AT&T employee with back injury sues Sedgwick Claim Management Services, Inc. for denial of short term disability benefits

Disability Lawyer Sues Sedgwick Claim Management Services

In the case of Richard Shane Burnett Vs Sedgwick Claim Management Services, Inc. D/B/A AT&T Integrated Disability Service Center, filed at the District Court for the Middle District of Florida, the plaintiff Richard Shane Burnett alleged that he is eligible for short term disability (STD) benefits under an employee benefit plan provided by his employer.

The Alleged Facts Of Sedgwick Disability Denial

The plaintiff was a former employee of the BellSouth Advertising and Publishing Corporation that operated under the name “AT&T Real Yellow Pages” at Tampa, Florida. He alleged that he was at all times a participant in a STD Plan called “the AT&T Umbrella Plan No. 1” under the BellSouth Short Term Disability Plan for Non-Salaried Employees program. Sedgwick Claim Management Services, Inc (SEDGWICK) acted as the Claims Administrator and operated under the name of “AT&T INTEGRATED DISABILITY SERVICE CENTER”. Accordingly, the plaintiff to the best of his knowledge and belief stated that the above mentioned plan was not insured and is funded from one or more of AT&T affiliated companies.

Following back injuries that he sustained at work, the plaintiff filed a claim for STD benefits on January 13th 2010. The plaintiff alleged that these injuries had resulted in several physical restrictions and limitations that prevented the plaintiff for performing the duties of his occupation or any other occupation.

The Claim for Benefits and Appeals to the Denial of Benefits

SEDGWICK, while operating under the name of or on behalf AT&T INTEGRATED DISABILITY SERVICE CENTER, evaluated the plaintiff’s claim for benefits and formally denied the plaintiff’s claim on February 5th 2010. An appeal was made to SEDGWICK regarding the February 5th 2010 denial but was also denied.

The plaintiff made a second appeal to SEDGWICK which was again denied by SEDGWICK on December 30th 2010. According to the lawsuit, SEDGWICK had denied the plaintiff’s claim for benefits on the grounds that he did not fulfill the Plan’s definition of disability at the time of its initial decision and the two subsequent appeals.

Legal Remedies Sought By The Plaintiff In The Lawsuit

The plaintiff alleged that he had exhausted all his administrative remedies as required under the Plan and as informed by SEDGWICK. The plaintiff argued that he was not provided or was deprived access to a copy of the STD plan. The plaintiff alleged that a request to the Plan Administrator to provide the copy of the Plan documents or Summary Plan description had yielded no result. As such, the plaintiff contended that he is unable to state the precise amount of benefits that he is entitled to under the STD plan.

The plaintiff asserted in the lawsuit that he is entitled to the benefits mentioned above because:

As such the plaintiff is seeking the following relief from the Court:

  1. A declaration that the plaintiff is entitled to STD benefits from January 14th 2010 and continuing (or for other such period as permitted under the STD Plan).
  2. An accounting of benefits owned to the plaintiff with SEDGWICK to produce the factors and figures necessary to render such accounting.
  3. An award of benefits plus interest at the legal rate from the date it became due until the date it is paid.
  4. An award of reasonable attorney fees and costs incurred.
  5. For such other and further relief as this Court deems just and proper, including but not limited to:
    • A declaration that the plaintiff’s claim continue after the last date of benefits awarded without the requirement by the plaintiff to file a new claim for benefits.
    • Remand the plaintiff’s claim to the Plan Administrator for further action to address continuing benefits under the STD Plan and for purpose of processing a claim for Long Term Disability benefits for the period following the expiration of the plaintiff’s eligibility for STD benefits.
    • An order to SEDGWICK to inform the plaintiff’s former employer or any other necessary entity that benefits in this action were properly paid through the date of this Court’s Order for the purpose of coordinating or reinstating any ancillary benefits which should properly be paid or for which coverage should be awarded as a result of the plaintiff’s receipt of disability benefits under the Plan.

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There are 59 comments

  • Hello, i am still awaiting the appeal process with att Ltd. When i first came out, i signedcpaperwork for sedgwick to get my medical records. Within about 3 weeks of coming out of work, a coworker, called me and said that sedgewick had accidentally sent him my medical records AND they emailed it to his personal email account. This person was a call center agent, who had only been at the company a few m9nths. He sat beside me in a cubicle and did tbe same job i was doing. My hippa law protection was violated. Att never called to tell me of the mistake, so i called a union rep. Union rep said get a lawyer. So, i finally got a consultation with a lawyer, and he said hippa was to protect the dr more than to protect me. And unless i show that it has caused injury there wasnt much i could do. I suffer from a mental illness, bipolar 2. My immediate concerns were who else did sedgwick send unauthorized info without my permission. This was devastating and nearly caused suicide. I went to outpatient therapy, and was in the psychiatrists. Office 2 times per week. For several months. I am now awaiting the appointment with ssdi judge, and have allsup represnting my claim. I am terrified that because i was forced to use allsup, because att threatened my std and ltd that my claim is not going to be approved if i didnt use them.i am afraid my files are not sufficiant by incompetent workers. I wont even be speaking to the representative in the case until 2 days before the hearing. Has this caused me emotional damage and financial ruin absolutely. Having a mental illness shared with my coworkers is a disgrace. By the way, the gentleman who reported that he received my records no longer works for att. He saved all records from his email. So many things with att and sedgewick, i dont think i will ever overcome the distrust and paranoia of my medical privacy. Sedgwick never offered an apology. Att never explained thier screw up.
    Help!! Please!!

    CedwardsJan 13, 2016  #59

  • Lorna,

    I have yet to see a policy that allows the carrier to reduce the benefit on account of an increase in SSDI due to COLA increases. However, if there was a re-calculation by the SSA of what your initial benefit should have been (sometimes the SSA messes up), then there would be a repayment due to that re-calculation. I would suggest you contact your carrier to discuss your concerns – it is possible there was an oversight on their part.

    Stephen JessupJun 5, 2015  #58

  • My understanding is when you receive your retroactive SSDI benefits, that the LTD company is not entitled to the COLA (cost of living allowance). For example I was awarded from January 2014 to Nov 14 $1355 by SSDI. they had a cost of living increase reflected from December 2014 throuhfh May 2015 bringing the monthly benefit to $1378–a $23 difference. So I would get to keep $113 of the $roughly $23000.00 retroactive pay. I know that’s not much, but going forwarded, is it correct that my LTD company can not subtract any SSDI COLA increase from my my monthly LTD check? It would remained based on the initial SSDI award of $1355?

    LornaJun 4, 2015  #57

  • Just,

    As it relates to your disability claim – as the appeal has already been submitted all you can do is wait for them to render a decision. With respect to the issues you are experiencing in the workplace you may want to consider speaking with an employment/labor attorney to see if any of your rights have been violated. Should you need assistance in contacting an employment attorney please feel free to call our office and we can assist you in same.

    Stephen JessupMay 29, 2015  #56

  • Just,

    As it relates to your disability claim – as the appeal has already been submitted all you can do is wait for them to render a decision. With respect to the issues you are experiencing in the workplace you may want to consider speaking with an employment/labor attorney to see if any of your rights have been violated. Should you need assistance in contacting an employment attorney please feel free to call our office and we can assist you in same.

    Stephen JessupMay 20, 2015  #55

  • My doctor put me off work from Mar 26 to May 7, 2015–I filed for my short term ATT benefits. Of course it was denied by Sedgwicked. I have gotten paid in the past when I have had surgery. Once 5 yr ago I was just waking up in recovery when they called me wanting to know when I would return to work (I had not been off even one day yet). They are horrible people, finally I got tired of them calling and callilng and I asked one gal why they were so mean. Their rep told me that the company Sedwicked gets a bonus based on all the denied claims they have per year with ATT. This makes sense because everyone I know (some even hospitalized) have been denied by Sedgwicked. This time I have filed an appeal and am waiting to hear about that now. My doc filled out all their paperwork and gave the reasons why I could not work. I suffer from insomnia, high blood pressure, heart problems (4 stents), stress, depression, anxiety, and to top everything off there is a horrible bully in my office that harasses me continously (been on going 4 years) I have had it with ATT. Sedgwicked and the bully…what can I do?

    Just down right p'o'dMay 19, 2015  #54

  • Onsmart,

    Partial disability is only available if your policy has a provision for it. As such you will need to review your policy to determine if it is available to you.

    Stephen JessupApr 18, 2015  #53

  • Hi,

    I am an employee with AT&T for over 10 years. I worked in a business office for much of my time. I got STD for 12 weeks due to a lower lumbar back surgery.

    I was later forced to take a technical position where crawling through attics, under houses, climbing poles and lots of physical exertion are common. I am not able to keep up and attribute much of the problem from lack of functional mobility. It is difficult for me to stoop, bend, and my gait is a little off. My back pain keeps me awake at night and I refuse to take pain medication beyond aspirin.

    I am probably going to lose this job and get forced into the job bank and possibly terminated, if I cannot find a job. Am I entitled to some sort of partial disability?

    OnsmartApr 17, 2015  #52

  • Tom,

    If there is a denial of benefits you will have to file an administrative appeal in an attempt to secure your benefit.

    Stephen JessupMar 17, 2015  #51

  • I filed a claim for STD on Feb 16th due to spine problems which prevent me from doing job functions. I’m supposed to hear from Sedgwick tommorrow. There was supposed to be a peer call today with my doctor. I have missed 4weeks of work no paycheck. If I am denied STD what are my options? My union rep said I would have to return to work. I am a facility tech with AT&T. How can I get repaid for my absence and what would be my best course?

    TomMar 16, 2015  #50

  • I’ve been out of work for 4 weeks with a bulged C7 disk. My Doctor put me out for 8 weeks and they only approved me for 4 which 3 of those weeks were my paid vacation. My Physical Therapist did release me with restrictions. No more than 5 mins with my arms up at eye level in a 30 min period. And returning back to work the same day Doctor put. I’m a hair stylist and my arms are up basically all day long. I still have not been released by my Doctor. I have a follow up appointment with her in 2 weeks. This is 2 weeks before my return date. Can they release me from what my Physical Therapist said and with out a release from my doctor? I have notified my work and they are not able to accommodate my restrictions. I can’t do 5 min Haircuts. Sedgwick has giving me so many different stories that it is ridiculous I have been told by 3 of their employees that my return date is what my Doctor has said. My advisor from Sedgwick already had determined my return date before and after my doctor faxed the paper work in. This has been so frustrating and makes it hard to recover.

    Hair GalDec 15, 2014  #49

  • AT&T has their own FMLA laws. They say FMLA covers first 7 days out, then Sedgwick pays disability. AT&T and Sedgwick break many laws but no one seems to go after them. What’s the problem? They need all files at Sedgwick investigated by state labor departments. AT&T needs investigated also for their fake FMLA they created. Why doesn’t anyone investigate?

    JL134FDec 3, 2014  #48

  • Mark,

    As the AT&T is an ERISA plan you do have to exhaust administrative appeals prior to being able to file a lawsuit.

    Stephen JessupOct 31, 2014  #47

  • I’ve been off work since 9/10/2014. I have 3 herniated discs in my neck – C5, 6, 7. My doctor put me on restrictive duty while obtaining treatment. AT&T no longer accomodates light duty. Policy is if you can’t do your specific job at full capacity you must go on STD. Initially Sedgewick approved my benefits thru 9/30 then after receiving updated medical from my doctor stating my injuries are not responding to epidermal injections in my spine he is referring me to a surgeon. They extended me to 10/20/14. Well I can’t get an appointment with the surgeon until 10/30/14. I recieved a call from Sedgewick today saying my benefits are being denied from the 20th on because my doctors recent updates medical doesn’t support STD approval. Basically they are saying the Ten days I’m having to wait between appointments that I’m not disabled from working. I’ve been out 2 other times in the last 14 years of employment with bellsouth/ATT and both times Sedgewick has denied me at some point during my claim. Usually right in the middle of my absence. I can’t afford to be short changed again. do I have to go through the appeal process (waste of time) before I can sue? I’ve had enough. I’d also like to sue for the 2 previous denials for similar situations.

    MarkOct 30, 2014  #46

  • Kristy,

    We would be more than willing to review your case to determine whether or not we can assist you in filing a lawsuit.

    Stephen JessupAug 21, 2014  #45

  • Hello Attorneys,

    I’m going to be filing a 2nd appeal for my disability through AT&T and Sedwick. If my claim is denied again are you still available to help me and file a lawsuit against AT&T and Sedgwick?

    I notice some of these post are older but I’m hoping your still out there. And still taking cases. I won’t go into depth with my claim but it’s quite lengthly. So I hope to hear from you soon and that you are still taking AT&T employees who are still dealing with their lies and frustration of getting the disability that I’m entitled to.

    I do believe this would be a easy claim for you to assist me with since Sedgwick isn’t following the guild lines of our disability program. That’s why I am in need of assistance if my claim gets denied once again.

    Please reach out ASAP and I thank you in advance.

    Kristy BaumanAug 20, 2014  #44

  • Jeff,

    As we do not handle FMLA claims I would not be able to properly advise you as to your question. I would recommend you contact an employment attorney in your area to get a better understanding of your rights.

    Stephen JessupAug 1, 2014  #43

  • I am off work due to a lumbar strain for 90 days we submitted the medical certification and Sedgwick gave me FMLA for the first month, now they want medical records to substantiate giving me FMLA for the remaining 60 days. Last time I checked this is against the law, am I correct? I live in California.

    JeffJul 30, 2014  #42

  • Too Blessed,

    Unfortunately, it often happens that a doctor is no longer willing to support a claim for disability. As such there is nothing we would be able to do to assist you as the problems you are experiencing are on account of your doctor. You will need to try to resolve the issue with the doctor’s office.

    Stephen JessupJul 11, 2014  #41

  • I have been working for AT&T over 14 years as a customer service rep. I recently had a total knee replacement on May 1, 2014. I requested STD due to being advised by my doctor that normal recovery and time from work would range about 3-4 months. My 2nd doctor’s appointment, I was advised by my doctor on June 11, that I was unable to return to work until next appointment on 7/28 and continue with physical therapy, and he gave me a doctor’s note supporting this as well. That same day later on I was contacted by Sedgwick Disability CASE manager asking how was the dr visit and when to expectw the medical records and dictations. I explain to the case manager that i didn’t know when they would receive the information. But I was told not to return until I get reaccessed on 7/28. Few days later, Sedgwick calls back and says they received the information from the dr appointment on 6/11, but the disability claim is pending and no further payments beyond 6/11. Sedgwick also stated they were requesting a PA review and will follow up with me within 3-5 business days. In the meantime, I’m still going to physical therapy and contacting the dr office to make sure they were completing everything that Sedgwick was requesting. Now its June 23, and the Leave Reporting person from AT&T is calling and letting me know that my disability claim is being denied and how many FMLA hours left and wanting to know when I would be returning. I contacted Sedgwick and was advised the claim is being denied for STD disability due to the PA review not completed by my doctor. and based on the medical records faxed in from the dr visit on 6/11, the patient is able to return to work as of 6/12 based on doing seated work. I contacted the dr office asking how was i able to return to work on 6/12 if i have a written dr note showing unable to return to work until next reassessment appt on 7/28? I also ask the dr when was he going to complete the PA review and he stated no he is not changing the paperwork and that i can return to work as of 6/12. This led to denied STD from 6/12-6/25. And I received no payments for these dates. Sedgwick denied me STD for these dates and I had to immediately return to work on June 26 to avoid attendance points. Then the doctor refuse to fill out job accommodation paperwork and FMLA paperwork to cover the denied disability dates. What should I do?

    Too Blessed To Be StressedJul 10, 2014  #40

  • Tony,

    You will need to consult with an employment/labor attorney as to the legality of AT&T’s termination of your employment. AT&T also offers a long term disability plan, were you covered under that as well? If so you could consider filing a claim for benefits under same while your SSDI claim is pending.

    Stephen JessupJul 6, 2014  #39

  • I’m in the process of being released from AT&T because of PMR (permanent medical restriction). My title is that of Facility Technician – a splicer in the construction crew. I drew STD benefits for approximately a year after 2 surgeries and many unpleasant dealings with Sedgwick. My Dr agreed to release me to return to work with restrictions, saying I was not to work at unguarded heights, lift over 25lbs, work in confined spaces, & that a 5 minute break was needed every hour. AT&T refused to accommodate those restrictions & therefore decided to terminate my employment after almost 16 years of service. Is that discrimination on the basis of disability? I have applied for Social Security Disability, and was promptly denied. I’ve retained an attorney who specializes in SS Disability but am told it takes 12-18 months to obtain a hearing, with no guarantee of benefits then.

    Social Security is not something we can opt out of – I’ve paid into it since 1977 with the understanding it would be available when I retired or in the event I became disabled. I’m at a loss & don’t know how I’m supposed to be expected to live for 12-18 months without any source of income. I’d appreciate your thoughts…

    TonyJul 5, 2014  #38

  • Bev,

    Thank you for sharing your experience so other can better educate themselves. To date there have been no class action lawsuits against Sedgwick that I am aware of as it relates to their disability claims handling.

    Stephen JessupMar 25, 2014  #37

  • Hi Stephen Jessup,

    Thanks for your response.

    Please know that after researching their history, hearing from co-workers, reading blogs etc… I am fully aware why “they” (Sedgwick) do what they do. They rest in a loophole that apparently no one has challenged at a higher level and have prospered for years there. Obviously, in that is why large companies choose to use their services in the first place. It’s just unbelievable to me that the various agencies that are supposed to oversee such issues allow the unfair treatment and bogus claim determinations to continue, it is 2014… right?

    I’ve wonder if there has ever been a class action lawsuit? After reading some of the above comments, adding to my previous readings, I find hard to believe there has not. And find it extremely sad that good and hard working people with legitimate claims are treated so poorly. That’s exactly why I am now in touch with your agency and your attorneys. I was just compelled to share my story and hope it helps others… but my story has much more detail than I posted.

    Thanks again.

    Bev16Mar 24, 2014  #36

  • Bev,

    In my opinion the only reason why Sedgwick acts the way it does is because they risk no financial repercussions. Sedgwick acts as a third party administrator and not an insurance company, therefore in the event of litigation the party that is responsible for payment of benefits is the company Sedgwick was hired by.

    Stephen JessupMar 19, 2014  #35

  • I fought AT&T IDSC for every STD claim I submitted, some were approved and several were not. I honestly believe that the claims review board are trained to deny you, and learn3ed that it matters who you are assigned to. One agent would deny my claim and once escalated or appealed another would approve it.

    This you deal with incapacitated after surgery. I was a previous employee with AT&T for 6 years through 2005, changed jobs and ended up as a re-hire with AT&T. I was considered to be a top performer. In 2012 I developed bulging discs derived from Degenerative Disc disorder, I had 4 surgical procedures was put in traction, and had ongoing physical therapy, including digital stimulus, all to no avail. It was recommended that I have my discs surgically removed. I can not stand or sit for more than 10 minutes without getting shooting spasms, swelling and am in constant pain. To make matters worse, unfortunately I have Closed Angle Glaucoma in both eyes and was rushed to the ER by ambulance from work one because the fluid developed behind my eyes caused pressure resulting in loss of conscience. For that issue I had 3 surgeries and was under care. I was not released to return to work after a relapse as my issues have worsened and I need a more serious surgery. My STD ran out and AT&T advised me that I was eligible for LTD (Long Term) I applied in July 2013 and was denied, I appealed and was denied. I have been in touch with:

    – TN Dept. of Labor & Workforce Development
    – Compliance Program
    – ERISA
    – Consumer Insurance Services
    – Tennessee Department of Commerce & Insurance

    and everyone states they find no reason for denial. I submitted Medical Certification in addition to all but a vial of blood etc… and IDSC Sedgwick denied my appeal. The literally told me to sue AT&T. Why are they allowed to continue to treat people like garbage?

    Bev16Mar 18, 2014  #34

  • Ruben,

    I would suggest you contact the lawyer you hired to find out what the outcome was.

    Stephen JessupMar 2, 2014  #33

  • I was injured in April 10 2013 was put back to full duty and on December my pain resurfaced. I got upper and lower pain and cannot work and also suffering from stress and depression and anxiety. I hired a lawyer on this matter, just want to know what is my outcome.

    RubenMar 1, 2014  #32

  • Sam,

    You will need to consult with a labor/employment attorney as to your rights regarding the FMLA denial and to investigate any potential wrongful termination.

    Stephen JessupJan 8, 2014  #31

  • I was recently fired from AT&T after they have aproved me FMLA claim and benefits. I have been with AT&T for 4.5 years and my FMLA condition has been on file since 3 years ago. After a recent FMLA absence that was approved, they fired me saying my FMLA was a fraud, wich is not, they have not presentef any proof. What can I do?

    SamJan 7, 2014  #30

  • Help,

    You need to immediately get a note from your doctor clarifying that you cannot work. You should also mail in several pictures of your scar so that Sedgwick understands why you cannot work. You should also write a detailed letter explaining why you cannot work.

    Gregory DellDec 26, 2013  #29

  • I work for AT&T Mobility as a customer service agent. I was diagnosed with severe endometriosis which causes severe abdominal and back pain most especially when sitting up for a long period of time. I was initially requested to be off work until December 15. Upon conducting laparoscopy, they found more cysts that needs to be removed and decided to conduct laparotomy which looks like a c-section. It was a 12 inch incision on the abdominal and due to this, my doctor extended my time off work until jan 6. I made sure that all the documentations were submitted to AT&T IDSC before the due date. On Dec 20, I was called by my case worker informing me of the denial which was passed the time I needed to get back to work. I talked to several representatives and I informed them that upon talking to the doctor’s office and due to holiday, my doctor will not be back until Dec. 26. Just an additional information, because of my high income from my previous job prior to transferring to AT&T, California Disability Insurance was the one paying for the whole check and haven’t received any checks from AT&T. It’s my first time applying for disability and I am clueless on how they determine approval. I was told that they can’t approve the claim based on pain but the standard recovery time was 6-8 weeks which is within what I am requesting. Will I lose my job because of my medical condition? I really hope not.

    I would really appreciate your advice.

    Help Badly NeededDec 25, 2013  #28

  • I worked for T for 32 years. During my last 5 years I was plagued with all kinds of problems. Apparently while I was working on a “cut-over” crew I broke my neck and my back after falling off a pole. I bounced up from the fall and after a few numbing minutes I went to the next pole and continued working (it’s amazing what you can do when you’re young). It wasn’t until 20 years later when I started having the worst pain imaginable. After the MRI’s my doctor did emergency surgery as the break was digging into my spinal cord. The surgeon took bone out of my hip rebuilding the affected vertebra in my neck, and fussed a titanium plat with six screws into other vertebra. This was a very painful event and I still needed a back surgery. I didn’t have the back done yet and have worked over the years with a pain management doctor and have had several series of steroid shots in both my neck and back. I also used some strong pain and sleep medication which at this point I’m addicted.

    I never had any problems with disability during the initial surgery and rehabilitation and I was out for a while, but after returning to work my performance suffered – I sure because of the medications and pain. On October 30 (my birthday, “happy birthday”) of 2009 I was given (forced) an FMP. I was selected from a group of peers with far less experience and sonority and was never given a reason for me being selected, but it was obvious to me – my performance must have been horrible. I had to take naps during my tour, I couldn’t sit very long or stand either – I just had to lay down several times a day. They gave me to the end of the year to find another job and I tried, but applied for disability at the same time with the intention of long term disability – I knew I couldn’t work any longer, my doctor told me I was done and diagnosed me with degenerative disk disease with recommendations for further surgery.

    The FMP package gave me a year’s pay if I signed an agreement not to sue AT&T but I needed the money – what the hell, I just got fired so I signed it. As the New Year came Sedgwick s began their BS and every horror story you’ve read happen to me. I never worried about receiving disability when signing the “General Release” document because of all the medical documentation I submitted to Sedgwick. I won’t bore you with all the stories (because you’ve seen them all) but after I signed the wavier I was denied benefits. After the appeals were denied I decided to pursue a lawsuit against them. That’s when the AT&T lawyers got involved and all the threats started. My Attorney recommended that I drop the suit because of the threats and the judge we were facing was a Republican judge and generally ruled in favour of the “cooperate world”. I followed his advice and drop the suit and have regretted ever since, especially after reading all the terrible things that ATT and Sedgwick has done to all.

    At the same time I was going through the Sedgwick/ATT denial process I applied for SSDI and was immediately granted disability. I always wonder how the Social Security Administration could grant disability and Sedgwick/ATT could deny it – seems like the SSA decisions would overrule an insurance company.
    Now I go on, living day to day, trying not to be bitter concerning my circumstances, but it’s hard. ATT discriminated against me when I was fired, they ripped off my pension with their “cash balance” BS, and they denied me disability for which I paid premiums for decades. How do they get away with it?

    I guess my question is why somebody doesn’t initiate a class action against Sedgwick/ATT? I also wonder if I still have recourse. If anyone need to use my case as an example, or if I can help others please let me know.

    MarkNov 29, 2013  #27

  • Jesenia,

    As the denial was for your husband’s FMLA claim to assist you and not a denial for benefits under a disability policy you would need to consult with an employment attorney to see if the company wrongfully terminated your husband.

    Stephen JessupNov 20, 2013  #26

  • My husband was fired from Pepsico/Frito-lay in 2013 for Sedgwick denying a FMLA claim for care me! I was on an approved disability leave with my employer and my husband needed to care for me. We attempted to appeal the decision however PepsiCo/Frito-lay does not allow the denied claim to be appealed. Not sure if the there is anything we can do now since so much time has past.

    JeseniaNov 19, 2013  #25

  • Clayton,

    The AT&T policy seems to afford very little protection to its employees. You have to keep fighting Sedgwick’s denial and try to get your doctors to provide the requested information as well as additional documentation to support any work restrictions.

    Stephen JessupSep 27, 2013  #24

  • I’ve worked for AT&T Engineering, Sacramento, CA. for 13 years many of those having perfect attendance. I was always a hard working and dedicated employee. Over the past five years my health started to decline due to severe obesity (even though I managed to lose over 140 pounds) extreme fatigue, terrible migraines, severe arthritis pain in hands, legs, feet and back. Also increased health issues with diabetes, asthma, high blood pressure and high cholesterol and angina pectoris. I tried to maintain working and did so until August 30th, 2012 at which time after speaking with my Doctor about the heavy increase in my chest pains and body pain in general I stopped working. Sedgwick immediately denied my claim for STD which I appealed and won only to continually repeat every month or two this denial, appeal process every time overturning their denial of my STD claim. These denial appeals included all my medical records as well as three letters written by my Doctor at Kaiser Permanente explaining the cause for my disability and that I will never be able to work again. A year has past now and I applied for my LTD benefits which would help carry me through until my claim for Social Security disability is approved. This to has been denied claiming that in their opinion I could do “some type of work” and due to not being able to contact my doctor directly by phone even though they admitted to me that they are fully aware that the policy of Kaiser Permanente is to only give out patient information by written request so that there is a physical copy of the information given. I am appealing again but am so tired of having to fight them and my health. I even asked them if they were trying to cause me to have heart failure due to the stress as my doctor had warned in his letters to Sedgwick. I find myself falling into a severe depression and a feeling of hopelessness. Since I have been out and have no current income I have been forced at 50 years old to move into my parents garage to keep a roof over my head. It seems to be some kind of cruel game and I am the pawn. What can I do to fight them? I’ve been told I need to go through the entire drawn out process before I can take legal action against AT&T and Sedgwick. I’m in a dire position, I could not afford the $500 a month to continue my COBRA so I now have no medical benefits, I’m not sure how I will be able to continue seeing my Doctor or pay for my prescriptions to keep me alive. Sedgwick suggested I tap my 401k but I fear huge taxation if I do. It seems AT&T has also emptied my pension it now show a zero balance. Sad to see after I put in so many loyal years of service to them. I don’t know what to do.

    ClaytonSep 26, 2013  #23

  • Brian,

    Disability and FMLA are two separate creatures. Disability is meant to provide monetary benefits on account of your disabling condition. FMLA is a Federal Law that is meant to protect a job for a set amount of time will out for medical reasons. If you do not return to work within the time allotted by FMLA your employer could terminate your employment, even if you are still out on disability. To learn what your company’s policies and procedures are as to same, you’ll have to contact your HR department.

    Stephen JessupAug 8, 2013  #22

  • I am an employee who has had carpal tunnel syndrome never had so bad that now I had release and I don’t understand if I was approved why it also removes my federal FMLA hours?

    Brian CurtisAug 6, 2013  #21

  • LittleMom,

    Hopefully they won’t deny you given the nature of your job and your pregnancy. With respect to continued healthcare (or any other benefits) you would have to consult with an HR representative for clarification on that.

    Stephen JessupAug 5, 2013  #20

  • Hi what about pregnancy? And Sedgwick? I’m a technician and climbing poles and in attics has gotten to be extremely difficult due to pregnancy. What happens if they deny me? Am I suppose to return to work in order to keep my healthcare, etc.?

    LittleMomAug 3, 2013  #19

  • Scott,

    If your doctor says you are able to return to work then there stands a good chance that Cigna will take that statement and run with it, which means that the possibility of a denial is high. If you’re then unable to return to work your employer may terminate you if you are no longer protected by FMLA or by any other type of work contract. If your claim is denied it is definitely in your best interest to contact an attorney to review your claim. Your policy appears to be governed by ERISA, which if you have spent any time on our site, you will know is not favorable to the insured.

    Stephen JessupJul 23, 2013  #18

  • I have a pending LTD claim with Cigna and my doctor submitted the paperwork needed to get me approved. My disability stems from a 2010 injury to my neck, 2 herniated disks with cord compression. I had a 2 level ACDF and the doctor that did the surgery is still my doctor that submitted the paperwork to Cigna. The reason falls under billing code 723.4. He wrote allot of restrictions. I cannot do the job I was hired to do if I followed these restrictions. My doctor also said in the report that I could go back to work. I’m thinking I will get denied the LTD and get laid off because I can’t do my job. Do u agree on this possibility? If so, should I get a lawyer to contest the denial?

    Scott HurtJul 22, 2013  #17

  • Brian,

    I am uncertain as to the direct nature of your first question, but I am gathering it has to do with STD vs. FMLA. It is important to understand that FMLA is a federally mandated law that protects a position with your employer while you are sick. STD benefits from your employer are purely voluntary, so if you didn’t have them FMLA time would still be used. As the employer sees it, you are not at work due to sickness – this in turn triggers FMLA to protect a position with them. As for your second question, I would have to defer to an attorney that specialises in Worker’s Compensation as to whether you would have a viable claim. Hopefully it will not come to that and Sedgwick will approve the claim during your recovery period.

    Stephen JessupJun 7, 2013  #16

  • I have had to work with Sedgwick and can’t stand them. Two concerns: the first is I was required to fill out paperwork so I can have additional restroom breaks due to my blood pressure which has a water pill mixed in so I have to fill out the papers like 3 times. They finally approved me at end of February and it is for six months but since I started the claim back in November 2012 my ADA approval ended a little over a month after it started and then same run around filled out the papers again… and told not good enough… So I actually just had Carpal Tunnel Release surgery on my Dominate right hand, I had the surgeons office send over the paperwork at least 1 to 2 weeks before the surgery to have it on file. I called to see the status and was told your claim has no status no reason to even send in paperwork before the surgery. They need the operatives notes and restrictions before they make a decision. This is irritating. I am also not sure why, when you have STD it also removes your hours of FMLA a year you are given since I have multiple chronic conditions. My other question: if they deny my initial claim can I request as workers comp since I have no history of carpal tunnel issues prior to working with ATT I have been there for almost two years in customer service?

    Brian CurtisJun 6, 2013  #15

  • Kutluhan,

    The answer to whether you need one lawyer or two lawyer depends on the experience of your attorney. It may not be the right time for you to apply for SSDI or disability insurance coverage if you have a third party case pending. We would need to know more facts in order to accurately answer your question. You should contact us privately.

    Gregory DellMar 8, 2013  #14

  • It is an accident happen September 16, 2012. The piece of concrete fell on to my head. Ambulance take me to hospital for head injury. I stay 4 days at the hospital. I have back and neck pains and I hired a lawyer. Since that day I see spine doctor, pain management and physical therapy. My neck is 70-80% better but low pain getting worst. I get steroid shots and not work. Yesterday I see my spine doctor and he decide surgery. Moment later he say he can’t do surgery because of my heart problem and high blood pressure. Also I have a heart attack in 2002 and stent replace it.

    At this point can go to SS disability? Also do I need a different lawyer or my lawyer can keep both cases together?

    Kutluhan KeskierMar 7, 2013  #13

  • Mary,

    Was Sedgwick your doctor or did your surgeon tell you that could return to work? Sedgwick will do anything they can to get you back to work. If you are unable to work, then you need to speak with your doctor and get documentation that you are unable to work due to your medical condition. Your policy may contain a recurrent disability provision, which would prevent you from having to satisfy a new elimination period. With AT&T you need to be on STD for year before you are eligible for LTD. You were only on STD for 2.5 month. You can make another STD claim and possible take FMLA again.

    Gregory DellDec 4, 2012  #12

  • I am 34 years old and had spinal fusion surgery in May 2012, having been off work since January 2012 unable to work due to severe pain, weakness in back and right leg/foot, while undergoing tests before surgery, my STD through AT&T Mobility under Sedgwick ran out in July 2012, I was forced to return to work 2.5 months after surgery and have been working a restricted schedule since. Having been told my back in not healing as fast as surgeon would like there is a chance that I may not be able to continue working – AT&T says restrictions are becoming excessive even thought most are off 6 months with this surgery, my issue is that when I returned, I returned when Sedgwick STD told me I had to, then found out after I returned that Sedgwick LTD says I returned before my STD was up to now I don’t qualify for LTD or leave of absence. Not sure what options I have.

    MaryDec 3, 2012  #11

  • Riley,

    It seems like you would need to file a new STD claim with AT&T in light of the new medical finding from your IME. As you know, Sedgwick is basically impossible to deal with. It often seems that you would need to have a broken back and confined to a wheel chair before Sedgwick and AT&T would pay you. It seems like you have a disability claim and not a workers compensation claim. Sedgwick / AT&T requires you to submit two appeals before you can file a lawsuit.

    Gregory DellOct 23, 2012  #10

  • Two years ago I had severe back pain that was affecting all my lower extremities however the MRI & X-rays indication nothing was wrong with me. My primary doctor at that time said I could treat this has a work compensation claim due to the fact that my pain became worse when I sat during the day and his personal findings. I went to physical therapy but nothing helped. The doctor took me out of work for 6 months and AT&T Sedgwick denied me all but the first 3 weeks and I was finally told to return to work or I would have no benefits except for Cobra.

    I finally decided at that time to file a work comp claim & hired a lawyer in which AT&T sent me to Concentra and they asked me what was wrong and I explained the pain and their response to me “nothing’s wrong with you and it’s not from sitting”. I replied to the doctor “aren’t you even going to check me”. His reply, was nothing is wrong with you so I left. I went back to the doctor who had given me 3 spinal injections which was before I decided to do work comp claim but they ended up putting me on cymbalta in which I was virtually pain free. Then just a year later I found the cymbalta wasn’t working and causing side affects so I went off the drug and my pain came back worse then ever and now my neck & shoulders are hurting so I finally decided to go to a chiropractor in which she took X-rays and found 5 slipped disc which one was 7mm out along with my tailbone being almost vertical. MRI also confirmed this.

    I’m waiting on the IME to make his decision but the chiropractor is stating she would rate me at the highest rating of disability (I have a desk job and AT&T will not even allow us to get up and get a cup of coffee if we wanted too and I’ve been in trouble for using the restroom to many times in a day) but can I sue AT&T Sedgwick for denying me std benefits for the first 6 months I was out even though it wasn’t a work compensation claim (as of today I’m still being denied work comp) and can I sue Concentra for denying me because they didn’t even examine me properly?

    RileyOct 22, 2012  #9

  • Anna,

    If your appeal is denied, then your only remaining legal option will be to file a lawsuit. Since you cannot work, you should also apply for social security disability benefits.

    Gregory DellApr 19, 2012  #8

  • I got into a wreck after ring told we could not leave early due to bad weather. When I started on my 25 minute drive home on the interstate, my truck hit the ice on a bridge and plunged over it thirty feet down. I have severe back pain from herniated disk in the lower lumbar part in my back and will need surgery eventually. Sedgwick has denied my claim for the second time because they say pain can’t be measured and not being able to walk on both legs due too numbness is not good enough. If my appeal for denial is not approved, I will lose my job because of the way our point system works. Please tell me what should I do ?

    AnnaApr 18, 2012  #7

  • Dee Dee,

    Sedgwick is a large company and in my opinion they seem to be very disorganized. I cannot say that they do these things intentionally, but we clearly see a pattern of activities similar to the ones you have described. Sedgwick originally handled Worker Comp. claims and now they handle disability insurance claims. We don’t handle Worker Comp. claims, but Sedgwick treats disability insurance claims as if they are worker compensation claims. We also think that Sedgwick hires employees that are not qualified to administer claims. Thank you for sharing your experience.

    Gregory DellMar 15, 2012  #6

  • My husband has a workman’s comp. claim with Sedgwick and twice they have stopped sending his checks. The first time he was told his payments had all been paid out that was in December 2008. He had a letter that said his checks would continue until about January 2013 so they said they made a mistake and began sending his checks again. All went well until January 2012, last check sent from them was 1-31-12. Called the same claim rep he had the first time and she said she wasn’t handling his case anymore and gave him a number to talk to someone else. The new rep told him the same thing he heard the first time. His claim had been all paid out. He told her of his letter and she said she didn’t have the letter, but would get back to him. She called, and also said our mistake, we will be sending you a check right away. What I’m concerned about is other people that may not no or remember when their claims should end. Is this company cheating people out of their money?

    Dee DeeMar 15, 2012  #5

  • Lana,

    You do not win by default during an ERISA appeal, but you may be able to file a lawsuit now due to their failure to respond timely.

    Gregory DellJan 9, 2012  #4

  • My husband was injured on 1/11 and is an bargained labor AT&T employee. He was denied STD pay for 101 days. While married, we keep our accounts separate. I, as his wife, had to sell many assets as well as exhaust my personal accounts to keep from going into foreclosure. After the first appeal, the disapproved disability was changed to an approved disability and was given 10 days of spent leave. After that decision, it was explained that AT&T had to pay my husband for the 91 days. That did not happen. Filed second appeal and, per Sedgwick’s rules, time frames were defined. Husband was to get a response by Sedgwick letter by 12/31/11 or by voice mail1/2/12. We have nothing to date. Does that mean he wins his appeal by default?

    Lana362Jan 5, 2012  #3

  • Patricia,

    Sedgwick is notorious for denying disability claims. I probably receive a phone call 5 days a week for a Sedgwick Disability Claim Denial. Don’t give up. Sedgwick stays in business because they are getting paid their fees regardless of whether you get paid your disability benefits. AT&T employees are stuck with Sedgwick. Everyday there are AT&T employees that are forced to deal with the Sedgwick. If you need assistance with your Sedgwick disability denial, then please call our office at 800-828-7583 for a free consultation.

    Gregory DellOct 21, 2011  #2

  • I have been going over the case against AT&T intergraded services known as Sedgwick Claims Management for I’m going through for my second time with this company denying my claims. First time, two years ago, I had a seizure disorder. Unable to work, they denied 29 claims submitted by my doctor. I could not drive and now I have stage four COPD and having problems breathing and on a machine most of the day, because my doctor is not saying what they feel is right. They denied me. I feel so upset for this condition already makes me have fatigue. They are not going by state and federal law per the labor board and per looking at suits filed. How do they stay in business?

    Patricia ZangOct 20, 2011  #1