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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


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