends are feeding me, and not sure what will happen when the rent and car payments come due. To say the undue stress of this is hurting my recovery is an understatement! Each time I call, I am given new terminologies, new requests are made of me, this can change DAILY! I talk to a new person each time because both times I was given points of contact, their voicemail then states they are “out of the office”. I cannot believe these people can get away with this. I am incredulous that the “Daughters of Charity”, Ascension Health / Seton Healthcare would subscribe to this service! I don’t know how the Sedgwick employees that participate in the blatant mistreatment of deserving folks can sleep at night! This is what I get after devoting over half of my life to the compassionate care of others as a nurse. This so saddens me, what kind of world is this?

Mary:

Sedgwick is a trickster, trying to discredit each claimant, harass if possible, deny bills, refuse to call back and easily cover it all it by backdating information. This group needs to be exposed for what they are. After contracting CRPS from falling at work, they are now denying necessary pain meds, refusing suddenly to pay for appointments and calling my insurance provider claiming to be my work comp attorney stating that “Sedgwick will not cover bills as of ___ date, so contact us if you have any questions. These claims should be put under the insured’s personal health insurance”. These illegal tactics, lies and lack of care for human beings while the bill our companies and pay themselves before paying our medical bills needs to be stopped. There has to be a way to expose how criminal their actions truly are.

Keith Smith:

Five months I’ve waited; they never returned my calls after leaving hundreds of messages. Nicole, my claim worker, told me at one point she was too busy.

I’ve been out of work for five months and they just denied my claim and will not tell me why? Or send a denial letter. Very poor custom service…

Karen Miller:

My husband was poisoned from PTFE while machining at Boeing of Portland on Feb. 14, 2011 through Feb. 18, 2011. He was diagnosed with polymer fume fever which enflamed his face, neck, ears. It actually gave him flu-like symptoms with body aches, fever. His appearance was so bad that the first Dr. visit the nurse wouldn’t take his fatals for fear that he was contagious. But because he was a good employee who didn’t like missing work, he never took 3 consecutive days off, but missed over 3 weeks of time off, here and there. He already had been told he had COPD, but this caused him to be much worse. It has also affected his blood, hormones and vision. The company says that yes he was made ill, but that there are no long term injuries. Since than he has retired due to the inability to work due to his health issues. We have hired an attorney that I’m not sure gets what is happening. The research we have done on this product indicates that this is a common event when dealing with it. Since my husbands poisoning, Boeing no longer uses this in the Portland plant and once agan uses vendors to make the parts he was asked to run. Our appeal is Nov. 27, 2012 and we need help.

Attorney Greg Dell:

Karen,

Please contact us privately and we will review your husband’s claim.

Reece Sherrill:

I am a liver transplant recipient with a complete colectomy and permanent ileostomy. I haven’t been able to work for years, and have been on Sedgwick Ltd, and am now at my two year review. I was awarded SSDI and have multiple medical source statements that that’ve been submitted to them both by my own physicians, a physician they hired, and a psychiatrist of their choice, all saying I cannot work. I was notified last Friday by my PCP nurse that Sedgwick requested a functional capacity exam. My wife and I are both also nurses, and believe this is just outrageous. We have read the CFR, and know that medical source statements are to be given the highest weight when making rulings, so this FCA is totally unnecessary. However, if I don’t go, Sedgwick can deny me for non compliance. What I disagree with regarding the FCE is that it only represents a snapshot in time, a short duration of a couple of hours, and from that says the individual is capable of working full time – 8 hours a day, 5 days a week. It is physically and mentally impossible for me. I am immunocompromised due to my transplant medications. I have to take OxyContin and Lortab to control my pain and this affects my cognitive ability. There is so much documentation over the past two years and it isn’t enough! My rep even called and told me I’d be getting the two year renewal letter and not to freak out. Looking at this board, however, I’m not the only one.

Attorney Greg Dell:

Reece,

Sedgwick is usually very unreasonable and follows nothing but a script. Their claims people are like robots. You must got to the FCE, but if your doctor thinks that it would be harmful for you to go, then you should get a letter stating as such. You can also ask Sedgwick to clarify the scope of the FCE activities so that you can discuss them with your doctor. You should videotape the exam so that there are no inconsistencies. If you would like assistance with dealing with Sedgwick, please let us know.

Carmen:

I currently live in Puerto Rico but work out of Chicago, IL. I need to be operated and unfortunately I have not received medical attention from them, nor have I received money that is due to me nor benefits that I’m entitled to. They did however start paying for medication, but as of September they stopped paying my medication. I have had to pay all my medical visits to every doctor I have seen. I never received my August 15th paycheck because the company claimed an over payment, of what I don’t know. I have been without any work payments since the end of July, using what I had saved up for medical treatment. I have run out of money at this time yet my bills keep coming in. I was told I will get re-payment for cash payout to my doctor’s visit but that has not happened as well. My medical coverage has ceased due to non-payment because I have no money coming in. I have an aging mother and if she were on my medical claim that would be another form of disaster without any medical coverage. I have a sick animal at home I cannot take to a vet at this time as well. My mother has kicked me out of the house on numerous occasions where I have had to seek help from a friend. I cannot count on my mother for any income for she receives very little from the state. I called for an appointment for “La Reforma” medical coverage from the state of P.R. and I am currently making arrangements to apply for food stamps from the state as well. I have car payments and not sure how long I will continue to have my phone service. I had to give up the place I was renting in Chicago when I needed to stay there because of my job. I had to be put on anti-depressants a month or so ago because of the stress with so many issues, and the constant pain. The longer the insurance agency makes me wait for my treatments the worse I become. They are impeding my health care strongly and they should in no way impede my health care. They are also causing financial damage to me and my family. I have a lack of health service from Sedgwick, no income and no insurance. They have inflicted emotional distress, which has resulted in injuries separate and distinct from the injuries I have suffered while working at American Eagle. They have deprived me of workers compensation benefits, and I have had to pay expenses. They only have their own interest and profits at heart. You can’t put profits over the well-being of people – it is cruel and inhumane. I have sent in so many medical documents with no results. I am in urgent need of medical attention. I don’t believe Sedgwick CMS is acting in “good faith”. I am currently making letters to go public with my issues for the governor of P.R., and the governor of Chicago. However, I’m seeking legal representation.

Kristin:

Today Sedgwick told me to get back to work on the 31st of Oct. and I am not scheduled to work. The woman told me my company is going to terminate if I don’t go to a doctor. My doctor told me to come back in 2 more months. I was called on a Sunday at 830 am by a Sedgwick claims examiner and harassed. My doctor’s office has tried to return calls to Sedgwick but they never call them back. Sedgwick calls me and bullies my until I am literally having a nervous breakdown. I am already very upset that my injury has taken 3 years away from my normal activities. I told Sedgwick I would rather take not money from them and be released back to work to never have to deal with them. They are causing me to have severe anxiety problems and are causing me to be put in a bad place with my employer. They are ruining my life and need someone to help me. They are so horrible I get so depressed that it is hard for me to keep things in perspective. The representative said to me why are you having so much trouble paying attention to me. I have ADD lady, my kids just walked into the house from school and didn’t know I was on the phone, she wouldn’t leave me alone! I have chest pains from them.

Matt DeLuccio:

AT&T employee denied benefits due to anxiety and depression. My doctor wrote 3, very detailed, 3 page notes describing why I’m out of work. NYS disability approved my claim and paid me… Sedgwick has not. Please help!

Attorney Greg Dell:

Matt:

AT&T requires you to submit two appeals before you can sue them. Sedgwick CMS handles all of the disability claims and it is very difficult to get Sedgwick to approve a claim. The AT&T policy language for short term disability benefits requires you to be able to do any work, but Sedgwick will never tell you the type of work that they think you can do. You need to keep fighting them and have your doctor write another letter for you. You need to send a letter to AT&T and explain to them why you cannot do any work. Your doctor should describe any side effects that your medications may have on your ability to work.

Marc Chasteen:

I wish this wasn’t so but this seems to be the norm. I am a 13 year General Motors employee and have been treated like nothing short of a criminal. I have chronic heart problems, 4 years ago I had my heart reconstructed yet my problems have returned and I have been prepared for a life-long battle. I am the just a statistic and am facing multiple surgeries. My Dr.(s) have provided books-worth of monthly tests reports and office notes etc. AND even gave a return to work date of 2014 at best if not permanent disability. Get this, Sedgwick even reported to my employer I was a voluntary quit until I got the Union involved to get this changed and almost a month of terminated health care coverage amiss my treatment etc. This has been nothing short of a nightmare. I’ve lost everything and this company still manages to find a way monthly to turn what is left of my life completely upside down. I called today and was told payment will be withheld till each surgery so I get paid once a month or every other month at best. I would be more than happy to file suit with anyone willing to tackle this horrible company. We used to have MetLife as our disability admin and I never had this much difficulty. They need to be stopped.

Matt:

Thank you very much! By the time the appeal goes through, I will probably have no job! I will hire you if anything. This is a clear-cut case of disability discrimination. I have anxiety papers in which I was diagnosed by NYU dating back to 1999.

Deanna:

I work for the Boeing Co. making 737 wings, blew 3 disks in my neck and had them fused in 09, went back to work and after 8 months my manager put me in another area to help him get caught up. After repeatedly telling my manager that my neck was hurting after a month went to Boeing medical and they sent me home. Went to doctor and fusion didn’t take and blew disk above my fusion… Sedgwick has determined that it is genetic and there for “not job related”… Like building 737 wings had absolutely nothing to do with it. They closed my claims and haven’t been paid since March. “Starving me into submission” didn’t work for them, because my husband makes enough money to cover our bills. Hired an attorney in March… what a joke… Sedgwick is now trying to have me terminated and almost was this last Monday, but I took care of… called my attorney at 8:30 and still have not gotten a call back from him… confused and don’t know what else to do… If I don’t go back to work by Jan. 7th 2013 Boeing can terminate me. I Love my job… really LOVE my job and do not want to lose it… but can not go back ’til I get fixed.

Debra:

I worked for a claims company when I became ill with a permanent and chronic condition and was placed on their long term disability policy. The company was then bought out by Sedgwick. They don’t take any better care of employees than they do claimants. First they reneged on continuation of benefits, then on the life insurance policy that was supposed to continue as long as I was disabled (or at least to age 70) and now they won’t allow distribution from my 401k… they are forcing me to roll it over to an IRA. They are bottom line only… just as miserable as an ex-employee as they were to work for. I haven’t read a complaint yet, either by employees or ‘victims,’ that doesn’t ring 100% true.

Derek:

My name is Derek and I recently was wrongfully terminated by AT&T due to a medical condition. I have had an on-going issues with my back and have been treated on an on-going basis with my medical doctor and other doctors in the field. I was diagnosed with herniated disk bulging and degenerative disk disease. I have been suffering from consistent paid, numbness, losing feeling in my legs, back and feet, head aces and so on. I was provided plenty of evidence via documents that was flexed over to the disability department under Sedgwick. I was also provided a note saying that I needed reasonable work accommodations and that was never fulfilled by AT&T. I have had an MRI, X-Rays, pain management shots and been though physical. Seen by many doctors over the past year and have had plenty of “objective” and subjective evidence but yet was still denied. I hope that Dell & Schaefer Law Firm will be able to help me.

Attorney Greg Dell:

Derek,

We would be happy to take a look at your denial. AT&T requires two appeals to be filed before a lawsuit can be filed. It is possible to win at the Appeal level but not very common due to Sedgwick’s unreasonable claim reviews. AT&T and Sedgwick seem to have a technique which forces disabled people to return to work out of fear of losing everything.

Rob:

I was injured on my job, June 22nd. I was told by my employer that Sedgwick Claims Management Services, will be handling my claim. I was assigned to an administrator, Kathleen Shallow. After a month, I called to check on the status of my claim. I spoke with Ms. Shallow, who was very nasty in her disposition, told me, “Mr. Brown, I am very busy! I’m getting ready to go on vacation!” I replied, “So, you are telling me that I have to wait until you come back from vacation, to handle my claim?”.

After five weeks, I spoke with another claims administrator named Justin Tarsi, who told me of the situation I had went through with Ms. Shallow. Mr. Tarsi was worse than the previous administrator. He lied to me, as well as, lied on me, stating to my supervisor (not knowing I was listening via speakerphone) that he stated something that was not true.

When I started receiving my checks, I was told that a check was sent, that actually wasn’t. Mr. Tarsi admitted that the reason being, was unknown.

Lastly, a check was sent. I deposited it into the bank. Sedgwick CMS had stopped payment without notice. This is a very incompetent, derelict operational company. If anyone has to deal with these people, please get an attorney.

MLB:

Unfortunately, I can relate to everyone here when it comes to Sedgwick. I have had on-going back and neck issues like degenerative disk disease, bone spurs, stenosis, spondyosis, hernias, bulges ect… for many years and have worked physically demanding type union jobs for my company for 24 years. I decided to try a less physical type job due to my chronic pain but that required going to very intensive training to be an electrician. Being in a classroom situation for 6 months was still painful because of the sitting, and it destroyed my neck because of the studying but I was not at risk of lifting, climbing, pulling ect… I was suddenly and unexpectedly removed from the classroom situation and put back in the physically demanding job because I did not pass a test. Love the job but by the end of the first day I was nauseous with back and neck pain. By the 6th working day I couldn’t move at all, called out and decided that this was the time to seek a new medical treatment. Since I have been with my company for 24 years I am entitled to plenty of sick time days. However, Sedgwick has made impossible and bizarre demands and has made threats to put a stop to my pay. They require me to get a Doctor to ‘recommend me not to work’ within their time frame when they knew from the very beginning that my appointment is December 11th. Their ‘time frame’ was a mystery until 3 days before there ‘deadline’, I told them that I have no control over how fast I can get an appointment and my Doctor will not fill forms out or write any ‘sick notes’ until he sees me for the first appointment. I also can not control my Doctor’s actions and if he will ever fax anything for me to them or how long it will take. He has an extremely large clientel! Then I found out that she already called my Doctor and told him HE was responsible for me being on short term disability. Which is not the case, it is automatic after 5 days. She already caused friction between me and a Doctor I haven’t met yet. Today my supervisor called me and said that Sedgwick has emailed him saying as of today December 7th, I am to have a ‘stop in pay’ because they have not received information from my Doctors. I am at home in severe pain and they feel the need to torture me. I had to go back on high blood pressure meds after the first conversation with them. My bp went from 128/78 (the previous day) to 168/104 after talking with Sedgwick. The Doctor I am going to doesn’t ‘do’ insurance so it’s very expensive, $425.00 for the first appointment. If Sedgwick stops my pay, it will wipe me out and I won’t be able to afford my Doctor! I just can’t believe they are legally allowed to torture people like this, I can’t believe my company would hire such a crooked company! I have documented everything that has happened since the first day I called out just in case it would help me in some way.

Attorney Greg Dell:

MLB,

Sedgwick is very hard to deal with as you are aware. You need to make sure you treat with a doctor that knows how to deal with the paperwork required for disability claims. Without strong doctor support the chance of getting approved for benefits is very slim.

John:

I work for AT&T and I am on disability for anxiety and depression. My doctor has sent numerous letters and office notes explaining why I am unable to work. Sedgwick denied my claim and even sent the case to physician review and spoke with my doctor one on one. They still denied my claim. They are telling me that I do not have a functional impairment. What else do I need for a functional impairment? Now I received a letter that if I don’t return to work by Friday, it is job abandonment. What should I do?

Attorney Greg Dell:

John,

You are in the typical strong arm position from AT&T and Sedgwick. You can appeal their decision and also return to work for a short period of time if you can. You can then refile again if you don’t feel that you can make it at work. You can also decide to not return and just appeal the decision.

MLB:

Thanks Greg. You are right, it seems that finding Doctor’s that are willing to cooperate with Sedgwicks demands on their time line is completely impossible. I thought that the people at work that put our times in would just continue to ‘approve’ my times. However, I just saw my last paycheck. So far 8 hours of pay has been removed. I suppose this weeks pay will have Zero$$. Real nice thing to happen after what turned out to be over a $2,000 Doctors appointment ….

Linda Philipps:

I was denied STD from Sedgwick CMS as the third party administrator for AT&T. First denial was because medical information did not indicate disability.  The appeal was denied (thorough medical information was provided, MRI, treatment, etc) because they could not talk to my physicians on the telephone!  Then AT&T sent me the “return to work or it would be job abandonment”.  I back to work with an accommodation list from my drs and only worked 4 hrs.  That was painful enough – only to lose my job over 2 hrs FMLA time that a form wasn’t submitted by my DDS on a timely basis in APRIL 2012.  This all was coming down October 2012.  I did everything right and everything turned out wrong.  I am here in severe pain..cannot walk due to spinal stenosis and nerve damage.  After all of this, I would like to know how can a two-cent employee at Sedgwick deny my claim when I had also filed for SSDI and it was APPROVED first time through.  HOWEVER, because I was forced back to work – no benefits for the 5 month waiting period and of course, no retroactive benefit.  No medical insurance as I have lost my job.  I need help – don’t know where to turn.

John:

I work for AT&T. What does Sedgwick consider a functional impairment for anxiety?

Attorney Greg Dell:

John,

Sedgwick would probably not approve your anxiety claim unless you were hospitalised. There are supposed to rely on what your doctor tells them, but they will likely not examine you and find their own doctor to review your medical records and say something different. You need a medical record that complies with all findings for Anxiety as stated in the DSMV-V.

Confidential:

I have been on Sedgwick for 2 years for an on the job injury, and without notice, they cut me off in the middle of December. I just got the paperwork last weekend. The claims adjuster made a subtle comment during a phone call that they could be closing the claim at the end of December so I hired a lawyer. Their IME (sent me to the same one twice) on the last visit claimed that I was fit to go back to work at my regular job. My primary physician said there was no way that I could return to my position-this was backed by a pain specialist and a physical therapist. Sedgwick even hired a vocational manager to do a job analysis in December with my HR and manager, and did not even tell him that they closed the claim 10 days later – I had to inform him of it today. Sedgwick is not providing the complete medical file to my lawyer, and has not provided any of my medical information to their vocational manager! After seeing your videos and reading the stories of others, it all makes sense now.

MV:

I work for Walgreens. I was injured on the job by a palette of soda crushing my ankle 6 years ago. I never missed a day of work; had to work overnight as the only mgt. on crutches for 6 weeks. The first Dr. wouldn’t do anything. When I went to him my whole ankle was black, I lost feeling in it. After a few visits and him not helping I finally got referred to someone else. I was told I had extensive nerve damage and it was to time consuming and to expensive to fix. Which was not right, I wanted my foot back to the way it was before the injury. I was sent to another Dr. to do surgery after they found the bone wasn’t sitting correctly anymore. The Dr. they sent me to flat out said it was a workers comp case and wouldn’t do anything for me. From that point on for 3 years I fought with the Dr. and Sedgwick; the Dr. would not let me make an appointment with him and the insurance company wouldn’t change my Dr.. Every time I could no longer handle the pain I went to the ER and each an every time they found out it was a workers comp case and turned me away. Now 6 years later and the claim has finally been closed I’ve been able to get a Dr. to look at my foot. The injury caused my right foot’s arch to raise extreme cavus while the left foot is normal. Since its been so long, it has affected my right knee, my right hip, an the right side of my back. I worked through the pain. Every time it got unbearable I would struggle until I got use to that pain. And each time it got worse that’s what I had to do. I shouldn’t have had to suffer. I didn’t ask to be injured and honestly I’ve had to change my whole lifestyle. Stop doing things I enjoyed like ice skating, skiing, roller skating and even walking for periods of time. I don’t think it’s right that a company can treat people in this manner. If you have the chance to sue them for any wrong doing, do it. I tried but I was told I had to quit my job and sue my company. I didn’t want to go after Walgreens, just the insurance company. If I knew then what I know now I would have sued them. I hope no one has to go through what I have and still do.

Dayna Vigil:

On Nov 4, 2011, I was taken by ambulance out of my place of employment (ADT now Tyco). Diagnosed with Vertigo, I went on FMLA with Sedgwick no problems. I went to Dr. Tyler Lewark who saw me when first diagnosed and prescribed therapy in which phone tag was played and never set up. The episodes started to get more frequent and severe I went back to Dr. Lewark and he was upset I never went to therapy and set it up for me and stated “it would cure me, that it cured his wife”. I applied for short term disability which Dr. Lewark’s approved for 6 weeks, but when it came down to the paperwork he stated my only restriction was driving so my claim was denied and I had to return to work with no pay for the four weeks I was off. I did appeal it, I started to get the episodes at work and also had three episodes while driving and my therepist gave me the number to Dr. Robert Muckle who did further testing and diagnosed me with Meniere’s Disease, he started me on treatments with medication with my body not tolerating any of them. I filed another short term disability claim in which again it was denied due to the paperwork being late, a decision was due on the first appeal by Dec 31, 2012, received phone call from caseworker stating her Drs had all the paperwork from both claims and I should hear back by the following week. Meanwhile, the HR Department starting sending me letters and calling me saying I need to return to work since the claims were denied. I was told I was being terminated and was asked to resign my position. I explained that I would be having surgery and be back to work as soon as possible. I since have kept Tyco updated on my surgery date of Jan 31, 2013 and be able to report back to work on Feb 13, 2013 if all goes well. I have been off work for three months altogether and have not received a penny. Stress and Fatigue are the number one factors of bringing on episodes, so Sedgwick and Tyco thanks for the episodes you have contributed to my condition.

Depressed and Bitter:

I don’t understand why a company totally devoted to helping sick people can be so cruel. I was hospitalised after they first denied my claim, depression is no joke, I am surprised they have not been sued for emotional stress. I had not been working for UHC that long, but long enough for Sedgwick but not Sate benefits.

When they called today I thought they were updating me on the recent approval of my disability, they wanted to know when I was returning to work, I wanted know where my check was (it had been two and half months with no money). They assumed I was getting $1000 from state! I have never heard that amount nor does it read anywhere on the form to call when you’re NOT receiving income, the forms also say in big bold letters that they coordinate benefits with the state department, if they had the ability to see I was making this “phantom income”, they have the ability to see my claim was denied. I am so depressed right now. I don’t want to be hospitalised again, but all my bills are behind, I can’t even afford gas to go to therapy, and I keep accumulating medical bills instead of being able to pay them. I cant believe this company has no mercy.

Des:

Hello, I am currently experiencing some challenges getting my STD approved by the third party processor Sedgwick. One main question I have is, I’m wondering if EDD approved my STD claim, can Sedgwick really deny the claim? It seems really odd to me that one entity would deny benefits & not protect my job under STD benefits, but EDD, using the same medical information, time frames & being CA State approve the claim. Thanks.

Attorney Greg Dell:

Des,

Sedgwick beats to their own drum and they are not obligated to follow any findings by EDD or social security. You should notify Sedgwick of the EDD approval.

Jimmie R. Reece:

I haven’t filed a disability claim but I have filed FMLA claims. They are consistently denieing my claims. I always have to get the doctor’s office involved to get anything done. The most recent claim they are trying to deny is because they said the doctor only prescribed over the counter med. When that was proven to be not the case they said because I work a swing shift that I was not out of work for 4 days. I explained that if that be the case then I will never be able to file a claim. Funny thing is my trouble didn’t start until last year when I filed a claim and the person I talked to asked me my age, date of birth and how many times I had filed in the past. So is it really about me being 61 years of age?

R. H.:

I have had an ongoing disability claim with Sedgwick/Chrysler for over 4 years now, this was a claim associated with a Medical malpractice claim that just settled last march (2012). I can not explain in words how tormenting, how insane, how absolutely criminal (on Sedgwick’s behalf) this process has been! Even with an attorney, who in my mind, also doesn’t know how to fight them! And hasn’t fought them.

I was told by my attorney that if we prevail in the disability claim (which, like I said has gone on now for over 4 years) Sedgwick would have to pay ALL attorney fees, interest on my past benefits, taxes, and the retainment fee I had already paid initially. This, my attorney had told me, that at that point of my case, through the ERISA statute, this is what Sedgwick would be responsible for paying. Then, my attorney (without notice) got Sedgwick to start paying me my back benefits and future ones, all of a sudden, then told me “I” owe him all the attorney fees ($24,500.00 to be exact), did not get interest, Sedgwick is not paying the correct amount, did not get taxes, anything that my attorney had made it clear to me that I would get, he has said he is done, until I pay him this money, and has left me in a whirlwind, an extremely bad position with my employment, my benefits, and my mental, emotional and already physical exhaustion!

If I weren’t aware of the fact that I am alive, I would honestly think I am living in hell with this entire experience! It is so emotional to me to hear all of these stories of unjust! People going through a holy hell and nothing they can do with it! If there is EVER a class action suit that should be brought to any business… it should definitely be brought on to Sedgwick and even the companies and corporations that use them! And “I” want to be part of that class action lawsuit! Please notify me if that takes place! I have asked my attorney about a class action, a bad faith claim, all of it and it was cast aside and was told there wasn’t a case for any of that!

I feel like almost everyone in this situation is corrupt, I can’t trust anyone, it has changed my life and my way of thinking! I had a doctor’s negligence, then an insurance companies’ negligence, then the attorney I was referred too, was negligent! Where or who can you trust from there? How does Sedgwick keep getting away with this criminal activity? I do know in one of Sedgwick’s doctor’s deposition, he admitted he was “paid” by Sedgwick! That this was not an independent examination!

So my question is… who else do they pay to keep their criminal empire going? I’m sure we will never get the answer to that question!

Attorney Greg Dell:

R.H.,

The experience you have described with your attorney sounds unusual. I am not sure if you hired an experienced disability attorney, but I have never seen a situation where the attorney received all of the benefits. In most cases the attorney received an agreed upon percentage of the disability benefit paid and the remaining amount is paid to the client. You experience and battle with Sedgwick sounds horrible and unfortunately sounds common for people that have to deal with Sedgwick. There are no class actions against Sedgwick at the moment, because a class action requires everyone to be similarly situated. Sedgwick’s action may be consistent across the country, but every claimant’s claim is different, which will usually defeat any class action.

Valerie:

Sedgwick CMS shorted my TTD checks in 2007 and has never reimbursed me to date, April 2013. The AME said I could return to work with restrictions, but not back to my usual customary job. My work comp doctors “disagreed” to the AME’s permanent & stationary finding.

My employer offered my usual customary job back to me, said if I did’t take this job offer, that I would no longer work at this warehouse. So I took my same job back.

I was reinjured and suffered new injuries. Sedgwick’s utilization board denied “all” of my work comp doctors requests for MRIs to prove new injuries, repeatedly. Sedgwick denied my claim, stating that, ‘after careful consideration, there is “no medical evidence” and that “employee did not work since the first injury”‘ (!?)

I went back to the AME, he rates my injuries as “strains” as there are no test’s to prove anything! My work comp doctor’s continued to fight with Sedgwick to get MRIs and all sorts of medical treatment. Finally almost 2 years later, exactly “22” months later MRIs are approved! They show the “true nature of my injuries”!

The AME rates me properly. Sedgwick’s “attorney” depositions the AME “ex-parte” and gives the AME old and incorrect information in which to base his answers to. The AME figures some of the defence attorneys tactics.

To date, I have a neuro genic bladder of “severe” retention from my injuries, a bone spur in my neck (from the injury that healed somewhat) causing stenosis in my neck, debilitating atrophy in my arms, that keep me from using my cane that helped me walk.

Sedgwick sucks… Their despicable tactics, denying medical tests to prove injury, denied medical treatment that has caused further advancement of “irreversible” symptoms, “neurogenic bladder, atrophy, bone spur causing more nerve damage”… denying TTD, when clearly the AME said it was owed… It all makes me sick!

How come Sedgwick CMS is not on “insurance, welfare, and social security disability “fraud list”!? They deny legitimate claims, that welfare, state disability, and or social security disability picks up! They deny legitimate claims, so we (the injured worker) have to use our state disability, 401k’s and now I’m on “social security disability.

Unless a person has an attorney that has time to properly address all the bad faith & “ERISA” that Sedgwick continuously gets away with, the injured worker is just screwed…

Kevin Carr:

What I would like to know is with all the complaints against them why is it only threats to take them to court? Why won’t an attorney represent someone and take them to court? I have a claim, it’s not long term, which means no attorney wants it, I didn’t break or tear anything, just collapsed at work and was hospitalised overnight and they will not respond. How can they get away with this? Why can’t we do a class action and be heard? Stop asking on video and start asking in court in front of a judge!

Attorney Greg Dell:

Kevin,

We got a lot of requests for a class action against Sedgwick. It is not impossible to do, but has a low likelihood of success due to the Federal Class Action Rules. In a class action all of the Plaintiffs need to be “similarly situated”. In disability insurance claims, every claimant has a different medical issue and each claimant is being denied based upon their medical condition. A group of employees from the same company with the same disability policy would have the best chance of bringing a class action. We have sued Sedgwick on multiple occasions and have cases pending now.

RH:

Valerie,

I agree… if not a “class action” that can be addressed (still don’t get that) but what about “BAD FAITH”, totally the “poster” for bad faith… but it seems no-one can touch them! I guess they have WAY to much money and power… that’s all I can get out of it! I was actually told from my attorney that I could get interest on my back benefits (close to 5 years of them), all the attorneys fees paid, and costs, then… nothing… my attorney is now seeing me for all the fees, and he said he could get all of this through the ERISA statute! Joke’s on me AGAIN! After going through an absolutely exhausting Med Mal case! I wish there were people out there that “cared” but they don’t… it’s insane to hear ALL of the people here (and I’m sure thousands more) that have to go through this… and like was said, the people that are on welfare (that we pay for) don’t have any of these problems! The “state” takes care of them! So, so… disturbing! Where is our voice?

Attorney Stephen Jessup:

RH,

We are sorry to hear about your struggles and experience. Unfortunately, until something changes on the federal legislative level, insurance companies will continue to act in a way that seems inherently wrong.

Robin McMullen:

I have MS – I went out on STD in November. As long as I stay inside, calm and stress free, I’m not suffering from the bad tremors, vertigo, etc. Probably won’t be able to return to work, I know that. But my STD was supposed to be for up to 12 months per my employer, a County agency. I’ve been cut off, because I had been told to only write it for 6 months at a time or through 5/15, and at the end of the 6 months the supplemental form online has dead links – when I called for it to be sent to me, they said they can only send it to my doctor. I asked for it to be faxed on the 7th when I had my neurologist appt. (one of many specialists) – my doc’s office received it several days later (on the 10th) and wouldn’t complete it without me and since I don’t drive I didn’t get there until Tuesday the 16th, but they faxed it right out as Sedgwick’s fax history proves. I logged in and discovered I was terminated! Guess no COBRA or any insurance or assistance for me… what is the agency that provides oversight to such companies? Who do I complain to?

Attorney Stephen Jessup:

Robin,

You can complain to your State insurance commissioner, or the entity that overseas insurance companies in your state.

CJ:

Not only should Sedgwick CMS be sued and closed down, the IME doctors that they are sending you to are making false medical reports and should be reported to AMA. They are charging enormous fees to make false reports to please Sedgwick, this is a crime against the medical profession an it should be stopped. Who is over Sedgwick CMS, what government agency can we file a complaint to? They are playing with people’s lives, which can result in further injuries or death. The more who stand against this type of action by this company & IME doctors, the faster we can stop this. Sedgwick can without doubt be closed down. You must fight against this type of company for your rights. The government closed down banks and mortgage companies because of their fraud practices. Who is Sedgwick? They should go also, along with these bad doctors.

Attorney Stephen Jessup:

CJ,

Complaints can be filed with your respective state Insurance Commissioner or other State Agency that overseas the regulation of insurance companies in the State.

Rory H. Garrison, Sr.:

Greetings,

I am a Labcorp employee, and on January 18th I suffered a systemic stroke. I was hospitalised for 4 days, and the stroke affected the left side of my body. The left side of my mouth is twisted slightly, and there is a constant burning that gets really bad when I have to speak, eat, and especially when I brush my teeth or rinse with mouthwash of any kind. My left hand is numb constantly, mostly my fingers. And whenever I type the pain really kicks in and become very bothersome. My left arm and left leg down to the sole of my foot also are still tingly and numb, but not as much as my mouth and hand.

One week after coming out of the hospital, I suffered a new fatal drug reaction to the “carbomonzapine” prescribed to treat my stroke after affects as described above. I spent 5 more days in the hospital and could not return to work for several weeks. I am a customer service support representative and my job is to answer calls for the lab. Our quota is 90-100 or more calls per day. Before the stroke I was averaging 140 calls a day. Each call consists of typing nearly every word the caller is saying and troubleshooting any problems. After being out of work for over a month, I went back to work and had to be placed on restricted or 4 hour days. Sedgwick paid me for two weeks.

Since that time I have been in and out of work with pain. Sedgwick stopped paying my claim and denied any further disability payments. I am struggling with eight hour days when my doctor clearly stated that 4 hour days until I am ready to function normally, if and when that ever comes about. My stroke left me in lots of continuous pain and limitations that the doctor has diagnosed as irreversible. What should I do to get Sedgwick to pay up?

Attorney Stephen Jessup:

Rory,

It depends on the language in your policy. From what I gather, it appears that you have returned to work and are working 8 hour days, although with difficulty. As such you may not be entitled to any benefit as you have returned to full time work. If your policy does not offer residual/partial disability you may have no means to collect. Please feel free to contact us if you would like to discuss your claim further.

Jay Loo:

My wife just gave birth to our first child. The delivery was highly complicated requiring extensive labor (5 hours pushing), episiotomy, forceps assistance operation, loss of half her blood requiring a transfusion, kidney shutdown postpartum, and an operation to remove excess massive clots that developed the morning after delivery. Needless to say it was not a “normal spontaneous” delivery and the doctors recommended 8 weeks recovery as opposed to 6 which is standard for NSVD. We sent the paperwork showing 8 weeks immediately off to Sedgwick.

We called Sedgwick when the benefits only showed 6 weeks approved the following week and were told the doctor could not just give 8 weeks without first seeing her at 6 weeks. So at six weeks checkup the doctor writes papers for 8 weeks as my wife is still anaemic (despite the transfusion) and has difficulty moving around. Today I heard she was on a phone all day with the Sedgwick administrator and was told her 8 weeks was denied (but she can take 2 more weeks unpaid).

We are thinking of giving up because we can see it is a bunch of inconvenience being pushed on us, but how can they flat out deny what her two doctors have indicated as the medically necessary recovery? We asked for a Sedgwick supervisor to call us back.

Can you please suggest anything to help? We are talking about two weeks compensation but we cannot afford to lose the pay and I am worried about my wife’s recovery if she tries to return to work next week against her doctors’ advice.

Attorney Greg Dell:

Jay,

Battling for two weeks benefits is frustrating and time consuming. You should submit a written appeal if it is worth the money to you. You have a good chance of prevailing if you submit proper medical support. Due to the limited benefits you are seeking, hiring an attorney does not make any financial sense in this situation. Please use the information on our website to help you.

Ron O.:

This is on behalf of my wife. She’s 60 years old and has worked 18years for a company that Sedgwick (or Sludgewick) represents. (I say Sludgewick because they are a bottom of the barrel co.) My wife has carpel tunnel syndrome so severe that she can’t move her fingers or thumbs without being in severe pain. She needs surgery and has needed surgery for five years. Her claim has been held up by Sludgewick for almost 5 years, she won two decisions and now they, Sludgewick, want to take it to Superior Court in a last ditch effort to deny my wife the care she needs. Her thumbs are notably worse and they denied any treatment for them. They have lied, paid off doctors and manipulated everyone involved in her case. I am sure they treat everyone they deal with the same manner. This company is the most evil and sinister of any company known in modern times. Their policy of intimidation and aggressively attacking and fighting anyone that has a legitimate claim is morally and ethically wrong. I can’t believe that there aren’t class action suits against them and if there are, we will gladly join.

William. L. Lane jr:

I just went out on May 1, 2013 for back problems. I have had 3 surgeries on my back in the last 10 years. Going back to work this week, June 12, 2013.

Dr’s papers sent to Sedgwick said I was disabled from May 1 to June 27, and also said that I could not do any work during this time. Sedgwick didn’t care, they denied my disability claim. I have sent in the appeals form, but haven’t heard anything from them yet. I am sending a letter and information to the Georgia Insurance Commissioner to see it they can help. People need to get together and put these people out of business.

Jamie C. Baca:

I have been dealing with Sedgwick in one form or another (workman comp of Texas) since 1993. I recently moved from Texas to Winder, Georgia last year. I have already had to pay for airfare to Texas twice to see my doctor, Dr. Paul Geibel of South Texas Spinal Clinic. I can only go once every six months. That’s what is allowed by Sedgwick. Plus it taks me 6 months to save for ticket. I’ve asked my adjuster Betty Connally for the neurologist’s name and number in my area; now she says she doesn’t know anyone in Georgia. I’ve had a Lamenectomy in 1994 and a spinal fusion in 2001. I saw my Doc. on June the 7th 2013. He has requested another M.R.I. I don’t go back ’till Dec. 10 2013. Maybe someone can help.

Jill Barber:

Thank you for speaking with me. Where to begin? Back on Sept. 24th 2012 while working at my store (GM family dollar)i was moving around dog food and throwing out the expired products I was almost finished and was sweating which I brought my right forearm up to wipe across my forehead I glanced very quickly and noticed a spider on my right forearm not thinking I just knocked it off my arm and continued to work. Later that eve I was in my office doing schedules and I noticed what looked to be a little pimple on my right forearm still not putting two and two together I put some neosporine and a band-aid on it.

Left work and came home around 3am I woke up and was achy,hot and then cold so took some Tylenol laid back down got up around 5:30 am and went to work. My director was there helping me set up Xmas she asked if I was OK and I said yea think I just got a touch of the flu and continued working still not putting two and two together my arm was killing me but put it out of my mind.

Finished up and came home that’s when I noticed that the little pimple was now the size of a half dollar so I put neosporine and bigger band-aid on it went to bed and woke up and got ready for work. It was Friday and pretty busy but I was not feeling well at all. Dizzy,sweaty and hot and cold so I went and sat down in the office one of my employees came to check on me and he said Jill your arm is huge what happened I said not sure and that’s when he replied did u get bit by something on that arm and that’s when it clicked I had been bitten by that spider. I called the nurses line that our company has and she told me to call 911 which I did and was transported to Cabell Huntington emergency room and that’s where the nightmare started.

My arm the size of a small watermelon with a bulls-eye in the middle. I was released being told I was bitten by a brown recluse spider by the way the markings were also circled my arm in pen and told me to return if the redness went past that mark. Well it did and early morning I returned to the er and was admitted saw several infectious disease dr’s and they had discussed debreeding it,packing it and wound vacuuming it but the next thing I know I was released and nothing was done.

I have been in and out of the hospital over 24 times and still nothing was done except for lots of iv meds and pain meds. Still they never opened my arm and still to this day. Since it happened at work its workers comp which we use Sedgwick. I went for almost 3 months with no caseworker come to find out she was on family medical leave for 3 months and my file just sat on her desk til she came back. meanwhile I’m running all over trying to get help with my arm. Back and forth I went but still no one would open it. Then my caseworker went out again and this time my file was passed onto many caseworkers but I couldn’t get in contact with anyone for months from Feb. 2013 til end of May 2013 no one was returning my calls and my arm had now lost feeling and shakes horribly.

This is just a small part of this story. It has and will become a huge case. From medical malpractice, social security and workers comp attorney have all taken this case. This has changed my life see because im very athletic and can play no more. I hope this sparks interest to hear my story because this can happen to anyone, even worse a child. I have documents that have been falsified by Sedgwick, hundreds of pictures and a lot more to this story.

All I want is to be heard and helped! Oh, almost forgot reason I was denied hyperbaric oxygen chamber is… ready for this I am a 47 year old male who uses illicit drugs, I smoke and am an alcoholic. First of all, I am a female, I don’t smoke, use drugs or drink, I am an athlete and the Dr. Sedgwick had look over my case was a family practice Dr. not a specialist. I am taking this huge insurance co. to court!

Thank you,
Jill

Attorney Stephen Jessup:

Jill,

I am sorry to hear of your struggles. It appears from your account that your claim is for worker’s compensation and social security benefits. Do you have a private or employer provided disability benefits? If so have you filed for same, and what is the status?

Jessica R.:

I was injured on the job back in late January of 2013 and have had to deal with Sedgwick. I have caught them in numerous lies where they stayed they were not paying me because they claimed they never received my pay stubs to prove reduced earnings, when a week prior I was told they had them and “the check is in the mail.” My claims adjuster vocally blamed me for my problems and told me its not her problem. I re-injured the same body part after returning to partial duty and am now back to full temporary disability. My claims adjuster started yelling at me so I hung up on her. It has been 39 days since my doctor requested physical therapy and Sedgwick still has yet to approve or deny it. Mean while as o wait my entire ankle and arch has begun to collapse causing extreme pain that has me in tears every day, and now my doctor says I may have permanent damage that would require surgical implants of more than three rods and six screws to rebuild my foot and ankle that could have been avoided if I had been able to do my p.t. over a month ago. Sedgwick is the most incompetent company I have ever had to deal with. They are lairs, cheats, thieves, and a disgrace. Lack of timely case management from proper payment, to pain management, and timely medical authorizations led me to have a complete nervous break down, Sedgwick refuses to acknowledge that part of the claim… They are literally destroying any chance of full recovery I had and slowly killing me…

Attorney Stephen Jessup:

Jessica,

Is your claim for worker’s compensation or for disability benefits? If it is for worker’s compensation I would suggest that you speak to a worker’s compensation attorney to determine what your rights are.

SA:

I was recently denied short term disabiity from Sedgewick for a major depressive episode. I have been employed with United Healthcare for 13 years (exceeds expectations ratings) and had this episode after finding my daughter was addicted to pain medication. After getting her to treatment and to a halfway house, I left work with near fainting and heart palpitations and unable to function. I went to the hospital but did not stay overnight. This was after several years of severe work stress where I was threatened in meetings, dealt with employee who had cancer and died, an employee who became pregnant by a leader, etc. My doctors are adamant that it is too soon to go back to work. I feel this hurt my credibility with my employer. I am about to appeal for the first time and my doctors are suggesting legal involvement.

Attorney Stephen Jessup:

SA,

I am sorry to hear of your struggles with Sedgwick. As I am sure you have learned, what you are experiencing is not uncommon. Please feel to contact us should you have any questions on how we may be able to assist you.

Christina:

I was injured in an automobile accident on Jan. 23rd and have not been to work since the accident and have not been paid in a month. I have a team of 8 doctors and those collaboratively agree I should not yet return to work. I have had three, nearly four IME exams where the first doctor agreed with my doctors plan. They didn’t like that answer so sent me to another which I did not go to as I brought it to their attention this doctor along with my last were being sued in Federal court for violation of the RICO statute. Two of the doctors they have tried to send me to are being sued in Federal court. They have since sent me to two more IMEs who say I am fine to return to work. Their doctors don’t care about my medical records. I am suffering from neck and back pain along with post traumatic stress disorder, anxiety and depression and migraines. In addition my insomnia has worsened and my medication titration is not yet stable. They just denied my neurologists claim that I am disabled and I am to report to work because I cannot continue to go without getting paid. I have made an official appeal but have yet to get the results. This company is dirty, I am really at a loss as to how to proceed. By the way, my employer does not pay for anything but my paycheck, my medical benefits have been paid by my husband’s employer and auto as secondary.

Attorney Stephen Jessup:

Christina,

I am truly sorry to hear about your troubles. I wish I could say that this is uncommon with Sedgwick, but I think a review of the comments and complaints on the internet make it clear it is all too common. Please feel free to contact us to discuss how we may be able to assist you in the event your appeal is denied.

Shea:

I got approved for LTD in 2009 and finally found another job in another state that I could do because it fit the restrictions late last year. Sedgwick was dragging their feet on continuing the claim and approved continuance the day I was loading up to move. While the company who employs Sedgwick approved my claim through 12/2014, Sedgwick kept having me fill out qualifying paperwork/re-examination every 3-6 months. Every dealing with them set me back in my recovery efforts. It was like I was a criminal. So the last month of their disability I notified them I thought I went over the benefit amount with income so they needed to close my claim. I knew I would owe them 1/2 of the salary I earned for the qualified days for that last month… 25.5 days to be exact. First they sent me a letter saying I owe them zero. Previously they had taken 2 months more out of the lump sum SS payment I received which made the offset even or that I was getting the SS offset for one month in advance instead of arrears as they now claim. I can prove this. So after they sent the I owe zero amount overpayment, a few weeks later (after I’d spent the money I had set aside to reimburse them of course), I get another notice that I owe them a full one half the salary for the entire month. Obviously the salary that month was more than the benefit amount since that income ended my claim. They want me to reimburse them $1000 more than what they paid me in benefit that last month! I keep telling them they can only take half of the income up to the benefit amount they actually paid me! No. They keep running me in circles on the phone making me relapse from their bullying. I’m so sick of this. Who can I report them to? This is the office in soCA and the LTD plan who hired them is in another state. They should be put out of business under the ADA for their horrible discrimination and harassment of disabled people. It is completely insane what they do to people. I just cannot deal with them anymore.

Attorney Stephen Jessup:

Shea,

You can file a complaint with your State Insurance Commissioner and explain what Sedgwick is doing and the errors they are making in computing the repayment.

Robert J Healey Jr:

Sedgwick approved my claim but due to financial hardship I requested an off cycle payment since I have not been paid in sometime the denied it with no reason why and my processor has never called me. I work for Optum RX, do I have any recourse for the hardship they have created for me?

Attorney Stephen Jessup:

Robert,

If your claim is governed by ERISA, unfortunately there is no recourse for “hardship.” Under ERISA the only damages an insured is entitled to is unpaid benefits. However, I would suggest filing a complaint with your state insurance commissioner, so at least the state is put on further notice as to what Sedgwick is doing. With enough complaints there stands a chance that the state insurance commissioners will enact stiffer guidelines for disability insurance carriers/administrators in the state.

Karin:

Robert,

I also worked for UnitedHealth Group and had issues getting paid, I would suggest you contact United HR Direct and talk to a payroll specialist. They were able to help me out once I was approved.

Pat:

I have been off work for almost a year with 2 bulged discs, multi-level degenerative disc and it is severe in my L-5/S-1 area where I had surgery 16 years ago. I have also found out I have moderate arthritis and bone spurs in my right hip along with sacroiliac joint pain. I have been treating with a doctor at the spine center since December 2012, I have had a steroid shot in SI area, an injection in SI joint (which made things worse)as well as a hip injection. I have gone to physical therapy 2 different times and both time have stopped due to reach a point of nothing helping. The steroid injections have done little to help. I recently was diagnosed by my GP has having panic disorder that he feels has been brought on by the injections. I was scheduled to have a third injection in my lumbar spine, per my GP request I have postponed that injection at this time. In the meantime I received papers from my ltd carrier for a 6 month review requesting all visits, tests, etc. as well as their form to be filled out and if not received by 8/31/13 my benefits will all be stopped including insurance and cash. I saw my doctor at the spine center to discuss other options at this time, he stated he doesn’t feel that the injection have anything to due with my panic disorder and wants to send me to the pain clinic so I can be sedated for the injection. He totally refuses to fill out the insurance forms stated he deals with spine issues. He is the Dr. on record and has been treating me. What if anything is there that I can do? My employer will not allow me to return to work until I am 100% with no restrictions and currently I am unable to return due to my inability to function normally with daily activities. Everything I do increases the pain and inflammation. The doctor has not released me and is now sending me to the pain clinic. If my benefits are stopped I will have no money to survive on and no insurance to continue my medical care. Is there anything I can do? Any advice would be greatly appreciated.

Karla Terrell:

Hello, as of January 2013 I found out that I had an workman compensation claim that had not been paid out the social security contacted me to let me know about this. In October 24, 2005 I had a work injury when I lived and Baton Rouge Louisiana and I hired and attorney but he told me not to hold my breathe because I probably would get nothing. Well, I went on with my life and forgot about it until January 2013 when I got that phone call from Baltimore Maryland Social Security Payment Center.

So, I had no way to find who had this information so I begin to do a lot of research until I came around Sedgwick CSM so I called them and I told yes we are handling your claim and we just need information I told no problem what do you need. I faxed them the letters from social security and now no one will contact me back. Why?

I wrote the White House about my situation and they had a represented from Baltimore Maryland payment center contact me again and they said we need to get the bottom of this and gave them my adjuster name and number but they never contact them.

I am sick and tired of people avoiding me I have the right to know… All they said to me tell the social security office you have never been paid, your money is still here… So, my question is very simply why is it taking so long to get back to me?

Attorney Stephen Jessup:

Pat,

Unfortunately, if your doctor is unwilling to cooperate with filling out claim forms then it could provide your carrier reasonable grounds to deny your claim. This is not an uncommon occurrence as many doctors do not want to be harassed by insurance companies. Outside of finding a new doctor, there is very little advice to give.

Attorney Stephen Jessup:

Karla,

Unfortunately I am not able to answer your question. You will need to consult with an attorney that specializes in worker’s compensation cases.

Jen Sylvester:

They said I got overpaid and now I have to pay them back. I call 4 times about how much I was getting how I was get paid every week I was told every thing was fine it was right. Now they say I never told them when I did and they just found out when I need more time off when I called them now I am not getting any money this time it will be going to pay off the money. Told them now it me that has to pay not right. Help. Thank you.

Attorney Stephen Jessup:

Jen,

If you Policy allows Sedgwick to reduce your benefit by other income that you have been receiving, they would have a right to recollect the money.

Ceci:

Sedgwick denied my request for intermittent FMLA leave. After I had outpatient surgery and was off 2 days, my eye doctor recommended that I be permitted to work on a reduced leave schedule (3 days per week) for a period of about a month following the surgery because my eye was still healing. Sedgwick wrote me a letter stating that my employer would not accommodate ANY request for reduced schedule leave, and the only way I could qualify for intermittent leave was for “flare ups.” But the purpose of my leave request was not “flare ups,” it was to limit my time at work so that my eye could recover. When I had the 2nd eye done, I got in trouble at work for taking 9 days off including the day of surgery – but I knew there was no way Sedgwick would approve my 2nd request for intermittent leave.

Becky:

I have severe rheumatoid arthritis. My doctor prescribed Humira for my condition. My insurance company mandated that I use Cimzia before Humira. Cimzia quit working after 5 months and I had a very severe flare up and went on STD. Sedgwick, of course. I was out 18 weeks due to this flare up. Sedgwick denied the last two months of my claim. The doctor’s notes don’t support the time off. I saw 5 other physicians for conditions related to my rheumatoid arthritis during that time. Sedgwick is unaware of the other physicians visits. I plan on appealing my case with Sedgwick by providing the medical records from the other physicians. If I lose my appeal I will be terminated by my employer. I have never taken time off for an illness or used any form of disability insurance before. Do you think I can win my appeal? There is an added twist to this. Please email me. Becky.

Attorney Stephen Jessup:

Becky,

As all claims are different, from the limited amount you have provided, it would be hard to determine chances of success on appeal. Please feel free to contact us to determine how we may be able to assist you.

Crystal W.:

I had 2 claims with Sedgwick. My first was a short term disability from the end of September 2011 – November 2011, they stopped my disability early and didn’t pay my last payment. When my doctor didn’t clear me to return to work Sedgwick bought in a doctor who never spoke with me or even examined me to say I was not sick. I ended up having 3 more surgeries after I was told by my employer (LabCorp) I had 2 days to return to work… I did but I got sick on the job and ended up having another surgery. I filed again and was given the temporary approval so they could verify my surgery but I was told by my doctor that they never did. When I got out of the hospital there was a COBRA package on my bed. Yes LabCorp fired me and Sedgwick screwed me.

Attorney Stephen Jessup:

Crystal,

I am sorry to hear of your difficulties. What is the status of your claim now? Please feel free to contact our office to discuss how we may be able to assist you.

Jessica:

I have had an ongoing claim since Jan. 2013 and Sedgwick has been horrible. From missed payments, wrong amounts, and disgusting comments made to me on the phone. I had returned to work at reduced hours in April and during my “light duty” I was asked to move 68 pieces of heavy furniture in my four hour shift with one person to help me. Needless to say I re-injured myself and was removed from work by the doctor in May. I was not paid by Sedgwick my lost wages while on reduced hours. Once I was removed from work the second time Sedgwick sent me to their doctor. He was rude and aggressive and didn’t even fully examine me. He made a recommendation that my injury was related to and accident that I had 18 years earlier that did not even affect the portion of my body my worker’s comp claim involves. In July all payments from Sedgwick stopped. They sent me a notice that they are ceasing my payments based on their doctor’s recommendation that it is not work related, mind you my injured area never caused me any issues in the past 18 years, just started in January when I was crushed at work. Sedgwick also did jot send me a copy of the C-11 form as required by law. I am unable to receive any of the medical treatment or physical therapy to get back to work. I have used all of my savings and loans from my 401k in order to support family. My lawyer waited until the end of August to apply for a hearing and I am still stuck waiting. I do not know what to do now. I’m still in pain, my lawyer is dragging his feet, and my long-term disability claim has been denied… Next time I het hurt on the job I won’t say a word if this is how employees get treated.

Attorney Stephen Jessup:

Jessica,

I am sorry to hear about your experience. So it appears that you are awaiting a worker’s compensation ruling? If so, then there would be no information I could provide to direct you one way or another. With respect to the long term disability denial, if the coverage is based on an ERISA governed group disability policy then you must be sure to file all required administrative appeals within the mandated deadlines.

Crystal W.:

Mr. Jessup,

I just settled with both companies yesterday. I wanted to fight but my attorney didn’t, so I’m not happy about the outcome but at least it will be over.

Jessica:

Am I allowed to sue anyone for all of the additional problems I am having? While I sit and wait for my court ruling I am suffering severe financial loss. I am now facing eviction because worker’s comp. is trying to say this is not a work related injury. My bills are two months behind with late fees and I am facing my utilities being turned off. I am a single mother of three young boys and have tried the assistance programs in the area. It has been since January of this year so I have used all of the help in the area. I am so depressed and don’t know what else to do… Are there any laws to help the worker that is being smacked around like a rag doll?

Attorney Stephen Jessup:

Jessica,

When you say waiting for your court date, I assume your claim is for Worker’s Compensation benefits? If so you will have to consult with an attorney specialising in that area of the law to be better informed as to your rights.

P.W.B.:

This is an old Worker’s Compensation case. In 1981, my mother was injured while working on the assembly line for General Motors Corporation, in Fremont, California. After filling out the Accident Report, she was sent to the GM company doctor. After the doctor examined her, he released my mother back to work, with a note placing her on restricted work. When my mother returned to work, she was assigned non-restricted work. As a result, she was re-injured. When she returned went back to see the company doctor, he wrote a letter to GM stating that “despite” his recommendation, my mother was re-injured because they could not accommodate her with restricted work. In the letter the doctor stated that my mother will be permanently disabled in the future. While on disability, there was a Model Change and the plant was closed. “While on disability,” my mother was sent a letter from GM or the Union, placing her lay-off status. How can this be when she was already on disability? Since 1981, my mother has been seeking benefit payments. Recently, my mother was labeled as a vexatious litigant because she keeps filing requests in court for a hearing. Her case has been taken off calendar several times. Although my mother has “all” the evidence to substantiate her claim, her request for benefit payments keeps falling upon deaf ears. The case was never settled after 34 years.

Attorney Stephen Jessup:

P.W.B.,

If the action is one for Worker’s Compensation, you will have to consult a Worker’s Comp attorney as to same. Additionally, if there are any concerns regarding any issues related to her employment with GM those would be best addressed by an employment attorney. However, please note that since the facts surrounding your mother’s claim occurred some 32 years ago chances are any applicable statute of limitations has expired.

Rosemary:

I filed for short term disability through my employer’s representative Sedgewick CMS due to my diagnoises of Recurrent Major Depressive disorder. The dates I provided to Sedgewicks were to commence 14July2013, however prior to the onset of my episode I did report an OJI and missed the days prior due to OJI and Dr appointment for OJI, which commenced on 05 Jul 2013. I did receive a denial of my benefits based on lack of medical documentation supporting my leave commencing on 05Jul13, the day my OJI was filed in office, and this in contrary to our companies policy, instead of the date I provided of 14Jul13 which all medical documentation does support. As of today I have yet to return to work but have lost all my benefits included my health insurance although I do continue my therapy and pay out of pocket for my meds to assist with my depression. My claim is under appeal, and my workers compensation case is now being handled by an attorney, however I have since been evicted and myself and my youngest daughter are staying with one of my other daughters, her boyfriend and daughter in a one bedroom apt. I have also lost my mode of transportation due to not able to make payments. I have since been approved for unpaid medical leave for original dates provided by myself by same company and have been advised by my employer not to worry about my job but they have put me in such an awkard situation I am almost forced to go back before I am really strong enough and my current situation is only making it harder. My disability is a DSM IV disability w/ the ADA and was noted as such by my therapist, and I fear going back too soon will only set me up for failure. At this point are you able to advised me of my rights. I am so sick of living in fear and ending in failure….

Attorney Stephen Jessup:

Rosemary,

I am sorry to hear of your difficulties. If the claim was denied you would have to go through any mandated administrative appeals that may be required of the policy.

Liz:

I am wondering if there is anything that can be done in regards to emotional stress. My Doctor put in for worker’s comp for the repetitive injury to my right wrist and it was denied. I put in for STD as I need the money badly. After 2 1/2 months that was denied. They are saying not medical reason for being off work. I have fought with them for the past 4 weeks and have gone in to a deep depression from it. Last time I sought help for it I was off work for 3 weeks per doctor’s requirements due to suicidal thoughts from the medication and we denied STD at the old employer. I am afraid to continue the appeal on this one with the additional stress. I have a special need son and we suffer serveraly fianacially.

Attorney Stephen Jessup:

Liz,

I am unsure as to your question. Can emotional stress be a disabling condition? If so, yes, but most carriers will deny benefits based upon emotional stress/depression/anxiety, etc that was not being consistently treated for prior to the period of disability.

Karen B.:

I have been approved the whole time for my LTD insurance. My major complaint is the disability time limitation for mental illness disorder claimants. I will receive LTD for 2 years only even though I worked for my company, a bank, for 28 years counting the time I’ve been on disability. I think I am being discriminated against because of my disability. I was told by Sedgwick that this is a typical practice of insurance companies. I think it is extremely unfair. Mental illness is just as debilitating as any other illness. Sometimes even more.

Attorney Stephen Jessup:

Karen,

Almost every employer provided disability insurance policy limits claims for mental health, with the most common time period being 24 months. Unfortunately, it is legal for them to write such a restriction and if your policy has this language there is very little that can be done.

Karen B.:

Stephen,

Yes, I understand that my policy states the limitation. My argument is that insurance companies that write this into their policies need to be challenged because this is gross discrimination against a large number of Americans. I can’t find anyone that is willing to challenge this discrimination. I understand that back pain is hard to determine but there is not a limitation on that disability. I just would like to find someone who is willing to challenge this policy. If not for me, but for future mentally disabled Americans.

Attorney Stephen Jessup:

Karen,

The policy is essentially a bargained for contract. The terms written into the policy are the ones paid for by the employer and then provided to the employee at no cost or at very low premiums. The adage, “you get what you pay for” is very much the case. To purchase coverage that isn’t limited one would have to secure a private policy, which comes at a substantial premium rate, and even then many disability insurance companies will still only sell a policy with a two year limitation for a mental health claim. Although I understand your frustration there is no applicable lawsuit for “discrimination” as the terms are a bargained for benefit.

SKumar:

My wife FMLA claims are processed and administered by Sedgwick. We have a 8 year old son who suffers from Severe Autism. We have had a intermittent FMLA case where by she was able to take time off to attend to my son need at time of flare ups and aggressive temper tantrum. My son school cut his hours to half day in August and are planning to cut to just one hours of schooling. My son needs to be watched at all time as he has no understanding of his surrounding and would often engage in self injurious behaviors amoung multiple other things. His speech is limited and often had to be engaged properly to understand his need from feeding to toileting and dealing with medication side effects. His condition is very debilitating.

last week we were notified that her FMLA case is closed because she reached zero hours remaining. It was .50 hrs remaining however. The asked us to send a new doctor’s certifications and process a new case. She builds up her FMLA hours based on hours worked last year. She will accrue 8 hours this Sunday 3rd Nov and 8 hours every Sunday after that. We have our Son’s Doctor already faxed the completed certification and we were asked to also sign and fax them a very open Auth of release of my son’s medical info, which we already did and faxed them.

I have a strong fear based on my conversation with the claim specialist and his supervisor that they will make it difficult for us. Just to let u know the FMLA is non paid and also forces us to use our vacations first. I will know more next week but am very concerned. Sedgwick took over processing this year, thus first time dealing with them.

CB:

I was working in an extremely loud environment for several months and developed tinnitus in my ears. When I filed a workers comp claim, Sedgwick was going to make me wait two and half months to see a doctor. During this time, the person assigned to me was impossible to contact and rarely returned my calls. My condition was unbearable and after two months of waiting I couldn’t endure the suffering any longer. They wouldn’t let me use my normal work insurance to seek medical attention. They told me that my regular insurance would reject any claims sent to them since it was workers comp. I learned that the doctor they were going to send me to was only a GP and was going to evaluate me to then see a specialist. This was going to then take several more weeks beyond the two and a half months. I had to plead with Sedgwick to drop the claim so I could seek medical attention sooner. They finally did drop the claim and I was able to see a doctor. Unfortunately I learned that there is very little medical science can currently due for tinnitus. I am out of pocket for all my related medical expenses. There are some therapies that are supposed to help, but insurance won’t cover them and they are far too expensive for me. Sedgwick is a horrible disreputable company that gives their clients nothing but disservice.

Randal Dickson:

I am a cancer patient on STD from AT&T, my cancer is inoperable but the Sedgwick calls keep coming after or even before my Endo appointments. Now they are trying to get my Endo to submit to a peer to peer review over the phone and he refuses. I expect any day now to be denied further STD.

Since no surgery is forth coming what am I expected to do? DIE?

Very little to no compassion from the AT&T machine.

Attorney Stephen Jessup:

CB,

Thank you for sharing your story, and I am sorry that you had such a difficult experience. As you can tell, you are unfortunately not alone.

Attorney Stephen Jessup:

Randal,

Unfortunately your situation is not uncommon. The insurance company, or as is the case with Sedgwick acting as a third party administrator, does have the right to make ongoing determinations as to entitlement to disability. As most STD benefits are paid weekly, this can mean weekly. Please note that your doctor’s refusal to speak with Sedgwick could have adverse effects on your claim.

Valerie Hardwick:

Why does some idiot in a cubicle have the right to override my mom’s doctor decision on how often I need to be off? I am allowed 12 weeks of FMLA whether I take it all at once or here and there. The diagnosis is chronic and I have medical power of attorney. My next step will probably be an attorney.

Attorney Stephen Jessup:

Valerie,

That is the million dollar question. Sedgwick is known for their incredibly frustrating claims handling. Hopefully you will not have to resort to hiring legal representation.

Ms. Bothered:

It’s been a nightmare dealing with Sedgwick. I had surgery on my hand earlier this year. I do a lot of typing for my current job so it is imperative that I completely heal before going back to work. Well, according to Sedgwick, they felt that after about 10 days post-op, I was able to go back to work because they claim they didn’t receive my medical records in time to warrant the rest of my time off and not only that, the information they did receive did tell them I experienced pain and did not have full function in my hand. However, according to Rep, the notes did not mention my range of motion status, so it was denied. Well, my first post-op visit was the removal of sutures…does that count for anything? It makes no sense! The doctors office sent in requested medical documentation at least 4 times and still, the rep claim she did not receive ANY records. Needless to say, I was still in pain and experienced stiffness. They sent in a form asking questions about my status and still, the answers guven wasnt good enough. I ended going to physical therapy for a couple of weeks an then foun out that my cyst reappeared as that te stalk wasnt fully removed an was attached to a nerve. This is why I was experiencing pain, weakness, numbness, etc. Still, this wasnt good enough for Sedgwick. I ended up with a second surgery about 4 months after the first one and still had to go through the appeal process because they considered this to be the “same claim”. This has been a total nightmare!

Ms. Bothered:

Oh and forgot to mention that despite my Doctor saying I need the time off and can’t function, Sedgwick decided I had enough time off!

Ann T.:

You know I was suspended from AT&T after my Dr. wanted me off. This Sedgwick company is now denying my claim to disability saying I am suspended pending some investigation, but I am not fired. Don’t know why… what should I do, apply for unemployment?

Diana:

My claim management was transferred to Sedgwick one month ago after my employer (in WA. state) sold to another. Without any notice, Sedgwick has denied payment for my medications. I have been on these meds for 2 1/2 years and require them to keep my complex regional pain syndrome under some control. I acquired CRPS after an entrapped nerve following reconstructive foot surgery due to a crush injury. I am not fixed and stable according to my physician and I continue to see him every 2 months. Sedgwick has also informed me that they are making appointments with IME doctors. My claims manager also let me know that my medications are very expensive. She also stated that my employer had tried to settle with me several times, but that is an outright lie. There has been no contact whatever with me regarding that. Which I found very unprofessional, at the very least. I honestly feel that I am being railroaded out of my recovery. My experience, although brief, with Sedgwick is one of OMG! I cannot believe that this company is still in business. What options do injured workers have with this company?

Nat:

Sedgwick scheduled a medical appointment for me to visit their doctor to continue my long term disability claim. Sedgwick’s doctor ended up saying I would need surgery because I did have significant issues. Sedgwick’s claims manager actually falsified restrictions for my employer as if it was from their doctor to help my employer force me back to work before my long term disability ended. Sedgwick then terminated my disability claim. I filed an Appeal but Sedgwick denied it of course. As a result of Sedgwick’s false medical restrictions I suffered with a lot of pressures by employer. I eventually lost my job all together as a result of complaining about a incident that occurred as a result of Sedgwick’s fake restrictions. I tried reporting Sedgwick to the insurance commissioner but they stated Sedgwick is a third party insurance administrator only so they could not do anything about their practices in the sorry state of California.

True or not I cannot believe this place got away with doing this and helping to cost me my job altogether.

Attorney Stephen Jessup:

Ann,

It is unclear as to what your disability status with the company would be, and as such I would not be able to provide any guidance. Please feel free to contact our office to discuss your situation further.

Attorney Stephen Jessup:

Diana,

Is your case for worker’s compensation or disability insurance? If it is for worker’s compensation I would suggest you consult with an attorney specializing in that area of the law.

Antuan Charley:

I’ve been at Comcast for 7 years 5 1/2 years as a Technician and 2 years as a Customer Service Agent in Michigan. Comcast just recently switched to Sedgwick in 7/2013 from Liberty Mutual which I never had any issues or problems with. Sedgwick is one of the Most Unprofessional Ignorant Company that I have ever Dealt with, I’m also a Disabled Veteran. I was on FMLA (Family Medical Leave of Absence) With Liberty Mutual 2 months prior to Comcast Switch to Sedgwick, I had 2 knee surgeries from returning from Iraq and since being Employed at Comcast, I’m on all types of pain medicine for my knees and get my Cortizone shots for pain and all my other medicines for my lungs and back. I contacted Sedgwick for short term Disability in August because my Doctor wanted me of work from 8\2013 till 11\2013 I filed my Claim with Shakia White and processed all the paperwork that she asked for, after going back and forth to my Doctor because they said he did not fill out the forms correctly before any deadline they denied me and never called to tell my, I found out by calling the Automated service very upset about that then I called to speak to her manager and she told me that they could not read my Doctor’s handwriting which was a slap in the face after my Denial to her that even though no one ever said it before. I Appealed it and spoke to Kerry Clay and she was mean and arrogant from day one and threatened me that if my Appeal was Denied then I can’t file another one, this Company is the worst ever and I called Comcast Corporate Office to voice my concern Multiple Times and warned them of A Lawsuit and Kerry Claw and she pretty much said I don’t care do what you have to do, I told Comcast what she said and that I’m writing a letter to Congress and also going to the News Media as well as The Social Network to voice my Concern so someone can Put Sedgwick on Notice about Mistreating Claimants and their Unprofessional and Rude Behavior as well as their inexperienced Agents rendering claims and turning people lives upside down.

Comcast said they are now investigating Sedgwick because there are other Complaints from other Comcast Employees beside myself. Only 5 months with Sedgwick and I hope it’s a short lived partnership.

Attorney Stephen Jessup:

Antuan,

You are definitely not the first person I have heard this from. I have handled disability cases under the Comcast plan when it was administered by Liberty Mutual and in my experience I found Liberty Mutual to be much more professional and competent than Sedgwick.

Destroyed Employee:

Sedgewick CMS for United Healthcare denied my Short Term Disability claim in 2011 in which we are still fighting. This is how it has unfolded. I went to their preferred mental healthcare provider, called them, it seemed like every other day to verify the medical documentation was received by Sedgewick, was instructed on many different occasions it was not received… called the mental healthcare provider, was assured the information had been sent… this went on for over 90 days… bear in mind, if the required documentation was not received within that 90 day period, the entire claim would be denied. Here is the reprehensible part… their preferred mental healthcare provider was not a licensed Psychiatrist, and could never do the cognitive testing required to approve my short term disabililty claim, but Sedgewick CMS failed to notify the healthcare provider or myself that the medical documentation would not be considered until received by a Psychiatrist… Sedgewick CMS allowed me to continue my treatment with a provider who could not meet the criteria of their policy provisions set forth in the mental health guidelines of the short term policy for the entire 90 day period so they could in turn, deny my claim for short term benefits. (I am still unaware of this)… I finally got tired of the run around, and made an appointment to go to my previous mental healthcare provider whom I had seen many years before, and had to pay out of pocket, who was a Psychiatrist, and she did the required cognitive test, and promptly sent the documentation to Sedgewick CMS, mind you… the 90 day period for this information to be received has already passed. But, because I was not told all my previous efforts to provide them with medical documentation to support my case wasn’t supplied by a Psychiatrist, my entire claim was denied, which in turn voided my benefits for long term disability. We are now at the court stage of my case, and all my hope resides in the Judge’s ability to see that Sedgewick made it impossible for me to provide the necessary medical documentation within the 90 day time frame which would have proven my disability and resulted in the approval of my short term mental health benefits. If that isn’t bad faith, I have no idea what is. I have been in mediation and of course to no avail… they have destroyed the lives of myself and my family, not to mention exacerbated my illness, and they are doing this on a daily basis, and hiding behind ERISA. I have no right to a jury, I have no right to mental anguish, I have no right to pain and suffering, because ERISA which was originally put in place to protect disabled persons, has been used by these corrupt corporations to shield them from large sum pain & suffering awards due to the disasterous effects their actions have on disabled people and their families. I am stripped of my right to a jury trial, and they are protected from large sum payouts… until severe fines and penalities are put in place against this type of practice, there will be no reason for these corporations to stop this type of bad faith practice, which continues the vicious cycle and many, many more innocent lives destroyed.

S. Smith:

I was a former employee of Sedgwick in Washington, DC. I currently live in California. I filed an EEOC claim and now have a right to sue letter. I need help, fast! Class Action is all over this.

Attorney Stephen Jessup:

S,

We do not handle EEOC claims. I would advise you to speak to an attorney that does.

Robert:

My name is Robert and I’m writing on behalf of my wife, Helena who is a Registered Nurse by profession. She used to work at Kaiser Permanente Medical Center in Vacaville, California, when she had an unfortunate lifting injury involving her right hand 3 years ago, June 17, 2010. Compounding the injury is the fact that she is right hand dominant. After the incident, she called her immediate supervisor minutes after it happened but was not relieved of duty until 7 hours later because of staffing issues. Although, she had a letter from the ED MD that she needed her hand to rest for three days, her immediate supervisor, told her to come in to work the next day because she was the only senior preop nurse that he had on schedule. After 3.5 hours of work in the preop area she asked to go home and did come home because of excruciating pain.

She sought medical care with the Occupational Medicine Dept. They initially diagnosed a wrist sprain. Although she followed medical advice and restrictions, she continued to have severe pain and sought the opinion of a hand specialist. The specialist diagnosed a torn TFCC that was prominent in the MRI, which the specialist had ordered. She immobilized my wife’s hand with a cast for 8 weeks before she performed an arthroscopic TFCC repair on August 30, 2010. After the cast was removed my wife started working with an occupational hand therapist who reported slow progress. We were told that it generally takes a year for the hand to get better but, my wife noticed severe pain after every therapy appointment. She reported this to the Occupational MD who ordered another MRI, which showed severe avascular necrosis. Therapy was discontinued at this time.

I went with her to see three different hand surgeons that all suggested another surgical procedure. On July 30, 2011, a Dr. of Kaiser Permanente, performed a Proximal Row Carpectomy. My wife’s arm was immobilized for 8 weeks after which she resumed occupational therapy, which lasted 4-5 weeks. At this time, we decided to move out of California because of family and monetary reasons. Although she was enthusiastic about getting better, my wife was skeptical because of her previous experiences. We were told by the Dr., and the occupational therapist, that her wrist was stable and that there was nothing she could do to re-injure it and that she should be able to resume activities as tolerated. My wife was then medically released by the Dr. to return to work starting in January 2012.

We returned to California so she could start work in the pre-op area (with obvious weight limitations), the first week of January 2012. On Feb 15, 2012, while releasing a tourniquet from a patient’s arm, my wife aggravated her right wrist and sustained severe pain and swelling. She sought medical help minutes after the incident and was given ice and a right wrist brace. She then tried to get an appointment with her Dr. but was unable to see him. She went back to the Occupational Health Department and was immediately placed on work restrictions. After this second injury we returned home to Tennessee, where we still reside.

After 4 months of temporary disability, because Kaiser refused to accommodate her with modified work, her hand continued to deteriorate with severe pain and limited mobility. Another MRI confirmed a severe tear of the TFCC and S/P PRC. A Dr. from the Kaiser Occupational Health wanted my wife to consult with the Dr. regarding this matter. He suggested cleaning the wrist up, but not reattaching the tear. At this time we requested for a second opinion. She continued to have severe pain and continued to fly out to see the Dr. from Kaiser until October 2012. Due to pain, hopelessness, financial difficulties mental anguish and the inability to get the right medical regimen from Kaiser, she was no longer able to travel back and forth to California to fulfill Kaiser Permanente’s requirement to get a letter from their Dr. with job restrictions.

With my support, and that of family and friends, my wife decided to try and was able to get a position starting January 7th, of this year, at Vanderbilt University Medical Center as a Recovery Room Nurse. All the while her right hand/wrist continued to have severe pain and obvious mobility changes. It was during this time she consulted with a hand surgeon from Vanderbilt, who, after a thorough assessment and examination in February of this year, proposed a Right Hand Arthrodesis with Implant. This surgery was performed September 24, 2013, and his diagnosis was a Failed Proximal Row Carpectomy with Allograft. She is currently on her 10th week, post surgery and has completed Occupational Therapy. She saw the Vanderbilt Hand Surgeon December 6th, for follow up. He wants’ her to return on the 6th of January, 2014, for another follow up and X-Ray. He may release her to return to work on January 13th, 2014.

We may need your assistance in correcting the obvious mismanagement of her care by Kaiser Permanente, from the date of the original injury until now. This has been debilitating and exhausting. Even though she has representation by a Workman’s Compensation Lawyer, she has not received any financial compensation from Kaiser since her state temporary disability pay was exhausted. Sedgwick CMS handles Kaiser’s cases now. Based on the latest AME report her subsequent injury and surgeries were a direct result of her initial injury in June of 2010. She has not seen any monetary compensation since November 2012, when her temporary disability was exhausted up to January 2013, when she became employed at Vanderbilt. Since this is an on-going case, she should have been receiving compensation from the date of her latest surgery until she returns to work in January 2014.

I want the public to be aware of how Kaiser treats their injured employees. Specifically: The pain, suffering, lost income, and, in my wife’s own case, the probable permanent disability, due to the loss of use of her right hand/wrist, all because her supervisor failed to act in a timely manner.

My wife has been a Registered Nurse since 1980 and has worked in Critical care areas such as Trauma ICU, Medical and Surgical ICU, ER, and Cath lab and has never had any injury at work until June 17, 2010.

Stumped Kmart Employee:

This is some really messed up information I am learning about Sedgwick. I work at Kmart and I was injured on september 6th 2013 while I was working. I was getting ready to unload a truck and I was moving a heavey metal row bar that had really heavy football team jackets and hoodies and I tripped on a empty palette. while trying to move this row bar it started tipping and I was trying to prevent it form happening it hit my left wrist swelled up immeditly put a ice pack on it and it got worse was sent to our loss prevention person and he did a claim this is when I got introduced to sedgwick. i was sent to my local five star office and they did xray told me it was severly sprained and sent me on my way with a wrist band. I went back the following day and worked still having problems. I finally tried contacting Sedgwick back to be referred to somewhere diffrent and I was to my local ER. They did a second x-ray and said it was not fractured but they were treating it as if it was then I got refreed to an othropedic Dr. He took me out of work until further notice. Not even a week in to me being out of work I was contacted by my work and asking me when I am going to return to work. I was like what are you talking about, I am under the influence, I am out until further noticed. They were like no, we have a note stating you can come back to work as long as we can accommodate, which was a joke in itself. I went from having almost 40 hours a week down to nomore then 1 day a week for not even 5 hours then I was told by my boss I was milking it lying and just plian not wanting to come back for more hours. Then I preceeded to tell my worker comp person that and she tells me it’s my fault why hours got cut down because I was complianing about my wrist (not true at all). I have had so many diagnoses I don’t know what’s true; I was having severe panic attacks just being near Kmart and I got sick of it so I went and talked to a lawyer. I just can’t believe Sedgwick treats thier clients like that. It’s near the end of December now and I am still having problems being referred to a physical medical doctor. Hoping I can get some relief from this consant swelling and popping in my wrist. I was sent to a medical specialist through Sedgwick and he states I have blunt trama to my upper aspect of left distal forearm just above the wrist.

William Clemens:

My wife fell on some ice in Krogers parking out a year ago. I was told by others CMS will try to ignore my wifes claim in hopes we will forget about it. Kroger seems to be trying to help by calling CMS without any help. My wife had to go to the emergency room and received several staples in her because of the nasty cut she received from the fall. She also a blue tooth ear piece in the fall which was never recovered. All we asked for was to pay the medicial bill and replace the blue tooth ear piece. Kroger felt that wqas very reasonable. We are very good customers and still shop at Krogers, but we don’t know what to do about the claim, I don’t want to get an attorney for something like this. With this long wait you think my wife should be also compensated for the delay?

Thank you.

Attorney Greg Dell:

William,

I would advise you to speak with a personal injury attorney to discuss your wife’s options.

Attorney Greg Dell:

Stumped,

I would recommend you consult with a worker’s compensation attorney if you haven’t already.

Thayne Zito:

Well, I work at Crest Beverages. I hurt my neck June 28th of this year. I have severe pain in my neck, down my arm, and my leg. I cannot lift anything with my right arm, and have severe trembling. I have NO strength in my right arm since the accident, and can’t lift more than a few pounds. That scares me. I am so uncomfortable, I can’t sleep at night. I also get severe migrains, that coincide with my neck pain. Sedgwick did not accept my claim until October. It’s now been 6 months. I’m hurting WORSE than when it happened. I have a Lawyer. But, even with the Lawyer, I have yet to have ANY treatment authorised! They have also denied my prescriptions. I was sent to an orthopedic surgeon, and they feel I’m a candidate for neck surgery. Sedgewick is trying to say it’s degenerative, and I’ve had it for years. Currently, I’m being paid bi-weekly. Two weeks ago, my check came on Monday, 3 days late. I still haven’t recieved this check. It’s 5 days late. Supposedly, it was issued on the 9th. This place is a complete joke Oh, and I am depressed. I probably won’t be able to do my job ever again. I work in a beer warehouse, throwing cases. I was at Coca Cola, doing same thing, for 11 years. Im 46.

Attorney Greg Dell:

Thayne,

It is good that you have a lawyer to keep pressure on Sedgwick. Unfortunately your company has entered into an agreement to have Sedgwick manage your claim. Sedgwick is often very difficult to deal with and they will likely never make things easy for you. Be persistent and ALWAYS deal with them in writing.

Confused and Worried:

I broke my ankle, off the job in Nov. Doc says I can return to work with many restrictions in Jan but won’t be 100% until around March. Walmart says no, I can’t go back until I am 100%. Sedgewick handles Disability. They are saying they won’t pay me because it’s an “accommodations claim” so they don’t have too. How is that?

James:

Wow I seem to not be the only one having issues with Sedgwick. I injured my knees at work, while working for Walgreens. The manager took his sweet time turning it into them. Finally after months of waiting for an approval for an MRI I got it. Thankfully it “appeared” normal. Then they sent me to an IME. Well that was a joke and 3/4’s. They didnt provide this Dr. with half of my medical records, and he didnt bother to request them either. However he was very astute in referencing it mentioned the other Dr.’s and there findings in his report, but never bothered to follow up with them and request my files. Then they go and deny me. Well that was after sitting on the IME report for almost a month to two months! Then they denied to pay some of the offices they sent me to visit, so now I get nasty grams saying I owe or its going to collections. Even one shows that clearly sedwick denied that part of the bill but paid the others. Talk about some clowns! I have 4 Dr’s. All 4 with different opinions for the MOI, and against the MOI (due to lack of “evidence” in their opinion, they are the ones Sedgwick directly paid.) Yet I still have constant pain, and I am only 28 years old. Some days I hobble around like an elderly person, which one of the doctors has seen, any mention of that in the “reports” sedwick furnished to the IME, yep you guessed it that was omitted. Good think I took notes during this whole thing. I was told from day one they would try and screw me, and they did. I am hoping the attorney I am having look into my case will accept it. For I had one out of state look at it, and said that there is something going on in his opinion. Before you go saying that is unethical etc. He is a family friend, and I simply asked if he thought something was fishy one night when he was over to a gathering. I just think that its sad that they get away with this. Even the reports show they have taken there sweet ‘lil ole time on dealing with this issue.

Attorney Stephen Jessup:

Confused,

Without a review of your policy and denial letter it would be difficult to provide any guidance. Please feel free to contact our office to discuss how we may be able to assist you.

Rob Douglass:

I work for UHG. I have congestive heart failure and a pacemaker/ICD. Also have severe anxiety and dysthymia. Applied for STD to undergo testing, with no less than four doctors helping me. Sedgwick took a month to “review” my application, only to deny it due to lack of “observed impairment.” Doctors appealed claim within 48 hours. Sedgwick then advised their appeals team is allowed 45 days to make “decision.” Meanwhile, no pay, no benefits + additional anxiety for me. Sedgwick are white-collar criminals who need a massive class action lawsuit brought against them as well as a federal investigation.

Attorney Stephen Jessup:

Rob,

I would agree with you as to the crooked nature of Sedgwick. Their claims handling is horrible to say the very least, and they are often insulated from any real monetary damages as they are not an insurance company, but rather an third party administrator of your company’s disability plan. That being said, unfortunately, under the law they do have 45 days to render a decision on appeal.

Christine E. Platt:

The doctor I go to monthly for pain took almost a month to fax records and the STD form to Sedgwick. I faxed them the forms on 10/17 and they were faxed back on 11/18. Before this I received a letter from the Sedgwick caseworker that another doctor, my neurologist, had approved me to be off until 1/15. I had given them my neurologist’s name but he wasn’t given any forms to fill out. When I told him of this he sent a memo to Sedgwick that they should not have used his name because he said nothing about my return to work date. After receiving the forms and records from my pain doctor on 11/18 they sent me a letter on 11/19 that I was approved for full disability through 11/2/2014. Prior to 11/28 I contacted Sedgwick to confirm this date and they agreed this was accurate. At this time they should have already scheduled an IME for 12/11 but didn’t mention it. I should have received a letter with the details of an IME scheduled for 12/11, but I did not receive it. The first I was aware of this was on the afternoon of 12/24 when I retrieved my mail from my apartment mailbox. There was a letter dated 12/18 with details of an IME scheduled for 1/15 with a Neurology Clinic doctor located in Kokomo, IN selected from a list of IME’s provided to Allison Transmission Inc. by Sedgwick.

Another dated 12/17 said I had missed an IME scheduled for 12/11 and due to this they had suspended my benefits on 12/16. They would remain suspended until I attended the IME on 1/15. The soonest I could call Sedgwick was on 12/26, which I did. I explained to my caseworker what had happened and after some discussion he agreed to pay my benefits and was to call me on 1/2 after speaking with an Allison HR employee. Allison was closed from 12/24 through 1/1, returning on 1/2. I called him again on 12/30 to be sure he understood how important it was for them to talk on 1/2 and to contact me. I left a voicemail with a person in HR, whom I know, about the situation. I called him again on 1/2. I emailed him on 1/3 along with another person. I received an email from HR at Allison that they were looking at my case but hadn’t made a decision yet. I then called the caseworker who said he was currently discussing the case with Allison and he would call me. I explained that it was not my fault I didn’t receive the letter on 12/2, and also that I would not have a way to drive to the doctor for records, to pay for records or gas to drive from Indy to Kokomo without receiving benefits. Allison is aware of some of my medical conditions from the past (started in 1998 and 2004). My supervisor is also aware that I have medical problems. I have been on STD before and had to return after the IME. I have also been on FLMA but couldn’t afford to use it without pay. My file should show problems at work and I also have problems at home with my 2 sons. This is ruining my life. I have an appointment with a soc sec disab atty on Tuesday, 1/7 and will discuss this with him. I will be seeing a psych tomorrow, 1/6.

Thank you,
Christine Platt

S. Carol Rosso:

In my experience, Sedgwick is the most unscrupulous of all CMS’s that I personally have had experience with since my 1984 Industrial Injury.

They promote themselves as being “cost-effective”, which simply means that they do not pay the physicians, they do not authorize referred physicians from Primary Treating Physicians, and they do whatever they can to delay and obstruct medical care. This is not only true for myself, whose case was inherited through the California Insurance Guarantee Association, but it was also true for my sister, who was injured while working at Ralphs.

Their licensure should be revoked because they clearly do NOT have the patient’s interests nor physicians’ interests in mind. It is time that Sedgwick be banned from Work Comp altogether.

If an injured worker such as myself is not in their network, they simply ignore requests. In my case, it nearly cost me life, and their 4 years of procrastination, which ended in a denial, of a repeatedly requested colonoscopy procedure ended up causing STAGE 3 Colorectal Cancer.

Sedgwick is corrupt to the core. They just ignore referrals, deny even AME recommended treatment, evaluations, and physicians. How in the world do they get away with it?

Can’t we file a class action suit to ban them from work comp?

Attorney Stephen Jessup:

Carol,

Thank you for sharing. I would recommend you speak to a worker’s compensation attorney to discuss the rights available to you.

Dragongirl:

I was injured at work in Dec 2010. My first claim with Sedgwick CMS was denied (because they sent info I needed to fill out to the wrong address). The second claim finally in July 2012 was accepted. I have been on TTD for almost a year and a half for torticollis. The problem is Sedgwick will not authorize any treatment for me. I am getting worse now. I go and see my treating physician and he just says “oh well denied”. He sees me for 5 min.

Meanwhile they follow me around (like I really can’t do anything anyway) with cameras. I probably leave the house every two weeks for food, always in pain. Believe me I if I could afford to fix myself I would just tell them to… off. My workplace laid me off saying I was too hurt to do my job? What? I will never be 100 percent again, can’t do my regular job. My attorney ? is he in on all this. He tells me the insurance company wants me to see another doctor. All doctors I have seen say I need treatment. Sedgwick CMS and the whole system suck. I paid into this insurance for nine years? What happens when the 104 weeks of TTD wear off and still not treated or settled? I just want my life back SEDGWICK CMS!

Attorney Stephen Jessup:

Dragongirl,

I am confused as to the nature of your claim being administered by Sedgwick. It seems that it may be a work related injury claim (as you state the will not authorize treatment). If so, there is little I would be able to offer in guidance as a worker’s compensation or employment attorney is the proper counsel.

J:

My Dr. told that I was not to go back to work for 3 months. Sedgwick called me and said that I have to report myself back work. Only a month went by, they said that my Dr. released me. He didn’t see me, how can I be released without the Dr. seeing me. Can that be done?

Connie:

I am an employee for a very large bank who uses Sedgwick for their claims management. I have been on Short Term Disability for 5 months and should be moving to the long term at the 6 month mark. During the holidays, I called Sedgwick on multiple occasions and asked they help get updated medical from my doctors as my doctors requested a fax request even though it was an extension. I have four specialist who says I am unable to work at this time and two who says I’ll probably never work again. My case manager went on leave and a new case manager took my claim. When I requested she fax the forms she got extremely nasty with me and told me that was something I could do. I explained my doctor wanted this form and she told me again in a very nasty tone that they don’t have anything like that. In desperation I went to the internet and found a website I didn’t know existed which explains how if I have trouble getting my medical records to call Sedgwick and they will be glad to fax a request to the doctor. In the meantime, my short term was denied. Now I have no income and am at my wit’s end with them. After the holidays, my doctor did fax in some more information but now I have to appeal their decision. They have always talked to me in a demeaning way. They have made me feel as if my medical problems are nothing or non-existent. I have ended up in tears after three separate calls with their employees. This process has done nothing for my well-being and if anything has made my healing and progress even slower. I am proud my employer offers this benefit and I am certain it is abused, but there has to be a better way than this.

Attorney Stephen Jessup:

Connie,

I am sorry to hear of your troubles. Unfortunately, as indicated in all the negative experiences with Sedgwick, you are not alone. Please feel free to contact our office to discuss how we may be able to assist you in appealing the claim denial.

Shelly:

I am a manager at AT&T. I just had my second disability in 42 years. It was a for a knee arthoscopy. The last two weeks of my disability were denied by Sedgwick. The doctors notes from my followup appointment stated “painless range of motion. Return to work 12/16.” This was sent to the medical advisor for review and I could understand this one. They wanted a meeting with my doctor that week. My doctor was on vacation so they talked to the PA and another doctor and denied my disability. When I found out my disability went to the medical advisor for review, I called everyday to check on the decision. There was no decision until after two days after I returned to work on 12/16. At my next followup appointment, I discused with the doctor who issued revision number 1 “Do not return to work until 12/16 due to pain and narcotics”, also denied. Called the doctor and asked for more information to be submitted to explain pain. 3rd revision “weight bearing pain, on narcotics, return to work 12/16″, also denied. I am at a loss at what else I need to do. I followed my doctors instructions and have missed out on two weeks pay. I spoke with a claim person at Sedgwick and asked her if submitting my physical therapy notes would help. The PT found my range of motion on 12/11 8 to 80 on my right knee, 130 on my left knee. She said that might help so now I’m trying that. This is ridiculous. I was not able to relax and recoup because of being tortured by these people the entire time I was on disability. I have much stress in my life right now and this caused me to have to take anti anxiety mediciine just so I could breathe and sleep.

Josie R.:

I am trying to help my friend write a letter to Sedgwick for her husband’s Final Appeal. He has retired from AT&T after 35 years and his FMLA was approved. So his attendance is protected but he did not receive any money because his disability was denied per Sedgwick. How do we even start the letter? This has been going on since June 2013. Do we really have to add all info from each Dr.’s visit and include all the verbiage and treatment? This is so confusing and Sedgwick has already received this info. Or do we just type a form letter pleading his case and then attach a spreadsheet with all the Dr. info? Please help ASAP, this is due 1-23-14 so time is of the essence. Thank you.

Attorney Stephen Jessup:

Josie,

Unfortunately, there is no boilerplate for appealing a claim denial as each appeal is as unique as the claim. It is imperative you submit all medical documentation supporting disability, and can make whatever arguments as to the denial of benefits as you see fit.

Marie S.:

I opened my case with my Employer a DDS and Sedgwick 17 months ago. EMG proved carpal tunnel and also excruciating head ache, neck and arm pain. Had carpel tunnel surgery then released back to work ignoring my neck issues. Finally a MRI was done showing some disc bulging. Saw a neuro surgeon who recommended surgery. Sedgwick denied it, saying it is not really medically necessary, now being sent to a pain management doctor. In the meantime I struggle with weak painful hands and neck. Meds aren’t even helping. It’s all I can do to struggle through a work day to double up on Meds go home and go to bed with heating and ice packs.

Attorney Stephen Jessup:

Marie,

It seems that your claim is a work related injury and your claim one for worker’s compensation benefits? If so, you will need to consult with an attorney specializing in worker’s compensation to best advise you of your rights.

Michele:

Two weeks of my claim was denied after knee surgery. At the time, I was on narcotics for weight bearing pain. The narcotics knocked me out. They put ‘no exception’ on the last information submitted by doctor stating I was not to return to work due to narcotics and weight bearing pain. I can’t get my claim adjuster to return my calls. I don’t know what this means. I don’t know what they want.

Attorney Stephen Jessup:

Michele,

I would recommend all communication be written with signature confirmation of receipt so you can track and document your attempts to contact the claims person.

CB:

Paying Doctors for Findings/ Withholding Evidence.

Sedgewick CMS has the ability to contact doctors for Independent Medical Evaluation (IME) and “express” what the doctors need to “find”. One doctor in particular, is an IME whore. This doctor literally spends a large portion of his business doing IME’s ONLY for insurance companies. I do not understand how this is legal, but because the doctor does not treat patients for anything, so there is not doctor patient confidentiality. Insurance companies select doctors for IME’s that have a proven track record of siding with insurance companies. Insurance companies pay upwards to $5,000! And yes it comes up as long as your lawyer is good enough to do their home work.

Also, Sedgewick deliberately withheld the transcripts and recordings of communication with my Workers’ Comp case nurse from Bunch & Associates. I contacted Bunch & Associates for these records and was told these records are owned by Sedgewick.

In the end I lost my case because the lack of evidence to back up my “here say” from the content of discussion with my case nurse, which deemed me non-credible by the judge and also an IME doctor who did not perform any type of evaluation except ask questions was found credible. I spent a total of 15 minutes over two appointments with the IME doctor. One time I did not even change out of my street clothes during the examination and mysteriously the “pain diagrams” that patients fill in before seeing doctors disappeared for the IME doctor.

Now the employer I work for told me they do not know if they have a job for me or not and told me to wait a few weeks for a response. Are you serious?

Attorney Stephen Jessup:

CB,

I am sorry to hear about your experience dealing with Worker’s Compensation. Do you have an alternative disability plan you can apply for benefits under?

Barbara:

I was injured in the job in 2009 and my luck Sedgwick is my employer’s insurance. It started out OK then became a nightmare; I had two shots in my back, sent to physical therapy and lots of pain meds. After all this and months of pain I got back surgery but because they took so long to get me in the neurosurgeon said I might have nerve damage and guess what, I do, I now have no feeling in my foot, leg spams that are quite painful, on many meds. Sedgwick decided I could go back to work by saying my back problem was not a work related injury, I just strained my back. My problems are now old age and not their problem. That is just the tip of the iceberg. Long story short, I need another surgery and they again are saying not related to my injury. Just fed up, not sure where to go from here!

Attorney Stephen Jessup:

Barbara,

You will need to consult with a Worker’s Compensation attorney to best advise you of your rights.

Michele:

The reason the last information was marked ‘no exception’ is because it was dated and provided on a date after I returned to work. Even though they needed additional information which I requested at my next appointment on 12-26, and the information stated no work from 12-2 thru 12-15 due to weight bearing pain and narcotics, it is denied because the date at the top is 12-26 and I returned to work 12-16. Sigh, just can’t win.

Pamela Lenartowicz Sine:

My husband recently had shoulder surgery. While we were lucky enough to have our claim approved, Sedgwick has decided it’s time for him to go back to work. He has not yet completed his physical therapy nor has he been released to go back to work by the surgeon. However, Sedgwick wants him to go see a doctor at his work place and if that doctor says he can go back to work, he has to go. About an hour after making the appointment, Sedgwick decided to call and harrass my husband with threats of being cut off short term disability if he misses his appointment. She then, in a sarcastic tone said to him, “we know you’ve had another claim before”. As if this was a crime or he was doing something wrong. My husband had a quadruple bypass in 2010. That was his other claim. He has artery disease. It runs in his family. This woman called on the phone with the specific intent of harrassment. Does she really think he wanted a quadruple bypass just to have time off work. He suffered terribly for the time he was off work. He was back working within 12 weeks time. I don’t know anyone that would rather have open heart surgery rather than go to work.

RG:

I was in the workforce for 39 years and never unemployed and was hurt in an industrial accident in late 2010 at age 56. I ended up with a blown disc with only 10% of my L-5 disc left. When this first happened I tried everything the company suggested, doctor visits, pain relievers, muscle relaxers, chiropractors, PT, etc… we finally got the insurance company (Sedgwick) to approve an MRI after months of trying to get approval. Over 1 year later after the injury in late 2011 they approved the MRI and guess what, L-5/S-1 disc blown out, bone on bone I was told. By this time I had some serious problems besides my back I had numbness and tingling in my feet, especially my big toes and the front of my feet, calves and buttocks aching etc… so my doctor took me off work. They then wanted me to do an EMG and that showed that I had “weakness of dorsiflexion and eversion of the left ankle with absent Achilles reflex on the left side, with chronic denervation of motor units in the right and left lower extremity’s involving multiple muscles, along with chronic L-5/S-1 radiculopathy. After that report Sedgwick didn’t like it so they had me do another EMG with a different Neurologist which turned out worse than the first one. At that time my doctor ask for approval for me to see a Neurosurgeon at a major Spine Institute in California for a expert opinion, that approval took 9 months to get approved while I suffered. Next it took months to get a discography approved at the same Spine Institute which turned out that they advised an anterior fusion/disc removal with hardware etc… while in there the doctors shot steroids and pain blockers into the disc which helped for about 4 months but… need another and here we go again! Not sure what I will end up doing at this time I can still walk and I am told the surgery probably won’t help with my neurology problems only my back, great huh, all because Sedgwick fought me all the way with everything money, approvals, etc… Why? I have even had a partial AME that the doctor said the injury definitely happened at work when I said it did and when I had turned it in at work (no prior back problems). Now I get to pay for the rest of my life! Tried to be a good guy in the beginning, thought they were there to help me but, I have an attorney now and I hope he is good enough to help me. I have been screwed by Sedgwick and it’s probably not over yet (BEWARE).

Slow And No Go:

Wife had a stroke. She received short term diasability from one insurance, then the time came for the long term and wow it was Sedgwick. The first thing they said was this was a prexsisting condition and they will denie the claim. Been four months now still working with them to provide all the info needed but no check. They told us it’s in the mail but we haven’t received anything. I feel I need to go to Calibassa California Office and kick someone in the butt. What a run around. The claim person never answers the phone but will call you back when she feel like it. No luck.

Attorney Stephen Jessup:

RG,

We hope your Worker’s Compensation attorney is able to get you what you deserve. You may also want to inquire to see if you have any disability insurance coverage from your company that you may be entitled to.

John:

I worked for 31 year for this company, 15 as a plant manager. My plant was closed and I was transferred to run another plant. After 6 months (August 18 2012) I went to ER with chest pains, anxiety, all of this due to lots of issues at work. Came back to work and on September 10, 2012 had the same symptons, was off for two weeks, my boss would call me and check to see how I was doing, ask me to come back only few days per week and work half days but only if I feel better. Went back on Sept. 25, 2012, we had a meeting, got projects to work on, a few hours later he came to my offices and wanted to talk about me, told me things were not working and the best thing was to give me a 60 day notice and a 12 week severance package. It was like a bomb. I din’t know what to say, was very upset, after my half day I went home very sick and went to the Dr. and been off since then. Last month my Dr. told me that I could not get more time off due to health carrier rules. I was getting paid by Reliance Group after STD and LTD run out of payments. My Dr. gave me a note saying I could work no more than 4 hours. My work told me I was no longer disabled and wanted to talk about my exit from the company. Got my vacation paid, and have 45 days to sign the agreement for the severance pay, still no reason as why I was let go, they simply say things didn’t work but never got any thing in writing nor nothing about warnings etc. I have a great reputation and history with the company, the company would use me to help other plants with their problems, production efficiencies, I had to travel to other states, been away from family to help the organization. I was not expecting anything like this. By the end of this month my health plan will be canceled. From the beginning HR convinced me not to report this as a WC issue, saying that if I do they would investigate my family, our personal lives would be revealed etc. We agreed not to at that time since my family was very concerned about me during the first 3 months. They didn’t want to go through this, it was already painful enough. I don’t know what to do, is this a case where I can sue them for wrongful termination or negotiate a much better package? The person I replaced was working there for two years when he was let go. He got two years of pay so he could not work for a competitor, I went there to do his job.

Attorney Stephen Jessup:

John,

I am not quite sure what exact guidance you are seeking. If it is on account of your company terminating your employment, you will need to consult with an employment attorney.

Randy:

My problem is very simple with and only in place to save my employer money via Sedgwick start date games. Yesterday I was informed that my approved disability claim was short of the weekly benefited amount because the first day missed started on a Tuesday. I work four 10’s Tue-Fri. I injured my back on Saturday the 18th and my official first scheduled day missed was the 21st. The disability benefits are paid 5.7 hours per day Saturday-Friday. I missed 40 hours in that Tue-Fri and only was considered to have missed 23. I haven’t lost a major amount of money here, but if Sedgwick is aware that it works on a Saturday- Friday bases and I was injured on Saturday the 18th why didn’t that begin my 14 day wait period? I’m tentatively due to go back on Tue March 4th but they had the Dr. put Saturday the 1st because that’s the beginning of that weeks payroll. I not able to use benefited time for that lost Sat, Sun, Mon because I’m never scheduled for those days and I’m not getting paid for the Sat, Sun, Mon on the week I return. Know your payroll system if you’re unexpectedly injured outside of work.

Attorney Stephen Jessup:

Randy,

You would need to review your policy or speak to HR as to how they determine what your short term disability payment is based on.

Connie:

My husband Michael was a hard working man. He was a former Marine and was in very good physical health and quite smart. He worked several jobs throughout the years after being honorably discharged from the military. His last job was as an electrician working for International Paper. He worked there for around 15 years I think. I do know he was making over $60,000 a year and it was a good job. He was the type person who was always working either on his job or at home. A true handyman who could work on anything. Something started happening to his health in 1998. We didn’t know what it was. The doctors didn’t know why tendons and muscle tore in his legs. He ended up with a distinct limp in his left leg where a tendon or muscle whichever it is called in the soleus tore completely away at the bottom of his ankle in the back of his left leg. It was never repaired. He had another tendon rupture at his right knee. It was repaired but months later a muscle in the center of his thigh tore apart. He always said as long as he had 2 good arms he was going to work. I had to wrap both his legs using all kinds of support braces and ace bandages before he went to work, but that man kept trying. Those were the visible things he was going through. In 1999 he tried to commit suicide and put a .38 in his mouth and pulled the trigger. Thankfully God intervened and he didn’t die from that although at the time the paramedics had me believing he was dying. The law enforcement report stated that he tried to kill himself. His health problems started happening in 1998 and seemed to continue for several years afterwards. There were other issues like tendonitis, numbness in hands & legs, jerking movements or arms & legs, etc. He continued to work even through all this. He also kept trying to get a desk job if 1 became available because his legs were getting worse and weaker. For a few years it seemed like he was at least stabilizing in his health somewhat as it seemed to stop getting worse. I thought maybe he had a chance of recovery from his many health problems. In 2004, his health issues started getting bad again. In 2005 the rupturing of tendons also came back. This time both his arms were damaged. He had nothing left to work with. Everything that had previously happened before with his health became far worse. He applied for disability and Sedgwick handled the claim. He was denied several times. He also applied for Social Security Disability. Seemed the only question Sedgwick wanted to know when we spoke to them was if we had heard from SSD yet. Sedgwick always wanted our paperwork on time limits that were set but they were late several times going past dates to respond from their side. It didn’t do any good to complain even to the union. Seems like all my husband got from paying union dues was an expensive turkey or ham each year. Times were very hard at this point since we didn’t have an income. In 2006 I finally found out what happened to my husband’s health. After years of searching, it was a medicine that he had taken. An antibiotic called Cipro. He had taken it in 1998 and also once again in 2004. Both times after taking it the rupturing began around 11 months afterwards. All the other health issues he suffered from were listed on the adverse reactions as well. Sedgwick denied the claim and my husband was fired in 2007 from International Paper. My husband had an appointment with a Social Security doctor and his report made it possible for him to be approved for SSD. Most the doctors from Sedgwick never saw or even spoke to my husband and yet they made this determination. I remember an appointment that Sedgwick made with 1 of their doctors. It was at least a 2 hour drive away from where we lived. I told them we didn’t have the money to get there. I guess it didn’t matter if we were there or not. Their doctor thought my hubby had no mental problems even though they had a copy of the law enforcement report he tried to kill himself. Perhaps if I had spoken up and told them about the other attempts maybe it would have made a difference, but I couldn’t do that cause the 1 thing my husband feared the most in life was being locked up and away from his family. I couldn’t do that to the man I loved so much even for money. I could do very little to protect him after he became disabled. He had always protected me but I couldn’t protect him no matter how hard I tried. We hired a lawyer to appeal his disability from IP. The lawyer told us to be very patient and that it might take many years before we heard anything. After a few years, we finally contacted the lawyer only to find out he said he had sent us a letter telling us he had dropped it. We never got that letter and time ran out for his claim I think. In Feb 2012, Michael passed away in his recliner at the age of 55. He had lived the last few years of his life from a recliner where he also slept. He only got up from that recliner to get something to drink or go to the bathroom. That in itself was a challenge cause there were always accidents from either 1 of those times. He fell a lot and couldn’t move very fast. There were very rare times when he would leave the house and they were mostly for doctor appointments. To me he was the bravest man who ever lived. Even though his life was pitiful, every morning he would smile at me and tell me he loved me. I miss that so very much. He never saw a dime of pension benefits from International Paper. I applied for spousal pension benefits at the amount of a little less than $155 a month. There was nothing we could do about International Paper, Sedgwick or Bayer who made the Cipro. Sometimes life isn’t fair and justice seems so far away. I’m still here though and am thankful for this day. I still miss my husband though and will until the day I die.

Attorney Stephen Jessup:

Connie,

No words could ever properly do justice to the struggles and loss you have experienced. My deepest condolences go out to you. Thank you for sharing such a powerful, personal story as I am sure it could not have been easy.

Ms. Skov:

I was employed at Office Depot BSD in Fremont, CA from 2000-2005 as a CSR Lead in the call center. I was at the end of my work shift and headed to the lunch room where the time clock was located. I entered and there was a large group of warehouse workers and a janitor whom was at that time mopping the floor. I turned to punch out and slipped on the wet floor, landed on my hip which resulted in a sprained lower spine. I did have a co-worker in the lunch room, she was at the vending machine. There were absolutely no signs in the room regarding the wet floor and no one assisted me in getting up. I immediately informed the admin for my department and the next day I returned to file a workers comp report. I did see their doctor on 2 different occasions and the case didn’t get handled or looked at for years. Office Depot reported and appealed my fall with an Attorney needless to say I got the run around and am still missing a full years pay from the time of the accident to the time of our case being heard. The court papers do not look legit! I have kept every piece of paper that I was given in the matter. ‘Til today I am still feeling pain and at times unable to get thru a days work. They considered me to be Perm/Partial Disabled per Sedgwick letter and the few workers comp check stubs. If any one has any suggestions on how I can go about getting the monies I rightfully deserve please respond to my complaint. I appreciate any and all suggestions you can provide. Thank you!

Attorney Greg Dell:

Ms. Skov,

The situation you have described is a workers compensation claim. You definitely need to consult with a worker’s compensation attorney. Our firm only handles disability insurance claims for short and long term disability insurance benefits. Sedgwick handles both workers comp and disability insurance claims.

Matt:

I am employed by AT&T. I work outside and have a very physical and demanding job. I made the decision to have my left elbow elbow operated on December 2, 2013. The recovery time my doctor noted would be approximately 12 weeks. Sedgwick approved the first 4 weeks. After the fourth week, I was told to submit doctors/physical therapy charts notes so the claim could be reviewed for denial/approval. To no surprise, they denied my disability and stated they needed more information to support my claim. After going through two shoulder surgery’s and hernia surgery over the past decade, those words were very familiar. My case manager stopped returning my calls and went MIA. After fighting with them for 2 weeks, I was finally able to convince them I needed more time than 4 weeks to recover. I wasn’t so lucky after 8 weeks came and gone. I’m still fighting them for wage benefits as I type. I’ve faxed every up to date doctors/physical therapy notes that include my restrictions that include no lifting over 10lbs or use of left upper extremity until my next March 17, 2014 doctors visit. I’m still recovering from surgery and going through therapy weekly under my doctors recommendations. I tried to return to work early on February 23, 2014 since I wasn’t receiving pay starting February 10th. I was sent home by management since my department doesn’t offer light duty. As of February 25, 2014, I cannot be accommodated for light duty by my employer and Sedgwick has denied my recent claim. My situation is becoming a financial hardship on my family and my attitude has changed for this worst. I don’t understand how the laws allow these individuals (case managers) to make medical decisions without having a medical license. After dealing with this no caring, piece dirt company known as Sedgwick, I might be filing mental disability.

John Doe:

My doctor did not release me back to work. Sedgwick says I should be at work, nothing wrong with my knee. I can not return to work at the plant without my doctor releasing me back to work. I’m confused. Sedgwick is a nightmare to deal with. I have been shown no respect, or common courtesy what so ever unless they are recording the conversation. Accused of lying about the hours and days that I work, who I allowed to inject cortisone in my knee… and so on.

I need help with the appeal. I will lose my medical, my job, everything if Sedgwick gets away with this. My PTO is almost depleted for the year.

Attorney Stephen Jessup:

Matt,

As you have probably discovered, you are not alone in your experience in dealing with Sedgwick. Please feel free to contact our office to discuss how we may be able to assist you.

BjroninsonH:

Sedgwick is the co. that’s working with me on my worker comp case. I’ve gone to all Dr appointment turned in all paper work. Two days ago my supervisor called and asked me did I receive my termination paper because I failed to turn in nonpayment leave paper work in time. Was given the nonpayment phone no so I called and I called Concentra to find out what happens. Lois one of the front office ladies said my paper was filed so the Dr never received it. I called Concentra at least 3 times to make sure paperwork was given to Dr. I admitted at this time I should’ve followed up on this matter now I had to make sure paper work was turned in and I had to do letter of appeal. Still may lose my job ok now it look like I’m stuck will I still receive benefit or will they stop because of this.

Attorney Stephen Jessup:

BjroninsonH,

It would be in your best interest to consult with a worker’s compensation attorney.

LP:

i had a stroke on 1-24-2014 was 2 month’s from retirement. my fiancee had no information on my medical from chrysler. she tried bto figure it out the best she could. my promblem now is chrysler has terminated me becauce my doctor hasn’t fax back the paperwork. sedgwick said paperwork not right. we were in the doctors office a couple of weeks ago and had my doctor try to talk to the lady from sedgwick. she was did not believe the he was the doctor. please HELP!

Attorney Stephen Jessup:

LP,

I am sorry to hear of your misfortune. Is Sedgwick denying a claim for medical insurance or disability insurance?

CynthiaH:

I am currently off work, due to Guillain Barre Syndrome, and incurable, disorder where my antibodies began attacking the nerves in my hands and feet, causing nerve damage, and inability to walk without physical assistance and the use of a walker.

I became ill, December 26th with the onset of a very severe upper respiratory disorder. It was very sudden, and given the fact that an infection was running rampant at work, I called my Dr. for antibiotics. He, knowing my history called those in. This was on a Thursday Dec 26, I started the antibiotics immediately. The infection showed no change, I scheduled an appointment with my Dr for the following Tuesday. He thought I had pneumonia at this time. He sent me for a chest x ray which came back negative. He continued to treat me with steroids, and strong antibiotics. One more week passed, and my legs started to feel like jello, and my feet and fingertips were tingly and numb. I went back to my Dr and he sent me to our local hospital ER. From there I was sent to another hospital for neurological follow up. The hospital stay was a nightmare, which is not the issue here.

Fortunately, my health care advocate got the short term disability going for me. I was in no condition to deal with anything while being treated.

Sedgwick has been chosen by Comcast to manage short-term, long-term and FMLA leaves this year. While I was in the hospital, apparently they had no choice but to approve a short term leave. I have received checks for about 6 weeks of leave at this point, my case was up for review, February 18. I have never received anything in writing about this, it was told to me over the phone. I scheduled a follow up with my primary physician, for February 11th. At this point I was still having severe issues with the nerves in my feet and hands, and he was treating me for pain. The prognosis for recovery is good, but the healing process takes an undetermined amount of time. I had spoken with a Sedgwick representative who told me the three page form and Dr notes needed to be submitted. The Dr I deal with is very good about paperwork and following up. The information was recieved by Sedgwick by February 20 according to their records.

On February 24th. I received a call from Iris, saying that she needed Dr notes. I called my Dr’s office and Denise faxed the information again, she said his notes were included with the original fax. This fax was sent immediately on Feb 24th.

February 28th at 4:30 in the afternoon, Iris then called me to state she did not get the Dr notes and my claim is now denied. When I became emotionally upset about this, she said to me: “You need to settle down so I can tell you what you need to do.” I repeated to her word for word what she told me, I was listening. She just told me my only income is being denied, and I was emotional but not hysterical, she did not explain the process of an appeal just that they needed a written request and the Dr notes. I could not do anything, and she did not explain just what the term Dr notes mean. It was the weekend, I could do nothing, I became so stressed that I was sick over this. Symptoms, such as the tingling in my feet returned and pain was exacerbated. She told me there was no faxed information on the 24th.

Monday morning, March 3, with the assistance of my health care advocate through accolade, and my Dr office We made a plan to fax the information to Sedgwick once more. Denise from my Dr office told me she also mailed a hard copy to them. March 5th everything was sent. They had it in the system by March 7th. At this point I was being told it can take up to 45 days for an appeal. I cannot wait that long. I have tried to escalate this through Comcast, and they have told me that once this happens, my health care advocate is not needed.
I did not feel comfortable with this since my Comcast manager told me no, when I asked for the Comcast representative who would be handling this, I have not heard anything from them either.

I called Sedgwick myself March 7th and spoke with a representative by the name of Jennifer, who treated me with respect and escalated my issue to John, her supervisor. The policy to call back is within 24 hours. Monday March 10, I spoke with 6 different representatives, some of whom were rather rude about my continual calls. I remained firm about my need to speak with a supervisor, and I left John numerous messages. I never did speak with a supervisor.

Today, March 11, I spoke with a supervisor by the name of Ebony. Again, she said they need notes from any Dr that I have seen, I explained my primary care Dr is now the only Dr that I will be seeing. I explained the nature of my disorder and that at this point, it is a matter of time and pain management for my nerves to heal. My Dr has recommended that I do not return to work at this time. I asked her to define Dr notes, she again used the term Dr notes, nothing more. She said that she has the ability to override the appeal process. She could not get into the computer system at this time, since she just got back from vacation. She promised me a call back before my Dr appointment today. I told her I need to leave at 2:30 for that appointment.

It is 1:30 now I have not yet heard back, and from the attitude and actions so far, I do not trust I will get one. We will see. If I do not get approved for a check by Friday, March 14th, I will not receive any compensation until April 4th, if not then April 18th. By then eviction proceedings will be filed, and I will not be able to pay debts that I have been working on diligently for years now. Some programs will not work with me. This stress is causing me physical and mental duress now.

My manager at Comcast has told me that she was told my case cannot be escalated. That Sedgwick wants to make sure they are doing everything to help me. The exact opposite of what Ebony said. More conflict.

Attorney Stephen Jessup:

Cynthiah,

As you have experienced, Sedgwick is a nightmare to deal with. We have represented individuals under the Comcast policy when it was administered and insured by Liberty Mutual and now as it is by Sedgwick. It is my opinion that Comcast did its employees a disservice by leaving Liberty Mutual for Sedgwick.

CynthiaH:

I actually ended up having a positive outcome on my claim. Tonight, shortly after 5 PM supervisor Ebony Miller called to say that my claim has been re-opened, she explained what information is needed to extend my claim past the March 19th date it is set for now.

Sedgwick really needs to improve on the information flow, I received a letter today, dated February 26th, saying my claim was denied. My primary claim representative called me February 28 at 4:30 as I stated in my earlier post. The postdate on this letter is March 3 and I received it March 11. This is way too long for correspondence to be sent on an issue like this. While I appreciate the amount of mail they must handle, in this day and age, it occurs to me that there are other alternatives that will speed up the information flow. It looks like even though this was post-dated March 3rd it did not get sent out for several days.

Again, if I did not continue to call over and over again, deal with reps, some of whom can have some terrible attitudes, and others who were ok, this would not have been resolved by escalation through Comcast. Sedgwick told them, it could not be escalated and they, Sedgwick, want to do the right thing for me. I called BS on this when my manager told me and informed her that Ebony told me she could indeed override the decision.

When all is said and done, Sedgwick is very difficult to work with due to conflicting information being given, lack of details, and according to my Dr, being in the business of saving the company money. People who are genuine and having major issues don’t have a very good chance of dealing with all of this. It has been stressful beyond anything I have had to deal with so far. The illness itself, a horrible hospital stay, coming home and having to fight for the tools and assistance I needed to start a recovery, then this. I was at the point of a breakdown. This is getting well in America.

I hope to go back to work between now and April 15th. Ebony gave me a pretty clear picture of what I have to do. I need to get the information sent, the be the Sedgwick police to make sure everything is in place and I am protected.

Thanks for this website. I will keep you in mind if I need further assistance.

Attorney Stephen Jessup:

Cynthia,

I am glad to hear! Hopefully there won’t be any more challenges between now and your return to work!

C. Smith:

I work for SunTrust Bank which offers Short Term Medical for a period of six months. I purchased through SunTrust, Long Term Medical which will not be allowed unless I am on Short Term for the 6 month period. During my fifth month, my adjuster went on leave and a new one took over. All at once my claim was denied and they said I had to submit an appeal. I have 4 doctors, physical therapy and psychologist who have submitted forms for me and evidence. I submitted everything for the appeal and found out today that I am denied the appeal saying medical doesn’t support my claim.

My neurologist has twice submitted paperwork saying I am completely disabled and not a candidate for occupational or vocational rehabilitation. He has advised me file my Social Security disability and I told Sedgwick that during the appeals process.

These health care providers see me monthly and some of them weekly. How can a doctor who has never, ever seen me tell me that all these other doctors are wrong? Supposedly, during the appeal process they make calls to the doctors for phone interviews. Interestingly, my neurologist who would be the most qualified to speak with, they didn’t talk to.

I truly feel SunTrust Bank is behind a portion of this and that they are in collusion to avoid paying benefits. I have called and requested a case file but was told my original adjuster would have to handle it. However, she hasn’t called me back. I am so depressed over all this and embarrassingly enough am feeling so defeated and alone and find myself just wanting to fade away. I can’t even get the health care I need now as my insurance will cancel now as well. Why do we have to be pushed to file a separate law suit which could take years and how do people survive during that time? I will do whatever I have to do and may never get any justice but this is such an inhumane way to treat employees.

Attorney Stephen Jessup:

C.,

Unfortunately, you are not alone in your struggle. This type of action happens every day to people on disability.

Colt:

Is there any way to negotiate a severance with my company versus fighting with Sedgwick? I am sick and do not have the energy to fight them. Thoughts?

Attorney Stephen Jessup:

Colt,

Any potential severance is something you will have to address with your company.

CynthiaH:

Mr Jessup,

Thank you. I have another claim with Sedgwick, for FMLA due to arthritis in my knees. They are playing the same game with me over this, saying that they have called three times in March, 4,5,6. Since I have been home due to my short term disability, and I have records of all my calls in March, I find this to be very unlikely. While the calls may come in with an unkown number there is no record on my missed calls or voicemail calls either online or in my voicemail as I have been checking daily. While this claim right now has ten days left, it does indeed follow the trend they have set with short-term disability claims. Calling in to customer service again appears to be a nightmare, the representatives insisting that they are right, and having no understanding for what I am trying to explain. Getting hold of the claim manager again, the most ridiculously hard thing to do. I have no expectation of a call back. I will be home all day Monday, 03/17. All I can say is let’s see what happens.

Again, thank you for being available to assist with matters of concern regarding Sedgwick short term disability. My Dr dictated a treatment plan and sent it Friday, March 14th. He said he does not understand with the information they have sent, why I would be denied for any period of time.

Having to be the Segwick Police was not high on my list of priorities while recovering but I guess it is the only way to keep things on an even keel.

Larry:

They did a MRI on my back and found a Hernia aided disc and then the sorry people from Sedgwick denied treatment after five months of pain.

Attorney Stephen Jessup:

Cynthia,

Hopefully your relationship with them will come to an end sooner than later and you’re well enough from surgery to return to work.

Alice:

I’ve filed a workers compensation claim for an accumulative back injury. I sit for very long hours, back to back, 10 days in a row, twice per month. We’re given 2 fifteen minute breaks and a half hour lunch – which is standard. Time-wise/efficiency-wise, it’s counted against us, when we take a health break for the restroom and it’s considered a “deviation” of work time, so the time is taken away from our efficiency score. If we utilize the breaks to use the restrooms (4 – 7 minutes, yes I’ve timed myself); then, get a refreshment (3+ minutes if microwaved, purchase from vending machines, etc.), that can consume most/if not all of the breaks. The company is within the law, because our work schedules are still within the Sunday through Saturday (7-day) timeframe. It’s very hard on the human body, to work 10 days in a row, back to back, sitting all day long, repetitive arm/hand motions. If you’re higher on the seniority list and if management “likes you” you may get 2 days off in a row. The rest of us have to take a number and stand in line, obediently. I’ve called my local CWA union, but have been informed they cannot assist me, because local laws prohibit the union from assisting people with disabilities (SDI). My doctor gave me a release from work until May 10, 2014; or, until my employer (a major telecommunications provider) can provide a sit/stand workstation for me. I have been diagnosed with sciatica (accumulative back injury) and neuropathy in both of my legs. This multi-billion dollar corporation is dragging it’s feet to provide the job accommodation. I have not been “denied” the sit/stand workstation as of today; but, it’s been over a month since I’ve placed the job accommodation request, and it still has not been provided. I’ve been informed that I do not have a “disability” by another attorney; therefore, my employer is not required by law to provide the accommodation. I spoke with DOL and they’ve said this is considered disability discrimination. I don’t understand all the legal requirements to get this into a “disability” status. Sedgwick handles it all, EEO, SDI Workers Comp/FMLA, code of bus. conduct/compliance. They’ve sent corporate newsletters bragging they never find any discrimination or violations by corporate; also, send monthly newsletters terminating employees for non-compliance FMLA/SDI/Workers comp., etc. They won’t go bankrupt to provide and most sit/stand workstations are in warehouses; not a burden to this corporation. It may cost only for labor $5-800. I’m average height for a woman, so there shouldn’t be problem locating a chair to match, in these large empty buildings, with vacant work spaces everywhere. I guess if your disabled you have to just fend for yourself, if the union cannot assist us.

John Nelson:

Sedgwick has caused significant physcological harm and are trying to harm me physicaly by using the UR system to cut off my medication since I am being forced to sell out my future medical claim. I became a cancer victim in august 2013 and Sedgwick automaticly started to cut my regular pain meds when I received a breakthrough med for cancer pain. I was able to fix that for awhile but this past January they dropped the bomb on me with a UR report stating that I am on a weening program. This is not my Drs plan their UR Dr is a anthesiaologist with so-called expertise in pain management. I thought was lucky I was able to get a expedited hearing at the WCAB and the judge told sedgwicks attorney that they were over stepping their boundaries. He told us to have a talk but I was taken advantage of again, was told not to worry and they would override the UR report. Well got a new one. same thing I still on a weening program. If get cut off my meds I will die. This is nefarious I didn’t choose to be in pro-per but I do what I can do. If anyone knows anyone who can help me please contact me. Sincerely, John Nelson

Monique:

My husband works for Comcast Cable as a Tech Support Agent. They recently changed from Liberty Mutual to Sedgwick’s, and I must say this is the worst experience ever. For those that don’t know, Comcast is already a stressful company to work for and they have a high turn over rate. My husband took a short term disability, which he pays for monthly out of his check. Hardly ever took vacation or anything. He was “conditionally approved” for leave and now they are denying his claim stating that for what he is going through should have only been for 10-11 days. And of course they are going to want whatever they paid him back. Our Dr. states that they are going to battle them on it because he authorized my husband to take the leave for 3 weeks. At this point we are not sure of what to do because we are just using my income at this time and there is no way we are able to pay back something that should automatically be given if we pay monthly for it. Any solutions would be great, thanks.

David Thorne:

So I was supposed to get a decision on my appeal for Short Term Disability today. I shouldn’t have had to do an appeal in the first place. Sedgwick placed my doctors notes in the wrong file. I have a letter stating I would received something in writing by 3/30/14. Today being the last business day, I get a call from the claims examiner. She can not make a decision because she has not received the report from Sedgwick’s doctor that is reviewing it. I was told that he had 7 to 10 business days. that was 3 weeks ago. Meanwhile 2 months without pay is a big pain in the butt. Anyone know a good lawyer? Like I can afford to give away a percentage of the nothing I have now.

Attorney Stephen Jessup:

Monique,

Have you received the denial letter? If so, please feel free to contact our office to discuss what options your husband has at this point.

Attorney Stephen Jessup:

David,

Please feel free to contact our office to discuss how we may be able to assist you.

Wendy B.:

I work for UHC and we have Sedgwick. I had a total knee replacement on 01/28/14. When I went for my 6 week check up with my doctor he told me I was not going back to work at 6 weeks but my Dr. stated he wanted me off till 03/30/14 and to go back to work on the 31st. I advised my Sedgwick rep and she said she would have to get the info from the Dr. Well she requested alot of reports and my doctor’s office charged me $25.00 before they would send them to Sedgwick. So here I am getting less my wages and I have to pay for the reports that Sedgwick wanted. And gee, guess what, they denied my claim. So now I did not not get paid for the last 3 weeks that I was off from work. During the whole time I had to do Sedgwick’s job, my doctor’s office would send the info they were looking for and I would call to make sure they got it and they always told me no. I have had intermittent claims for other medical issues and it is always the same thing I have to follow up every time to make sure they got the paperwork. What or how do I fight Sedgwick for the 3 weeks pay that I have coming to be that they denied? I am going to fight them on this just because they are jerks. It is really funny, I goggled “total knee replacement disb will not pay me all my pay” and this website came up with all this info on Sedgwick and what crocks they are. I am calling them in the morning and asking for my rep’s boss and her rep’s boss and her rep’s boss till I get to the head person. Not dealing with the idot that makes decisions and have to medical training at all if my Dr. says I should be off from work then they should have no right to do what they do.

Attorney Stephen Jessup:

Wendy,

Thank you for sharing. As you can tell, Sedgwick does not have a stellar reputation. In order to potentially secure the three weeks of STD benefits, you will have to go through any designated administrative appeal process for any claim denial.

Randy:

I have been working through all of the Sedgwick hoops since 1/18/14. My PCP sent me to a specialist for my back injury who refused to fill out leave paperwork our disability paperwork. My PCP took up the reigns and continued with the physical therapy and medication prescribed. Sedgwick called yesterday and told me that I’m only approved until my follow-up visit with my PCP on 4/9/14. She claims after that my PCP will no longer be enough to continue my disability and that they will require a specialist to do any extension. With this not being a workmans comp claim is Sedgwick able to dictate which physician is valid? My employer already extended my leave till 5/9/14 via notice from my PCP.

Thanks,
Randy

Attorney Stephen Jessup:

Randy,

I think they will be hard pressed to make the argument unless it is deemed the PCP is not the proper category of physician to treat your condition unless the language in the policy as to what constitutes appropriate care allows them to determine same. Please note that this is not to stop Sedgwick from denying the claim based on those grounds, which will then prompt the need to file an appeal.

kp:

Sedgwick WC claims person never returns calls, never follows up with emails…. In head on car crash in company truck 3-10-14….had a few days of PT for hands and later have had shoulder pain for 2 weeks…no one will get back with me. Supervisors also do not return calls.

Withheld for Privacy:

I think this is a great service you have where people can vent and others can see they aren’t alone but I am uncertain how many really has a law suit. What I have learned:

Sedgwick stopped my short term disability approx. 45 days before it would have turned into long term disability which Long Term is something I purchased from SunTrust Bank as their employee to protect me in the event of a long term disability.

When my short term was denied I filed an appeal w/ 4 doctors who said I was unable to work yet Sedgwick was able to say I didn’t meet their guidelines.

Once they denied it the appeal there is no other recourse that ended it and at the same time ended my Long Term claim since I needed those final 45 days.

I have since filed for my Social Security disability. Now, if I had of gotten the long term approved and then my Social Security disability, any back payments would have been paid to Sedgwick for long term payments that are owed them. Therefore, my case isn’t worth anything to a lawyer.

My complaint is that SunTrust and Sedgwick are doing this to people and we have no way to fight back. I could (if I had the money) hire an attorney and pay out of pocket but that wouldn’t not be financially beneficial it would just be to make them answer for their behavior.

I feel so defeated and abused by the system. Nothing will stop this company, and I would never, ever work for a company (if I were able) again that has any involvement with Sedgwick.

Funky Bella:

I worked for a bank forc17 years. In between that time I had 3 major back surgeries. I never filed for disability after any of these procedures. I took vacation time, personal time or whatever time I had to get myself back to work. However, the last surgery was a triple fusion. My Neurosurgeon warned me this wa an extremely complicated, painful and long recovery of at least a year. Keep in mind I was working with extreme nerve damage, numbness and indescribable pain. I explained to my manager at the time of what I was up against if I were to have this surgery on my back. He was very understanding knowing I was a dedicated employee with nothing but stellar reviews. I went to work one day, stood up and fell down. I had lost the feeling in my left leg. I actually had to be walked out of the office to my car. I went straight to my Dr. Who immediately put me on FMLA. I tried physical therapy for 2 months doing everything I could to avoid this surgery. My physical therapist wrote a note to my Dr. That my legs were so weak he could no longer work with me and advised surgery. Within the next 2 weeks I had a triple fusion. I left work thinking I’d be back before my FMLA ran out. Unfortunately, I was still bedridden for 6 months. My FMLA turned in to STD, which Sedgwick did approve. My STD turned in to LTD which again Sedgwick did approve. The final result of all these surgeries, added major nerve damage where I could no longer sit, stand, walk, kneel or do anything any working environment required anyone to do. My pain was extreme and my great quality of life that I once had no longer existed. I was I heavy doses of pain medications of multiple types, I should not have been driving nor could I since I am unable to sit for 15 minutes without my back and leg throbbing. However, Sedgewick continued to pay my benefits for a year and a half. In between that time I was trying to get approved for SSD, knowing my LTD only paid out for 2 years. However, once SSD kicked in, Sedgwick would have to pay me the difference that SSD did not pay to equal my 70% income along with the continuation of our medical benefits until I was 65 as long as I “fell under the Sedgwick laws of being disabled”. Now, keep in mind I have been paid for a year and a half. My condition has worsened and has been documented as so, my Dr always sent the paperwork on time, and stated in his final paperwork to Sedgewick that my condition was “lifetime” and I was unable to work in any working environment for any amount of time. Still completing the paperwork in full as required by Sedgwick’s so called “law”. I week before I was supposed to get my disability check, I received a letter from Sedgwick that I was no longer entitled to benefits because their Dr contacted my Dr, along with my Neurosugeon and my employer who all said I could return to work. Now we all know that no Dr from Sedgwick contacted anyone! As a matter of fact, when I showed my Dr their letter stating they actually spoke to him, he wrote a letter regarding no conversation had ever taken place and he would take action himself if they used that against me for denying my benefits. Sedgewick then stated it was an incorrect statement and that their Dr (who I don’t even believe exists) stated that after examining my old job description back from dec. 2011( my last day of work) that I was able to perform that job function. I contacted Sedgwick to discuss their decision and try and figure out if they had paid me benefits for 18 mo., my conditon has only been documented to them as “worsened” how could they figure I could go back to work? Here comes the big one… The resonse I received was, and this is from a manager for claims was this verbatim…” you can appeal this claim, you can get an attorney, you can do whatever you want to do, I don’t care, but I will make sure you claim is never, EVER re-opened or approved”. As angry and as appaled as I asked her if there was anything else she had to say? And she hung up on me. This is Sedgwick manager people! I don’t believe in getting nasty as that gets you nowhere. I do have to say it has been 2 months and I’m still angry and simply in awe that Sedgewick thinks it’s ok to treat people like they do. Just like everyone else who has dealt eith them, we paid into this insurance in case we had problems right? We did everything we were supposed to do even though we are all in pain in one way or another right? And most importantly, we all need the income or we would not have filed for benefits in the first place right? Have I filed an appeal? Of course! Did my attorney get involved and was he copied on that appeal? Of course! Can I afford to go through all of this and have NO INCOME while I wait for them to make a decision? NO!!!! But I will never give them the satisfaction of just letting this go. I will get them and they will never know what hit them. I WILL get what they owe me since I have been paying for LTD for as long as I have been employed. Sedgwick needs to have a eye opening experience. I hope that this group of attorneys that allow us to let everyone know how awful Sedgewick really is. I hope they figure out a way to help all of us get what is owed to us. I am ready to go to Washington right now and let Congress know how Sedgwick treats their people who have paid into these benefits for years and in return they get nothing in return but rude and horrible treatment when you are in a time of need. I don’t know how these people or these liars that work for this company can possibly look at themselves in the mirror every day. if you havo no choice but to go back to work because you need some source of income, go to the Sedgwick “careers” section and see what’s available… Do you think they would hire someone who can only sit for 10 minutes then take a 45 minute break? Do you think they would hire someone who tries to work and when they go to stand up they fall down, then have to be walked to their car? I would think….NOT! I wish all of you the best and hope you get your benefits. As for Sedgwick, I hope they get what’s coming to them. Maybe a couple of back surgeries to that manager who spoke to me the way she did so she can get a taste of her own medicine. I would love to be the one to Hanley HER case! Good luck Sedgwick… Someone is going to sting you and when they do? You’re going to feel the burn! I hope it’s this group of attorneys who gets the good fortune of bringing you down!

Pissed Off:

So I was put on bed rest by my doctor bring that I miscarried one child their trying everything to save this one, I was told that isn’t a reason to be off work. It’s going on my third week and I must say this is the worst company in the world, rude people all around. They’ve contacted me to tell me my claim for short term disability was denied because I don’t have a real reason to be out of work so I guess their doctors too.

Karen B.:

To unknown SunTrust employee who just posted:

I too used to work for SunTrust. They had a different disability company when I went on LTD. Then they switched to Sedgwick (cheaper and denies more requests). SunTrust caused my disability because of the terrible work conditions and goals pushed on us. It was a minute by minute what have you done for us lately. You were lucky that Sedgwick denied, even though it didn’t seem like it at the time. I wasn’t denied by Sedgwick and received LTD until my 2yrs were up because of the 2yr limit on mental disability claims. The 3rd party company that helped get my govt disability got me approved. Out of the $23K I received in back payments, I got to keep $1700. Yes, I signed a paper stating that I would owe Sedgwick (in turn, SunTrust) the difference between my LTD disability minus my SS disability. I still don’t see how I only received $1700. That’s just 1 month difference. But I didn’t fight it. Didn’t seem worth the damage it would have done to add to my mental illness problems. I’m not sure I can complain about Sedgwick or not. I was approved but also had to give up a lot of my back disability that would have helped me tremendously. After reading all of the statements about Sedgwick, I guess I must consider myself lucky. But it sure does make you wonder why you pay extra for LTD when denial is almost a given. Thank God for my Psychiatrist. She took good notes and was behind me 100%.

Michael:

I have sciatic nerve damage. I have been out of work from February 18th until now. Sedgwick’s deadline for their paperwork was March 27th and I did not receive the paperwork until after the deadline. I took this paperwork to my doctor to get this filled out as soon as possible. Sedgwick immediately denied me because it was late (their fault) and I had to file an appeal. I’ve been trying to call Sedwick for 3 weeks and left numerous voicemails for them to contact me immediately!!!! I finally got a call back from the Disability Specialist Christine Okreglak…and she had the nerve to act like I was bugging her. Her excuse for not calling me was because she never got my messages! It’s Sedgwick’s job to help me! She basically told me with extreme attitude that I’m screwed and I don’t have enough medical proof for my claim to be approved. So I’m wondering, why do I bother paying medical insurance every month if I will be denied my benefits??? I have been paying out of my own pocket for chiropractic care and physical therapy because I did not want to go through the Worker’s Comp route so they can fill me up on pain meds and force me to get surgery. I have been struggling because I’ve been out of work, and Sedgwick just doesn’t care!

I’m not trying to get long term disability. I’m trying to get well enough to go back to work. I am frustrated, stressed out, and on the verge of going crazy because of their lack of support. I have no choice but to go back to work hurt because I can’t afford this.

Trevor J.:

I had been out on comp. with Sedgwick for 30 days and my doctor tried to return me to work “light duty” to see if I could handle it. My employer said that they could not accommodate my restrictions and that I would have to stay out of work until I could return without restrictions. Sedgwick cut my comp payments to less than half when they caught wind of my doctor releasing me to return to work light duty, even though work wouldn’t let me return. Is that legal? Shouldn’t I still be compensated at the full rate until my employer allows me to return?

Attorney Stephen Jessup:

Trevor,

You will need to speak with a Worker’s Compensation attorney as to your rights under applicable laws.

Beverly Duncan:

I currently have worked for Walgreens for 8 years and never taken leave. I am 32 weeks pregnant with twins which makes me high risk and I also have pregnancy related high blood pressure which makes it even more dangerous. My doctor has taken me off work but Sedgwick is denying my claim saying there is no reason why I cannot still work. It makes no sense being that my CA state disability has already been approved. Sedgwick only knows the words deny!

Attorney Stephen Jessup:

Beverly,

Attorney Rachel Alters in our Office has a great deal of experience in dealing with Sedgwick under your very policy. As a matter of course I would agree 100% with your summation as it relates to Sedgwick. Please feel free to contact our office to discuss how we may be able to assist you appealing the denial of benefits.

Mary:

I worked at Walmart until about a week ago, and Sedgwick handles their LOA claims. I filed for LOA due to an injury, my LOA was denied before they even sent out the paperwork they said I had to fill out before they could continue with the LOA application and they didn’t even inform me that it was denied, until I called my employer who also had never contacted me and found out that I had been fired because it had been denied without me even knowing about the denial.

Melinda:

I have had multi level depression and anxiety and was diagnosed with ptsd which causes me to lose my short term memory and causes confusion, I cry and can’t function when a customer yells and screams at me, I had bells palsy from the stress, I was awarded STD from dec 27 to march 31, had the same issues from Sedgwick as the others, required to see a psychiatrist but couldn’t get an appointment before the deadline except to someone who doesn’t take insurance… 600 dollars later I get initially approved, but then extension past march 31 was denied even though my doctor put down June 20 as return to work because Sedgwick requires a return to work date even if doctor can’t say when you are able to return. Anyway I was approved for social security disability. So 2 psychiatrists, a clinical therapist, and the government says I can’t return to work, but according to Sedgwick the information doesn’t warrant the approval of the extension. My psychiatrist says they are evil, and would only correspond with them in writing and the other psychiatrist played phone tag with their consulting doctor and so part of the reason I was denied was that they couldn’t talk to my doctors. What a crock of crap! This whole process with Sedgwick has caused my anxiety and depression to worsen.

Attorney Stephen Jessup:

Melinda,

Have you appealed the denial of continued benefits?

Jeffrey Copeland:

I have been on short term disability from Walgreens for over a month now. Sedgwick sent my paperwork to the wrong address and denied my claim because I didn’t fill it out and send it back to them. I finally got it sent to the correct address but they are putting me through a long process before they will approve it. I have very little time before I get evicted from my apartment because I don’t have the money to pay the rent. Sedgwick says the first address they sent my paperwork to was the only one they have on file, and that I gave them that address, yet they somehow managed to send it to the correct address the second time. If they had sent it to the correct address the first time I would have my rent paid and wouldn’t be in this mess but they refuse to take responsibility for the mistake and they refuse to let me speak to someone above my case manager to make a complaint.

Joyce:

I have been receiving short and long term disability from AT&T and in March I was informed that I was being denied permanent disability because the definition of disability changes in their system when you reach permanent disabled. I appealed and was told that on May 17, 2014 they would have an answer for me. Then I received a notice that said they were extending it until June 27, 2014. I sent in all information to them including a letter from my Doctor. I never was denied disability from AT&T and even was approved for total disability from Social Security. I don’t know what to do from here. The only response I got from AT&T was the language changed when it came for permanent disability from ATT. Is there anything I can do?

Attorney Stephen Jessup:

Joyce,

If AT&T properly exercised their right to an extension beyond the initial 45 days to make a decision on the appeal, then all you can do at this point is wait. That being said, you would be wise to provide them any potential new supportive information that may arise while they continue their review.

Attorney Stephen Jessup:

Jeffrey,

You are certainly not alone. Attorney Rachel Alters in our office has extensive experience and dealings with the Walgreens disability policy. She has litigated under the policy and was successful in getting the judge to remand the claim back to Sedgwick for further review. To date they are still being contentious as ever.

Kristi:

I have a LTD and Sedgewick is the ins. co.. After not receiving payments for over 3 weeks they claim they calculated my weekly check wrong. So after two years they say they are not paying me until the overage is satisfied. This could be months. Can they do this after two years? And leave me with no income now?

This is IL. If this is true it’s their problem they had all the correct paperwork for their calculations?

Attorney Stephen Jessup:

Kristi,

What you are experiencing is not uncommon. A majority of disability policies contain language allowing an insurance company to collect an overpayment based on their own mistake. It should be noted that Sedgwick is a third party administrator and not an insurance company. The benefit is probably being paid by your former employer. As such you could contact your employer to vocalize your position.

Yay Union:

Sedwick is giving me the same thing to, denial, appeal, etc… I wonder why this isn’t heard of much, because it’s only a small percentage of employees who actually fight AT&T in the southeast. I have been diagnosed with extreme depression and anxiety very bad anxiety, axis1.

Ann Armstrong:

My employer has Sedgwick. My co-workers and I felt WE were the only ones getting the shaft. I’m letting people know at work tomorrow. My doctor on 3 occasions was out of office for 1 to 2 weeks. Sedgwick needing MORE information would not extent my due date resulting in denial. My paper work is due by July 13 (yes, Sunday) and my doctor returns Monday the 14. They will not extend. My doctor forgot to put in his notes for medical secretaries that this was a renewal of FMLA so Secretaries cannot submit paperwork requesting it. This is a scam. I went without pay before but occurrences are adding up and it may be my job on the line.

Dee Nelsen:

I injured my foot at work, have had surgery which has not resolved the problem. Sedgwick denied my claim, sent me to an IME, who at that time niticed there was a mix up of my medical records with another client, that was last August, the problem has not been fixed to date. As a matter of fact the other person showed up for my court date. I am getting ready to go to trial to get my claim accepted. Any advice?

Attorney Stephen Jessup:

Dee,

You will need to consult with an Worker’s Compensation attorney as it appears your claim is under your company’s worker’s compensation policy.

Brittany:

I work for Time Warner Cable. I have been with them for 5 years. They just decided to switch over to Sedgwick for our disability management. So far this has been a huge headache. Sedgwick told me I am approved through 7/11/14 (even though my doctor gave them an estimated date of return for 8/23/14) and I haven’t been paid! They said they sent over this “voucher” to my payroll and it is up to them to approve it… I call my payroll department and they haven’t gotten ANYTHING from Sedgwick. So I haven’t been paid for 4 weeks so far and as far as I can tell they’re telling me that I have to start working again tomorrow, against my doctors wishes, without my doctors approval!

I am also being told now that my company requires that I see a Phychiatrist if I’m out more than 30 days. The problem is when my insurance and accolade do a search for me they can’t find anyone available within the next 30 days.

What am I supposed to do here? I am so confused and scared about what’s going to happen. I surely can’t focus on getting better!

P.S. I have contacted my human resources. I contacted them via email on Monday and they have yet to respond (it’s Thursday).

Attorney Stephen Jessup:

Brittany,

Sedgwick’s actions are common, but it is unfortunate to hear what your employer is doing with respect to assisting you in getting the problem solved. Please feel free to contact our office to discuss how we may be able to assist you.

EvaAnn:

I am recently experiencing extreme frustrations with Sedgwick our company recently switch from Liberty Mutal at least they didn’t make you jump through hoops. I have found Sedgwick to be very picky and the LOA are worthless. I am writing an appeal letter as we speak. My claim was closed be cause Dr. office didn’t send medical and the LOA calls me several days after the fact. I am also experiencing a bigger issue with DR. Office not wanting to comply with releasing medical records.

Which led to my case being closed. Is there anyway is there any way to launch formal complaint. I thought maybe they would have people spying on claimants. Since I’ve been out I’ve had instances were there has be a random car with someone sitting there. I’ve seen it 3x since I’ve been on STD who knows if there watching me or the house getting a new roof. I have never been so stressed I have reached out to accolade for assistance and they are going to further help me. This hasn’t been my only bad experience with Sedgwick I have had several since my company switched. When you do call they are very robotic and they never show empathy and each and every time you call you have to go through a call enter makes it very un personally and you have to repeat your situation every time you call. I have complaint to my human resources they could careless. Sedgwick also makes you report within 48 hrs or they will deny it for reason not fmla related is wht the letter says.

Attorney Stephen Jessup:

Brittany,

If the policy does in fact have a requirement that you be seen specifically by a psychiatrist then there may be little that we can do to assist you. With respect to unemployment – if you are still employed, you wouldn’t be eligible for unemployment benefits. Please obtain a copy of your policy and feel free to contact our office to discuss how we may be able to assist you, as a specific requirement to see a particular type of doctor is highly unusual.

Doug:

You must go over your forms and any information you send with a fine tooth comb. They will look for any loophole they can find to deny your benefits. And YES, they can and will lie to you. You must have ALL copies of documents your physicians faxes to them and the “fax confirmations” (dates and time). You will need these when they tell you “they did not receive anything from your physician”. They will then miraculously see that the files have been sent and further delay the process while they review them. You must get copies of your doctors notes pertaining to when they talked to Sedgwicks doctors and what was discussed (without this proof they will say your doctor never returned their calls). Any typo on the files your physicians send will be used as a loophole. Unfortunately, doctors are not attorneys and do not fill out papers with a legal mindset.

We are currently trying to correct our doctors conflicting dates regarding “return to work date” and “limitations date”.

I’m not sure if it will do any good, but there is a complaint form for “Employee Benefit Security Administration” (ERISA/EBSA) at the “Department of Labor” website – http://www.dol.gov/ebsa/contactEBSA/consumerassistance.html

Good luck to all.

Brittany:

I am on STD and Sedgwick has approved my claim for 30 days. My 30 days is up today. They advised me that in order to continue to be paid for the time I’m out of work that I have to see a psychiatrist (apparently a requirement through my job) which is fine with me. The problem is, however, my insurance, EAP and Accolade has done a search for me and there are NO psychiatrists within 50 miles taking new patients for anytime in the forseeable future.

Accolade is checking with their nurse aids to see if we can find anyone outside of my insurance plan that will take me. So we’re trying absolutely everything we can. Sedgwick has advised me that the psychiatrist is specifically for medication – ummm… my doctor gives me medication and she makes sure that it’s working for me… so if that’s the issue why can’t they just continue to follow up with her?

When I brought this information up to my HR department he basically told me he would send it to corporate. He emailed me back today and said corporate requires the psychiatrist – even if one is not available to continue to get paid or keep my job – this is NOT possible so far, not just that I don’t want to do it, but nobody is available! Aside from creating a psychiatrist out of thin air I don’t know what else I can do here.

Please help me! Can I file for unemployment since they aren’t paying me?

P.S. I contacted the Labor Board – who referred me to the civil rights board – who referred to me the EEOC – I have been on hold for them for well over an hour and a half – but we will see what they say.

Jill:

If Sedgwick is stating you must see a psychiatrist then Sedgwick has to provide you with one to see. Also they should have sent you a letter as to the time, day and name of the Dr you are being sent to. It’s usually called an IME Dr. They can’t without documentation just tell you over the phone, they must respond with a letter.

Attorney Stephen Jessup:

Jill,

That is not necessarily true if Sedgwick is asserting policy provisions that require treatment and care under a doctor appropriate for the disabling condition.

Breanna:

I work for Walmart, and they go through Sedgwick. I got hurt on the job while stripping the floors to wax them. The machines are old and work correctly only when they want to, malfunctioned and slid pinning my knee between the machine and a blood pressure machine. I filled out the accident report that night but did not seek medical attention until 2 days later due to the on shift manager guilt tripping me about the company loosing money. I went to urgent care on the morning of June 15th after working a full shift because my manager didn’t think I needed to go (I threatened to sue if they did not allow me). The doctor thought I tore my MCL and took me out of work until I got an MRI of my knee. Sedgwick took a month to approve the MRI, they are STILL saying they didn’t get paperwork faxed by my family doctor, right along with the “not filled out correctly” – all the excuses they can find! After saying I was going to contact an attorney they forced me back to work before the MRI even happened, stating they could fire me if I did not return. After I returned (before the MRI) they retaliated. My store manager, and shift managers began treating me terrible. My store manager yelled at me on the floor in front of customers at the end of a shift to the point that I had a breakdown. The retaliation was so bad I quit on July 5th. Sedgwick says my leave is still pending (bullcrap) and I’m now receiving all the medical bills that they’re supposed to cover. What am I supposed to do?

Attorney Stephen Jessup:

Breanna,

As your situation is a Worker’s Compensation issue and not a disability insurance issue I would suggest that you contact a Worker’s Compensation attorney to address your concerns.

Dean:

I was injured by slipping off a ladder and slamming into a 5 inch steel beam causing a compound fracture of my L2 on 4/26/14. I had surgery to repair it within 2 days and was sent home from the hospital with instructions to return to surgeon within 3 weeks. That’s when the nightmare of dealing with Sedgwick began. They did not file a claim with OHIO BWC until 5/15/14 and I did not receive any money from them for 6 weeks and it was for the minimum allowable because they said they had not received any information about my average weekly pay from the disability side of Sedgwick. This is where the problem is… they have a workers comp side and a disability side and they do not communicate at all. I had to do all the leg work to get the information required so they could figure out what they were supposed to be paying me and all it took was 1 phone call to my company’s records department. They would rather send faxes or email instead of picking up the phone and calling who they are supposed to in order to get the job done. I did not hire an attorney in the beginning even though friends and family kept telling me I should. In the middle of June 2014, I had left a message 5 days in a row for my “rep” and she has still not returned my call. The managers and/or supervisors are argumentative and defensive and do not listen to what you are asking and don’t even let you finish a question because they are to impulsive to shout out what “the rules” are. I’ve since hired an attorney to handle this claim for me as I am still trying to recover from my injury and have fallen into a deep depression because they are still not paying me what I am entitled to. After reading a lot of information online about Sedgwick I find it laughable that they are able to do this to people and for all of us to hire attorneys to get the job done.

Attorney Stephen Jessup:

Dean,

Please feel free to contact our office to discuss how we may be able to assist you with your claim under the disability insurance policy.

Darlene Sawicki:

I was injured at work in January of 2009. I fell as a result of my employer removing floor mats from entrances, January ice and snow. I expected a mat to be in front of the door. 3 year battle ensued and I ended up never being fully reimbursed and now, same employer, I fall in the back of the truck after I had repeatedly asked for new cargo straps and bars for my truck. Sedgwick is denying claim and I am getting bills from the emergency room. Company security took me to hospital. And as an added bonus, I am being financially harmed. this company operates as though it is an illegal immigrant and above the law. Do we have any laws to protect workers or has this become a right to work state and right to be injured and lose everything by expecting to be protected by workers comp? I am a single mom who is trying to pay for her youngest son’s college education. I spent the boys college fund the last time I was injured and I am still dealing with issues with IRS over that injury.

Lyh:

I just had a surgery for a cervical neck injury. Not only was my surgery delayed for almost a year (causing more damage and suffering) post surgery I have not been paid by Sedgwick in over a month. No return calls not responses at all. My HR dept is useless and bills are pilling up…

Attorney Stephen Jessup:

Darlene,

As we handle disability insurance claims I would not be able to properly advise you of your rights under worker’s compensation laws. I would highly suggest you contact a Worker’s Compensation attorney to discuss your rights.

Attorney Stephen Jessup:

Lyh,

Is your claim with Sedgwick a disability insurance claim? If so, please feel free to contact our office to discuss how we may be able to assist you.

V. Turner:

I have been dealing with Sedgwick for almost 2 years now. They paid me for the first 24 months and denied it after that even though medical reports side with me on my ability to hold a job that meets their own requirements of their definition of being able bodied. I have a lawyer and he feels we have a reasonably strong case. The problem is now that a suit has been filed he called to say that they were able to have the venue moved to St. Louis Missouri federal court. I worked and live in Alabama. He has until Friday to respond but he said that if they are successful we would not be able to represent me in Missouri. Is there anyone that you might know who could pick up the baton on a contingency?

Any help would be appreciated.

Attorney Stephen Jessup:

V,

Please feel free to contact our office to determine if we may be able to assist you.

PM:

My ongoing STD claim was just denied because of a clerical error by my surgeon which was corrected before the required 7 period in which to get Sedgwick my updated records and have my claim period extended. My last visit to my doctor was on 7/31 and as of today, 8/13, I have still not received a denial letter and the information on how to start the appeal process. but I was just told verbally and of course much of my check was not there. I spoke with my claim handler’s supervisor who informed me that once I am denied, it is too late, I just have to start with an appeal and they will get it looked at and inform me regarding approval within 45 days. They even admitted to me that they have the information required to extend my leave, but refuse to fix the problem with me without appealing it. I am the main income in my home and pay 95 percent of the bills. Now, almost halfway into the month I am told that I will not receive any form of payment starting back at the first of this month. I will likely be forced back to work, in a very labor intensive job with a double hernia repair that is not healing in what Sedgwick considers a “reasonable amount of time” – even though my doctor doesn’t want me back at work – I am still having severe muscle spasms and pain. These people absolutely do not care about you as a human being. They do not care that you have bills to pay. They do not care if you have done everything within your power to jump through their hoops and do what you ask and have done it right. Their supervisors will not return your phone calls – you have to demand to speak to them and endlessly wait on hold.

If you are a company that is looking to find a self insurance administrator for your company I highly suggest that when you get to their name in the list, keep looking, they will only add aggravation and frustration to the life of your employee that is trying to get back on their feet and come back to work.

Sedgwick Co. employees should be ashamed of themselves and I hope they have trouble sleeping at night knowing that they are screwing over hard working people who have paid for their harassment and mistreatment through years of hard work for “benefits” that are hardly what the name implies.

For the record, you have no recourse through your state insurance commission or the US Department of Labor because a company that is self insured (your employer) is not under their jurisdiction and the Dept. of Labor will only help you if you are denied and appeal at all.

I will be looking into the services of these attorneys should be first attempt at appeal not be handle quickly. I will do it knowing that some of the money will be lost to the attorneys, but I will do it because if enough of us do, just maybe they will treat us more like human beings.

Attorney Stephen Jessup:

PM,

Sedgwick can certainly be a nightmare to deal with. Please feel free to contact our office should you need any assistance with your claim for disability benefits.

Nelsie Marie Antique:

I applied for short term disability through my employer and it was denied because my employer failed to submit my EOI and health approval during open enrollment. My employer will pay my STD but I have to sign a waiver for long term disabillity.

Paula Gardner:

I was approved for FMLA in April 2014. I have severe pain and am going to be operated on in Sept. I became ill with my sugar levels being elevated and have missed a lot of work and was having my Dr. refile FMLA paperwork to increase my allowed days off from 2 to 3 a month to 3 days a week.

Suddenly my FMLA claim is closed; Sedgwick claims I didn’t accrue enough hours and my job at Apple for last 8 years is in jeopardy.

I need help.

Ann White:

I have been off work 4 months now, all Sedgwick has allowed is one shot. I have 4 disks out, had my MRI, in able to get shots to go back to work, instead I’m sent to the IME doc. In turn it’s been 5 weeks, no one has returned my calls. I went above my adjusters head and called her supervisor and he did not return my calls?! I called my state rep, who is checking into this? I find it negligent on Sedgwick’s part, all I figure is the IME report did not go their way, so now I feel like I’m in limbo and all they had to do was allow me to recieve 3 series of shots, 2 doctors recommended it! And I’d be back to work. Funny they waste paying you but not fixing you? What more does this backward insurence company want? I followed the rules, yet they break em. This should be against the law, to allow people to sit in limbo. I see why Massachusetts stopped lawsuits, this company should be out of business. So I will now seek an attorney, seeing they like wasting money and my time, they now can pay the high attorney costs seeing money is nothing to them LOL.

Attorney Stephen Jessup:

Paula,

Have you made a claim for disability benefits under Apple’s disability insurance plan? If not I would highly suggest you investigate same. Please feel free to contact our office to discuss your options further.

Attorney Stephen Jessup:

Ann,

It appears that your claim is for Worker’s Compensation benefits. I suggest you contact an employer specializing in same to discuss your rights. Please feel free to contact our office and we can assist you in finding a Worker’s Compensation attorney to speak to.

Very Worried:

I work for an auto maker and I have been off if work for a year now because of carpal tunnel in both hands. I also was complaining of my right arm hurting me so bad that the simplest task was difficult to do. I had carpal tunnel surgery in February of this year on my left hand with plans to have surgery on my right hand after the left hand healed. They also gave me a cortisone shot in my right hand when I had the surgery on my left hand to try to alleviate the pain that I had in my arm. So my doctor sent in a amended claim to add the problems that I was having in my arm and they sent me to one of their doctors. Well this doctor did not do anything except ask me a lot of questions & asked me to do things like put my fingers together, lift my arms and a couple of other things. So I went back to my doctor on several other occasions because of the complications that I had with my first surgery and the ongoing pain with the carpal tunnel & my arm. My surgery was scheduled for the surgery for my right hand and a couple days before the surgery the doctor cancelled because he said that he was referring me to the Cleveland Clinic because he thought I needed to see a specialist. But in the meantime they cut my workers compensation because the doctor they sent me to said that I reached the MMI. So needless to say I’ve been without any money for about 2 months. When I went to Cleveland Clinic the doctor found out that I had carpal tunnel in my right hand, the pain in my right arm was determined to be tennis elbow & I also have trigger thumb in my left hand which I already had surgery on. Now where do I go from here because I’m waiting on approval for the carpal tunnel surgery and how do I get them to add the tennis elbow & trigger thumb to my claim and will they owe me back pay? Please help cause I don’t know what to do!,

Attorney Stephen Jessup:

Very Worried,

Do you have a concurrent Disability insurance claim with your employer? Our office handles Disability Insurance claims, as such you will need to discuss your situation with a Worker’s Compensation attorney. Please feel free to contact our office and we can assist you in contacting a qualified attorney.

Paul:

I have been on my job for over 15 years. In that time, I have had to use Sedgwick 3 times. Once for a bone disease (avascular necrosis) in which I had to have a hip replacement, once for a hernia, and most recently for a bacterial pneumonia. Each time I have had to contact and ask these people for short term disability help, I have gotten a horrible experience. They give you the run-around shuffling your claim and demand deadlines that are hard or almost impossible to meet. I had to wait 6 weeks for my first check, causing my bills to go behind and forcing me to drain savings to feed my family. Once they get the huge packet of forms they want filled out by my physician (he had a good laugh at the size, amount and type of questions they wanted answered), they then inform you they have a certain amount of time to “review” your claim. Then my doctor still found on my follow up x-ray and examination that my lungs still were not completely clear and I had quite a bit of wheezing, so the claim needed to be extended. Instead of just letting my doctor fax them over a simple form or letter in his office, they decided they have to start the whole process over again! They assign the claim to a certain person they call the “examiner” and every single time I have tried to contact this person they switch me to her voice mail, and she has never once has returned any of my calls. Now here I sit, with no check coming in again next week, and in the same situation. They make recovering from your illness worse then the illness itself as it has caused me much grief and worry, and unnecessary trips to the doctors office to try and get the matter they caused solved. This company is terrible and their practices shady to say the least. They need to be stopped or reigned in, this is totally ridiculous over a claim for bacterial pneumonia in which I spent 2 days in the hospital. They make it hard on people on purpose, and it needs to stop.

Betrayed:

I recently have gone on short term disability due to severe symptoms from a hormonal imbalance. I currently just started therapy less than a week ago. Sedgwick denied me for MY benefit, the one I earned through the company I work for. The reason for the denial was medical information did not support short term disability. I argued with this jerk telling him it takes time to see specialists, nevertheless, I escalated the call to a supervisor whom approved the leave, (my doctor told them 2 months, she approved it for one) but told me they would need more doctors notes to extend it. I had my doctor as well as the specialist send them the notes, Sedgwick got back to me telling me it was denied again! I asked why, they said they needed the specialists to put in writing that I could not work. I asked why didn’t you say that initially? Their response was sorry that should have been messages to you. So, I had the specialist send them a letter stating that I would need one or two months to allow therapy to work. They called and denied it again. This company is no doubt committing fraud, and the companies that hire them are also committing fraud. The unfortunate part is they are costing not only the company more money by causing much stress and aggravation to the employee in result making it more difficult to heal because as we all know stress makes us sick. They are also costing the economy more money, by having more people rely heavily on their state disability benefits, as in the state of California where no taxes get taken out. I just want to get back to work feeling good again being the Dad and husband I was prior to becoming ill, and it doesn’t help that the soulless people at sedgwick don’t care to understand. I will be the biggest advocate from my company as well as others to stop using this company and drive them out of business along with any companies that behave like them. It can’t be that hard. Let’s do this!

Attorney Stephen Jessup:

Paul,

I am sorry to hear of your difficulties. Please feel free to contact our office to discuss your claim in greater detail to determine what can potentially be done at this point.

Attorney Stephen Jessup:

Betrayed,

Do you have any additional appeals left or is your only option at this point to file a lawsuit? Please feel free to contact our office to discuss what rights are available to you and how we may be able to potentially assist you.

N. Tunstall:

On June 3rd, 2014 I was sent home from work extremely ill. I have been ill on and off since we returned from back east in April 2014. I submitted a claim to Sedgwick due to my illness being constant. I’ve had high fevers, flu-like body aches, severe headaches, “fainting/blackout” issues & being found unresponsive and taken to ER via ambulance (my job requires me to carry a 9mm & M16, also climb several flights of stairs!), yet Sedgwick has denied my claim due to “the tests show no illness”. Hence, seeing different specialists, now seeing an Infectious Disease Specialist. I now have my denial under an appeal.

I have seen doctor after doctor and specialist after specialist, my doctors have sent Sedgwick paperwork & more paperwork with recommendations of not returning to work until they can “find the source of my illness”.

I have exhausted my 12 weeks of FMLA, I’ve not been paid since June, & now our company has informed me that I have till Sept. 11, 2014 to return to work or face termination! Had Sedgwick approved my claim in the beginning (under doctor recommendation) I would not have used up my FMLA, I would not be enduring this additional stress & my body would have one less issue to deal with. How can individuals that are not seeing the patients first hand go against a licensed medical professional? Where can I go for help? Who can help? I feel trapped & at a complete loss! Please give me some direction!

Attorney Stephen Jessup:

N. Tunstall,

If you still have an Appeal of the disability denial please feel free to contact our office to discuss how we may be able to assist you in securing benefits.

Denied and Hopeless:

I am a health care provider currently employed (I think) by an HCA facility. I have been off on std since the end of April. I am suffering from major depression, severe anxiety, panic attacks and PTSD. All was going well until I was hospitalized for my condition due to worsening symptoms and the need for a medication change. The psychiatrist at the hospital failed to “completely” fill out the paperwork/or to Sedgwick’s satisfaction. Instead of my “disability advocate” faxing back to the Dr. and asking him to complete the paperwork, she denied my benefits effective 8/4/14 based on the lack of supporting medical information. I have been trying to fix this situation since the 22nd of July, trying to get the paperwork completed and re-faxed… it was again denied. So I had to appeal the decision or the “denial” would stand. Here I was ready to slide into home base and return to work until this denial letter, stress, increased anxiety and depression was so bad this went on and on, until I ended up back in the hospital the 18th of August. It is now the 7th of September, I still do not have completed paperwork, return to work release and no pay. I am widowed and have no other source of income. I am now being told that even though three physicians, two of which specialize in mental health have stated I can not go back to work, that I have to write a letter in my own words explaining “why I feel I can not perform my duties”. I wonder if I was a cardiac patient if they would ask me to write such an appeal letter? I will be back up tomorrow trying to fight the system, get the paperwork I need and appeal this decision. I am currently searching for the right attorney to help me fight Sedgwick. Any referrals to a fabulous attorney would be awesome. Also, I am going to make a formal complaint to the State of Missouri Insurance Commissioner. I hope I can hang in there without having to return to the hospital once again.

Attorney Stephen Jessup:

Denied,

It appears that Sedgwick is continuing its usual tactics and the denials have prompted the need to file an administrative appeal. Please feel free to contact our office to discuss how we may be able to assist you.

Disgruntled:

Like so many others, Sedgwick is taking it’s sweet precious time. I currently just received FMLA approval from Sedgwick – my guy for that is amazing, possibly the only competent employee they have. I also have a short term disability appeal from July 2014, which was denied because I did not follow their “instructions” properly. They said that my doctor needed to contact them every thirty days for an update on my treatment/progress, even if I am under the same treatment plan, still unable to work, while waiting to see a specialist in September.

My question is this… If they have approved me for FMLA leave which precludes that I have a serious health condition – the same health condition from the appeal, are they required to also approve the short term disability for that same health condition?

Attorney Stephen Jessup:

Disgruntled,

Approval of FMLA does not guarantee that Disability Benefits will be awarded. Although each claim operates under the same set of facts, the requirement to receive each is different, and therefore receipt of one does not guarantee the other. Similar situations arise when someone is awarded SSDI benefits but a private insurance carrier determines the person to not be disabled under the terms and conditions of the insurance policy.

Laconn4:

I was injured, while driving a transit bus for the C.T.A. Which required me to have a A.C.D.F with a titanium plate, screws on March 11, 2012. I was in a lot of pain before, after surgery. Well, Sedgwick only gave me benefits 10/12/11-09/15/2012.

When my surgeon said I was MMI, my workman comp benefits was discontinued. I tried returning to work three times, but I was having excruciating pain. It’s September 11, 2014, I’m having chronic pain. I was also told my surgical site is infected. That’s why, I’m having chronic pain. I haven’t received a workmans comp check since 2012. To my knowledge Sedgwick employers are working against us, the employees.

A.D.:

I’ve been injured now for a year, sustained a concussion which led to memory loss, seizure disorder and MMD. They stopped my benefits 3 weeks ago without notice or reason. I went to their IME appointment over 2 months ago and still haven’t heard anything.

They don’t return calls or emails. This is crazy, what they do to people, and they don’t care. Bills are being shut off, I’m beyond stressed, my medication has been raised due to stress and anxiety. I was hospitalized for an extreme panic attack and stopped breathing, I woke up in ICU with a breathing tube down my throat.

I’m ready to just end it, I can’t mentally handle the stress.

Attorney Stephen Jessup:

Laconn4,

You will definitely need to consult with a Worker’s Compensation attorney to determine your rights. Additionally, contact your employer to determine if they provide any disability insurance coverage that you might be covered under.

Katherine:

I’ve been dealing with Sedgwick since 2012. I got injured working for Target. When I reported my injury, they told me to finish working, go home and rest but instead I went to ER. When I started receiving medical bills I approached Target’s store manager and HR. They told me they weren’t going to pay me to sit at home and watch TV. I went and hired a lawyer. Sedgwick kept giving me nasty phone calls and demanding me to return to work. Soon after, Target’s HR recommended me to get Medicaid and have them pay for my bills. My lawyer at the time told me that’s illegal. 2 years go by and they offered a settlement. We discussed it and agreed upon signing the section 32. The judge said that my medical coverage was continued until the next section 32 hearing. Well, it’s been 6 months, I come to find out I haven’t received the hearing due to Sedgwick – they have decline all my medical payments to my doctors and they’re saying I should cover it from my settlement, which my lawyer said the agreement was they are supposed to pay until my section 32 hearing. So now I don’t know what to do, since I’m in college, single mom and my new job it’s only 26 hours a week. These people are monsters; they have stopped paying for my medications and my lawyer hasn’t given me a time frame.

Sharon:

I got carpal tunnel and filed workmans comp through employer Cardinal Health. For awhile I was getting paid then and going to the doctors then all of a sudden they stopped paying me just like that, no explaination and then I called sedgwick and they said I should of returned to work 2 months ago, I told them I have dr statment telling me I was released, they stated they have release to work no restrictions but I did not receive anything nor told otherwise. I called the dr which stated I was released to work no restrictions I stated then why didn’t I get a note releasing me, they stated nothing just kept telling me I am under care but no restrictions but, nothing was told to me which I find very funny, I am the patient and I was told nothing. So, needless to say, I am very upset and will not return to work to make this injury worse, also the same dr referred me to a neosurgeon, ok if I can go back to work then why was I referred further.

Attorney Stephen Jessup:

Katherine,

We handle claims for short and long term disability insurance benefits, and do not handle Worker’s Compensation claims. I would suggest you consult with your attorney in greater detail as to your concerns and questions.

Attorney Stephen Jessup:

Katherine,

We handle claims for short and long term disability insurance benefits, and do not handle Worker’s Compensation claims. I would suggest you consult with your attorney in greater detail as to your concerns and questions.

Attorney Stephen Jessup:

Sharon,

You will need to consult with an attorney who specializes in Worker’s Compensation to discuss your rights.

Gonsagrie Reddy:

I am suffering from severe depression, anxiety and memory loss for eight years, now it’s gone worse. I am alway in hospital and absent from work. I have being admitted in hospital for three weeks in August for treatment and evaluation was done to see if I can continue working. After all the specialists did the evaluation it was said I should be medically boarded off. All my documents for disablity was compelted by me and my pychitrist and the medical reports were given to my company to be sent to their insurer. Can I work while I am waiting for my disablity claim to be proved?

Kaye:

I am scheduled for surgery I’m the next couple of weeks and have been out of work for over a month. Sedgwick has 6 years of medical problems sitting on a desk somewhere. I have to pay rent and for my medicine but they still have not made a decision about “my claim”. I guess I won’t be getting my necessary medicine or paying bills. To top it off they want me to pay my health insurance premium. With what? Are they going to cancel my insurance now too? All I want to do is get healthy and back to work. I get the impression they don’t care if I ever go back to work or even able to get my medicine. Reaching anyone is impossible. I can’t work but they don’t care.

Tim:

I worked for Boeing in Everett Washington, they like others use Sedgwick for their injury claims. Four years ago now I exploded a disk in my back while working on their 7LATE7. I have endured 2 major back surgeries, have spent countless hours at 13 different doctors, have perminante nerve damage down my left leg from botched treatment, it has now grown to include my right leg as well. In February 1014, I traveled to another doctor in Salt Lake who diagnosed me with CRPS directly related to this injury. The claims manager at Sedgwick, Heidi Coleman, has done everything in her power to keep me from getting treatment, from not paying my doctor for over three years now, dispite State orders to pay, has refused to pay legitimate bills for medications, travel, tests and many other things. The Boeing company has the State of Washington department of Labor in their pocket, refusing to sanction them for blatant violations of the law, from closing my claim without sending any of their so called IME doctors that they sent me to, to my attending prior to claim closure for review as the law states and many, many other outright illegal violations. They tell you what is done is done and it can’t be changed, this is totally a bunch of garbage. If you are sent to prison and it’s later found that the prosecution broke the law during your trial, they over turn the conviction. Not when it comes to Boeing or Sedgwick. I live my life on heavy amounts of narcotics, fentanyl, tisazidine, gabapenton, cymbal tea and others. These drugs make it beyond dangerous to even operate a washing machine let alone work, they make you fall asleep at any time, vision issues, depression,sever memory impairment, and a list a mile long of other nasty side effects. I can not even get out of bed because the pain is so bad I am in tears most the time just trying to cope.

Don’t ever ever ever accept payment from a workers comp or Labor and Industries claim, they don’t tell you that once you accept money from these firms you loose all your rights to sue your employer for negligance or anything else. This is the law, and they go out of their way to make sure you don’t know it. I have been fired, one month short of being vested in the company because I refused to return to work as they ordered me to, while I have written instructions from my attending doctor that I can not work, do you think the State did anything about it? Not a chance. Their so called IME Doctors are anything but independant, they are paid by your employer and issue the exact report they ask for. Folks, 13 doctors from both sides of the world have said the same thing, I will never be fixed, there is no cure for the nerve damage I received, and I will never be able to work again. Yet they send you to their IME, you see them for like the man from Fritos said for a very short amount of time, they do no tests other than minimal exam items, no scans, nothing, and issue a report that Sedgwick uses to cut off your benefits. I have lost my home, my car, everything I had worked my entire life for due to their lies and deceit, yet no one will take a stand against them because the Boeing company employes so many people in the state and pays so much in pay offs to keep the system in their favor. Did you know that because Sedgwick is a quote “Third Party Adminnistrator” that the insurance commission has no authority over them to as the law states make them treat you in good faith. These companies know this and use it to deny you what you rightly are intitled to by law. I’m to a point that I can’t even feed myself, or my family who has stood beside me through this nightmare, that I am about to be forced to go to work, which through no fault of my own, put anyone, be it employee, customer, person on the road if I end up having to drive in grave danger of injury or even death due to what these drugs I am forced to live on due to you. It won’t be intinentual but an accident will happen and someone will either be severely hurt or even killed because these companies are allowed to force people to be in situations no one should ever be in to survive.

I’m am forced to either live my life in dibilitating pain, letting these meds kill me slowly, or choose to end my own life to get relief from this Pain caused by their neglect. I am not smart enough to figure out how to beat them at this well rehoused game they are allowed to play with people’s life’s, but I would love to hear from anyone, in great detail, about your experiences with these monsters. Please feel free to email me at tha1672338@aol.com. Maybe if we band together, we can stop companies such as Boeing from using people until they become a liability to their company, from being left with they desperate choices I have to make, I have nothing as I stated, and I am now having to sell this trying to keep a roof over my head and food on my family’s table. Please help if you can, I beg you, I am more than desperate and my time is up. Please send me your support and your stories and maybe we can find a way to beat these assassins at their own game.

My apologies for autocorrection on the computer, I think you can figure out what I was trying to say. Again I hope this can help someone before they are put in a position such as mine.

Nikki:

I have worked at AT&T call center for 7 years. Very stressful job. In May we changed to a retention office and my performance level went down, began feeling anxious and had just been coping with racing mind, no sleep etc. I took several vacation days because I got to the point where I felt like getting hit by a car walking across the street to work was a better option than dealing with the stress of that environment and the day. Got to where I didn’t want to leave house. In July I had a severe panic attack at work / breakdown and my director was very helpful told me to have my husband pick me up and get myself better. I immediately saw an AT&T Eap therapist and medical doctor. Diagnosed with severe depression, anxiety / panic attacks and placed on meds: an anti-depressant, Xanax and sleeping pills. Therapy once a week. Both doctors submitted proper paperwork to support my need for short term however Sedgwick denied my claim stating I can still sit, type and talk, which are my job duties. Forward 8 weeks, I’m on new meds because the first ones were not working. Still no energy, no sleep and add to the mix worsened anxiety causing me to pick / self mutilate as my doctor calls it. New documentation was sent in to Sedgwick to support social anxiety disorder, depression and self mutilation. Again denied. I’m out of options and getting worse and can’t deal with this. Help please!

To add to it I received a letter advising I need to be back at work next week or they are removing me from payroll.

Attorney Stephen Jessup:

Tim,

It would appear that your claim is for Worker’s Compensation. If you do not already have a Worker’s Comp attorney I would highly recommend you get in touch with one as soon as possible.

Attorney Stephen Jessup:

Nikki,

Do you have any additional appeals or is your only option to file a lawsuit at this point? Unfortunately, if you do not have FMLA and your claim for disability is denied, many employers will sever employment on grounds of job abandonment. Please feel free to contact our office to discuss further.

Sonia:

I live in WA state. Who holds Sedgwick accountable for not paying me every 14 days, which I was told by my employer was required by law?

Attorney Stephen Jessup:

Sonia,

Sedgwick is a third party administrator for your company’s disability plan, they are not the entity legally liable for violating terms of the plan. It would technically be your employer, or more specifically, your employer’s disability plan that would be held accountable.

Gordy:

Sedgwick is horrible. They care only about the employer. I do have lawyers (I hired a lawyer 5 months into this), but it’s like Sedgwick doesnt care, they are going to do what ever they want.

At first Sedgwick helped me than they denied medical treatment and recently delayed temporary disability. I was injuried in a multi-vehicle accident over 2 years ago at work. Staples were put in my head, plus I had a back injury and groin injury. MRI ordered 1 month later showed 4 mm disc bulge. Workers comp. clinic did spinal manipulation for 2 months after the accident. They used cycling to deney the groin injury which I ending up using my own insurance to pay for surgery for the groin injury. I have been to around 40 rounds of physical therapy, which they tried to deney around 12 of them. I made it back to work about 10 months after the accident. But I had pain from waist down, tremors, and hypertension, which all got worse since coming back to work. A MRI and CT were denied twice, even with 2 different doctors wanting them done. Back injections were denied at first than they were approved a month or 2 later. Then I was able to get a MRI and CT done with some help a couple weeks ago and the CT found that my pelvis was fractured in 2 spots. One healed and the other didn’t, midway down the SI joint on the sacrum.

If they would just take care of hurt people like they are suppose to, people could get back to work after the proper treatment and it would cost them a fraction of the price!

Tim Haight:

Somia,

In Washington State the Department of Labor and Indrustries is supposed to enforce the law. It appears though, that they have been manipulated to the point they refuse to sanction Sedgwick for anything at all, even blatent violations of the written law of which yours is in writing. If you go to the State website for L&I, you can access everytihing about your claim, read up on the laws that they are supposed to abide by, and find out who to contact in that department. I worked for Boeing and they have paid so many people off that it is impossible to get the State to follow the law. Anyway check out that website and see if you can find the answers you are in need of. You want to look for the Third Party Administrator within the States L&I department.

Kathy:

I have been paying for short term disability plus benefits as a payroll deduction for over 7 years. In Feb. I lost my only daughter and I am raising her two year old daughter. I went to my family doctor in early September for several reasons. I was told I had fibromylgia, arthritis, copd, anxiety and depression. She took me off work and ordered several test to be done. I filed for my benefits through Sedgwick and was approved for the medical time off, but denied for the pay benefits. Said the disability didnt match the medical. Now I have to appeal it. I’m one of those people who live paycheck to paycheck but always paid my bills. But since this denial which i feel was not properly considered all my bills are late, my car is ready to be repo’d, I have disconnect notices of electric and gas, I’m losing my car insurance.. .all because they denied my claim. I have had no money at all come in, in two months, I am losing everything, because of a policy that I have paid for. They also did not pay my medical premium which is the plus part of my benefits, so they cancelled my insurance and now have a bill for $9980. If or when I can go back to work, if I have a car to get to work, I will be cancelling that benefits, because it is all corrupted.

Attorney Stephen Jessup:

Kathy,

I am truly sorry to hear about your loss and struggles. If you have not already appealed the denial of benefits please feel free to contact our office to discuss your options in detail.

Izora Armstrong:

My husband has been on short term disabilty since July. He was diagnosed with congestive heart failure, acute on chronic systolic and diastolic heart failure, Nyah class 4, ischemic cardiomyopathy, coronary artery disease, prostate cancer, type 2 diabetes. In July went to the hospital because he was having breathing problems, they transported him to another hospital and the next day they put in a s/p defibrillator, AICD because of severe ischemic cardiomyopathy. His heart was only working at 20 percent. He still gets short of breath and falls asleep frequently, tired all the time. Sedgwick has stopped his short term disabilty and has denied his claim. He has until Oct. 23 to repeal his claim and cannot find a lawyer that has any knowledge of Sedgwick and how they work. We don’t know how to start with the appeal process can you help?

Matt:

Was put out of work January 1, 2014 due to severe anxiety and severe chronic asthma by my doctor. Sedgwick kept claiming I never sent any medical info. As of September 1, 2014 with no warning AT&T terminated me. I contacted the CEO of Sedgwick letting him know I have 70 pages of medical information with fax receipts. He told me to fax them to him and he will review them under the appeals process. What else do I need to do to get this approved? Can I sue? AT&T definitely violated my civil rights as I was unable to work?

Attorney Stephen Jessup:

Izora,

Unfortunately, as the appeal is due in three days we would not be able to assist in the drafting of same. What I can suggest is that you make sure to provide Sedgwick with all pertinent medical records supporting your husband’s disabling condition.

Attorney Stephen Jessup:

Matt,

Without an understanding of your medical conditions and their effect on your ability to work in your designated profession it would be impossible to say what information would be required to secure benefits. With respect to AT&T terminating your employment I would strongly suggest you speak with an employment attorney to see if you have any rights as they relate to the termination.

Spontaneous:

Wow, this is the most shocking thing I have heard and am very surprised. Literally as we speak an incident occured at my place of employment (below is an example of the time frame).

Incident occurred May, 2000. Sedgwick has paid and accepted incident. While seeing doctors for almost a year pertaining the case, Sedgwick has denied the claim which now ends up being SDI.

If I am able to go over the issues over this site I would but for confidentiality I would like to be contacted.

Attorney Stephen Jessup:

Spontaneous,

Please feel free to contact our office to discuss the denial of benefits in detail.

Add your comment or complaint

Please be advised that your comment will be public. Any information contained on our website is for informational purposes only and not legal advice. If you are seeking assistance with your claim, then please use our confidential Free Consultation form.



Your name will appear with the comment


Your email address will not be published

Please note: The comments are moderated.
Your comment will need to be approved before it will appear on this page. No off topic post will be accepted. Our attorneys may respond to your comment.

Subscribe without commenting:


Request a Free Consultation

Click here or call 800-682-8331 now!

We respond the same day.
We represent disability insurance claimants all over the United States.

Testimonials

Read what our clients say about us.

  • Ron K. I was on disability with a major insurance company for five years without any problems, upon a field rep's visit to my home, I let him know that I was planning to try to...› continue
  • O. Lee My experience with Dell & Schaefer has and continues to be, outstanding. First, I would personally like to thank Cesar for his experience and expertise in handling my...› continue
  • Wade S. My experience could not have been better. I was instantly made to feel and to know that my best interest was important, that I would be informed of all development in...› continue

More Testimonials