Sedgwick Claims Management Services
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Post or View Comments About Sedgwick Claims Management Services (59 comments)
Disability insurance claimants are often seeking information regarding Sedgwick Claims Management Services long term disability reviews. We have created a forum where insurers can post reviews and comments about Sedgwick Claims Management Services short term and long term disability claims. Our disability lawyers respond to most comments posted by our visitors.
Sedgwick Claims Management Services is a third party administrator that manages short term and long term disability insurance claims on behalf of employers and insurance companies. A third party administrator means that 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.
Sedgwick claims to have more than 6,400 colleagues in more than 150 offices throughout the US and Canada. Sedgwick prides themselves on providing cost effective claims management, which usually means that they have 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 at https://www.sedgwickcms.com/disability.aspx
Sedgwick has all of the resources necessary to attempt to prove a claimant is not disabled. For example, in November 2010, 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.
Our attorneys have provided and offer the following legal services for disability claimants that have a disability insurance policy administered by Sedgwick CMS:
- Application for long-term disability benefits with Sedgwick CMS
- Application for short-term disability benefits with Sedgwick CMS
- Monthly claim handling of Sedgwick CMS long-term disability insurance claims
- Appeal of a Sedgwick CMS denial of long-term disability benefits
- ERISA appeal of a Sedgwick CMS denial of long-term disability benefits
- Lawsuit against Sedgwick CMS for denial of long-term disability benefits
- Lump-sum buyout of a Sedgwick CMS disability claim
- Department of Insurance complaints against Sedgwick CMS for wrongful delay and denial of long-term disability benefits
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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!
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.
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.
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!
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.
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.
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.
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.
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.
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?
Alan,
Sedgwick should not be ignoring your attorney. You should discuss with your attorney filing a complaint with your State of Department of Insurance.
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.
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.
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?
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
Sonia,
We represent clients nationwide. Please contact us via our free consultation form or telephone to discuss your claims.
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?
Shelley,
Sedgwick’s conduct you describe is not unusual. You need to appeal their denial immediately.
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.
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.
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.
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.
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.
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?
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.
Steve,
It is scary how often we hear the same story from disability claimants about Sedgwick.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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?
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.
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.
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.
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.
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.
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!
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.
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?
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.
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.
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!
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.
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?
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.
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.
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.
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.
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?
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.