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Sedgwick continues to deny disability benefits to AT&T employee

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.

I too work for AT&T. I began my short term disability in Aug 2011. The first 4 months I received my STD pay without issue. Then in Dec. 2011, my claim was put into denied status when my claim representative did not receive my discogram operative report in a time frame she had established. My doctor even called to explain it would take 2 weeks to get the report completed and sent to them. Sedgwick received the discogram report and my doctor has made it clear in his notes that I am also under the care of a neuro surgeon and I need fusion surgery in my lower back. Note from my December doctor’s office visit was provided and I was again denied, reason: they claimed they could not read the handwriting on the office visit note. My claim rep never called the Dr. for clarification, she continued to deny my claim. Then the rep went out on maternity leave.

January 2012: January office visit note was sent which was very detailed and my denial was continued, no response from Sedgwick after repeated calls and the run around. After 3 weeks I was put in touch with my new rep and she stated the denial reason was due to information provided was subjective. I also had a procedure done a week after that office visit and a note was faxed. Denied again: non supportive medical. She informed me that I was still in denied status and she needed a note from the doctor as to why I could not perform my job functions.

My doctor then filled out a work restriction form which included my dx and my physical limitations. Again denied, reason: note did not say why I could not perform my job. Now they want a letter from the doctor stating why I have been unable to perform my job duties since Dec. until current. My doctor is at his wits end. Every note has my medications listed and current findings regarding my condition. My condition has not improved and I am still under his care as I was when I began STD in August. I am also under the care of a neurosurgeon now as well.

I don’t understand how for the first 4 months, the doctor’s notes were sufficient for me to be approved for STD and boom out of no where the notes are no longer sufficient and every time they receive one, there is a different reason the note is not acceptable. My claim rep did admit when I questioned her that she does not have any medical training or certifications. I requested a peer to peer review of my file and she advised that I am unable to request one, it is done at the discretion of Sedgwick. I have spoke to a supervisor who was extremely rude and unprofessional and actually hung up on me.

I have to return to work within the next 2 weeks or I will be unemployed. I will be returning to work in agony as I was unable to schedule my surgery since I have no income thanks to Sedgwick. I no longer qualify for LTD or leave of absence since they have put my STD in denied status. I explained to them that since I have not been paid in 3 months I can no longer afford my medications, doctor visits, mortgage or support my family of 5. They are bankrupting me and making my health condition even worse. HELP!!!

Do I have any recourse to get this overturned and to receive my pay they have withheld from me? Strangely enough, my LTD rep is on my side and cant believe the STD side is denying me. Please, please, please help me… I am at my wits end and I have no where to turn…

Michelle

There are 27 opinions so far. Add your comment now.

Attorney Greg Dell:

Michelle,

My blood boils as I read your comments about Sedgwick and the way they treat AT&T employees.

Several times a week I receive the identical complaints about Sedgwick. I find that most of the Sedgwick employees have no idea what they are doing. You need to keep fighting the Sedgwick and be persistent in the information that they request.

Sedgwick’s goal is to make it so hard for you that you return to work in desperation. You have the right to APPEAL as the AT&T plan requires two appeals. You then can sue them if they deny both appeals. I know your plan has a one year STD time period, which is longer than most.

Give us a call if you would like for us to review your denial letter and see if we can assist you with your claim.

Barbara:

I am dealing with Sedgwick now on a short term disability claim. It’s been over a month since they got my Doctor’s notes and it’s still pending. First they couldn’t read my dr.’s notes and called him. Now it’s under review and they need to have their dr.’s talk with him. After all I’ve read about Sedgwick I am now better prepared to do battle with them. I’ve had FMLA for 10 years due to a lower back and sciatica problem but used it up because of some other health issues and surgeries last year. Now here I am dealing with them again. Last time they tried denying me even after my surgery because they couldn’t get my dr. on a conference review. It’s very upsetting and stressful dealing with them but at least now I know my rights.

Ms. P.:

I am a 56 year old employee of major cable company. I was taken out of work by ambulance in March due to near fainting due to high bp. I have never requested any type of FMLA. I was advised to contact Sedgwick to protect my job in the event of future flare ups. I followed every request but was denied intermittent FMLA. I reached out to the very rude representative who is never available or able to return calls. Can I request upper management to dispute? I will also request the call to be pulled where I asked very specific information on what missing information needed to be clarified. Any suggestions? Thank you.

Attorney Greg Dell:

Ms. P.,

You should demand to speak with upper management and only deal with Sedgwick in writing. Sedgwick is very difficult to deal with and we receive at least 5 complaints a day about them.

Christine Armes:

Sedgwick is just plain horrible. They denied my claim over and over because according to them I was not disabled with end stage renal disease. The people who called me didn’t even know what dialysis was. They at one point wanted to speak to my doctor. He called them and spoke to them while I was in the office with him. Two days later I got a call stating that my Dr. never called them so I needed to return to work. I told her that I was there when the Dr. spoke to her, all of a sudden she remembered speaking to my Dr. Sedgwick is just a joke, they try to scare people into returning to work.

Attorney Stephen Jessup:

Christine,

Thank you for sharing your unfortunately all too common experience with Sedgwick. I hope you’ve found resolution to your matter.

Linda:

I worked for AT&T for over 7 years. My first call center job. I am dealing with Sedgwick as well. My appeal with the Appeal Tribunal is tomorrow. My manager actually lied in the paperwork and I have no way to prove it except my word. So I will see. The people talking about AT&T… I know what you mean!

Joseph:

I have worked for AT&T for nearly 5 years. On July 15 of this year I called into work with a horrible migraine. I went to the doctor the next day and saw a PA who prescribed me new meds and set me up for a blood work test since my Blood pressure was through the roof. After the test I went to the Doctor’s office again and ended up seeing the Dr. on hand. He started off treating me immediately for my blood pressure and I told him that wasn’t why I came in. He listened and made an appointment for me with a neurologist, but that was over a month away. Meanwhile I’m having continual migraines and have began to stutter. The meds they but me on make me feel like a zombie and I told the doctor so they gave me a note for work saying DO NOT DRIVE. I live 40 minutes from work and have no one to take me. I filed for short term disability with Sedgwick CMS and it was denied. I asked the doctor to help me with the paperwork to get it approved and he had his office staff tell me that that would be the neurologist job. Meanwhile I’m not getting paid and feel horrible. I finally get to the neurologist and he sees me and sends the correct paperwork to Sedgwick and they still deny me. They say that there are conflicting reports from my first doctors visit and they can’t help me. I just talked to my boss today and he tells me if I don’t come back to work tomorrow I will be terminated for job abandonment. I said I will come back, but the stuttering doesn’t make me at 100%. He says if you’re not 100% don’t come in unless you have Sedgwick give you an approved accommodation. Sedgwick says they can’t do that, that I just need to appeal. So here I am. I lose my job tomorrow, my medical insurance, and I was told I won’t qualify for unemployment. How on earth am I going to get better?

Attorney Stephen Jessup:

Joseph,

I wish there was an answer to your dilemma. Please feel free to contact our office to determine how we may be able to assist you.

Brianna:

I work for Optumrx and have been put all STD until after the birth of my baby in November due to gallstone attacks and migraines. Sedgwick denied my STD stating that pain was not something they deemed as disabled. I work on a computer and headset all day and can’t take anything for my migraines for risk of injury to my child and the only way to correct my gallstones is surgery something else that can’t be done until after my child is born. What can I do?

Attorney Stephen Jessup:

Brianna,

Your only option is to go through the administrative appeal process they have in place.

Robert:

I am filling out the paper work for Sedgwick at this time. Do I fill out and sign the “Authorization for release and use of medical information” form? When I called and asked a Sedgwick representative, she said “We strongly recommend it.”

Attorney Stephen Jessup:

Robert,

Sedgwick will need medical records in order to evaluate your claim. If they do not have them, and do not have an ability to request same it can adversely impact your claim.

Opal Taylor:

I have Gastroparesis, which is stomach paralasis. I was out from November 2012-March of this year on STD, which after appeal was approved. Starting in July the Gastroparesis flared again & I was out from July 30th to October 7th. We redid all of the tests that are gold standard for this disease & they show that I do in fact have Gastroparesis. I have been denied for STD, and the appeal was also denied. Sedgwick says it has been denied because the medical doesn’t support my inability to work. The paperwork basically says that because I did not end up in the ER or lose 30+ pounds(which I did last time); I wasn’t sick enough! The caseworker told me I have to file suit, what would be the best next step?

Attorney Stephen Jessup:

Opal,

It would appear your only step is to file suit under the STD policy and/or make application for LTD benefits (which will most likely be denied). Please feel free to contact our office to discuss how we may be able to assist you.

DJ:

I was diagnosed with breast cancer last January 2013. Underwent a major surgery twice and had chemotherapy. I am a nurse. I was on medical leave for 8 months. Went back to work and my husband went out of the country to look for job opportunities leaving our 2 kids with me. I was so stressed out having to work 12 hours night shifts 4 times a week and had to take care of the kids. 3 months later my husband came back, stayed for 2 months and left again but this time we agreed he will take the kids with him since there will be relatives who can help him take care of the kids where he was going. We had to let go of the house and all our things. It was very hard emotionally. After my family left, I had a hard time adjusting to my new life. I can’t focus and concentrate at work. I tried to ask for a vacation but was denied. I realised I never had a break since the breast cancer journey until the time my family left. I just knew I needed to refresh. I went to a doctor and was advised to take a stress leave. I did not qualify for FMLA but I qualified under my hospital’s Medical Leave of Absence. It’s been 6 weeks now since my medical certificate was submitted to Sedgwick. When I call them they say it’s under peer to peer review… I don’t know exactly what that means. Is there a possibility that my claim will be denied? I might be able to go back to work in 2 weeks but my claim is still not approved.

Attorney Stephen Jessup:

DJ,

I am sorry to hear of all the difficulties you have had to endure. There is always a possibility that a claim can be denied for any number of reasons. If in fact Sedgwick determines you are not entitled to disability benefits please feel free to contact our office to discuss appealing the decision.

Justin:

I am an employee of General Motors. Due to unexpected health issues I was placed on disability. I am unable to walk more than 25 yards without the assistance of a cane. I did not apply for disability and received a call from GM HR stating that I was not to return to work and that I needed to contact Sedgwick to file a disability claim. Now Sedgwick is refusing to pay any benefits until after I see another specialist. The earliest available appointment to see a specialist is over a month away. I have already been a month without benefits and am in jeopardy of loosing my home as well as my job. I am not sure what I can do or how to get this resolved. Any advice would be greatly appreciated.

Carol Cole:

In April I had surgery on my right knee, they did a lateral release and Sedgwick worked with me no problems as long I kept after them calling multiple times a day. Then in July, I had to the exact same surgery done on my left knee, this time around with Sedgwick has been to say the least a nightmare. They gave me 10 days to have surgery, recover and get back to work, the doctors sent in records, notes, post-ops notes you name and stated numerous times I cannot return to work until after they re-evaluate me on my next appointment august 15th. I called Sedgwick 9 that nine times to make sure they had all the paperwork they needed and was assured that they had everything to make a determination. Today I called and the automated system said I had been denied due to them not receiving paperwork. They didn’t even have the decency to make a call to me, I had to find out through their automated system and by that time they were closed, so tomorrow I have to put my recovery on hold to deal with whatever moron is handing my case and try to figure out what they need. I hate Sedgwick, they are the scourge of the earth! I may be contacting you soon for help because they are messing with the wrong lady! I won’t back down!

Attorney Stephen Jessup:

Justin,

First and foremost, I would suggest you obtain copies of your short and long term disability policies if you do not already have them. Please feel free to contact our office to discuss your claim.

Attorney Stephen Jessup:

Carol,

Hopefully you will prevail and not need our assistance, but if you do please do not hesitate to contact our office.

Adrienne Hughie:

I’m lost for words right now. I’m reading all these comment and empathize with each person. I’ve been denied with Sedgwick because they are telling me that I don’t have enough proof to be out of work. I went to see a psychiatric and two therapist and they all noticed the same symptoms. I’m a single parent not even getting child support so my children and I are about to lose our house. I’m behind on so many bills. I’m sad, hurt and now I have to return to work and not have any income to survive… What should I do? This is not fair that my boys have to go through this too!

Attorney Stephen Jessup:

Adrienne,

Have you appealed Sedgwick’s denial of your claim yet? If not, please feel free to contact our office to discuss how we may be able to assist you.

Serenity:

I have a friend who was out of work for 4 days from 4 fractured ribs. It was a medical LOA. It was denied by Sedgwick because the doc did not send in the paperwork soon enough. My friend went to the doc’s office, had them fill it out and fax in the info. It’s been 7 days and it still has not been approved. He lost his job as they counted it as 4 unexcused absences. Can you tell me how long Sedgwick takes to process a medical LOA? They told him as soon as they recieved the papers from the doc’s, it would be aproved.

Attorney Stephen Jessup:

Serenity,

Unfortunately, I do not have an answer with respect to how long it would take Sedgwick to process the leave of absence. I would suggest that your friend contact an employment attorney to discuss what rights he may have as it relates to his being fired.

Monica:

Hello everyone, I need advice or guidance. I too am going through the same thing with this people I am tired and exhausted.

I was in the hospital on the 1st due to severe pain; it was discovered I have another umbilical hernia and for severe lower back pain due to herniated disks. I also suffer from bad muscle spasms and severe fibromyalgia. The ER doctor strictly put me on bed rest until I see a surgeon. I then went and saw a surgeon which scheduled me for surgery. Sedwick has denied me. I asked them why, when they have three different doctors telling them why I can’t work and they said it was not enough. My doctors are also so fed up with these people. I am so ready to hire a lawyer.

Attorney Stephen Jessup:

Monica,

Please feel free to contact our office to discuss the denial of your claim and what steps are available to you.

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