Our client, an AT&T employee for more than 40 years became disabled and unable to do her job due to cervical myeolapathy neck pain, chronic headaches and a torn rotator cuff in her shoulder. Her claim for short term disability benefits under the AT&T disability benefits plan has been nothing but a “headache”. AT&T hires Sedgwick Claims Management to handle the administration of all disability benefit claims.
Unfortunately for AT&T employees, Sedgwick can be very difficult to deal with and appears to be trained to deny more claims then they approve. Sedgwick handles claims for multiple companies throughout the county and their background is in handling worker compensation claims.
From our experience the Sedgwick employees treat every disability claim as if it is a worker compensation claim, which is not good for disability claimants. It also appears that the claim reps that are assigned to manage a disability claim and make claim decisions are not qualified to do so. For example, on numerous occasions, multiple Sedgwick claim reps have admitted that they don’t understand or have any knowledge regarding a claimant’s medical condition.
Our client’s claim was initially denied despite overwhelming medical support. Her claim was immediately approved by Social Security Disability. Sedgwick sent our client for a Compulsory Medical Exam with their hired doctor. The Sedgwick hired doctor determined that our client could not perform any occupation and Sedgwick continued to deny the claim. Our law firm submitted an Appeal January 25, 2012 and on February 22, 2012 Sedgwick reversed their claim denial. One would think that Sedgwick would leave our client alone at this point and continue to pay benefits, but on March 7, 2012 Sedgwick once again attempted to deny benefits despite a letter they sent stating that benefits were approved through March 17, 2012. Our law firm contacted Sedgwick and after several letters and phone calls, they advised that they made a mistake and benefits should be paid through March 17, 2012.
In the mean time, Sedgwick requested no additional information in their February 22, 2012 letter, yet during the week March 20, 2012 called our office and claimed that our client needed to submit additional medical information our they would have to send her for another compulsory medical examination and they are stopping payments AGAIN! We submitted updated medical information and a statement from our client’s orthopedic surgeon certifying her disability.
Without any basis whatsoever, Sedgwick calls our office and states that our client does not have support for disability and she needs to be examined again. Keep in mind that our client is only eligible for another 4 months of STD benefits with Sedgwick. The following is a response letter we sent to Sedgwick as we refuse to allow them to push our client around.
What more could you possibly expect from Ms. XXXX? You have had your own doctor physically examine her and she has been seen by five of her own treating physicians. She has also been approved for SSDI benefits. In the month of March 2012 she has been seen by a Physiatrist, Orthopedic Spinal Surgeon and her Physical Therapist. She continues to take narcotics in order to manage her pain. On March 27, 2012, her Orthopedic Surgeon documented that her condition is progressive and that she has significant restrictions and limitations that prevent her from working. Ms. XXXX has spinal myeolapathy which is a permanent condition affecting her spinal cord. She is unfortunately not going to get better and she cannot return to work.
Please provide an explanation in writing as to why the medical support provided to AT&T is insufficient evidence of Ms. XXXXs’ disabling condition. In accordance with ERISA regulations please specifically state what additional information Ms. XXXX must provide in order to support her claim for disability. Please identify the names and qualifications of any individuals at Sedgwick that have determined that Ms. XXXX is not disabled. Please address any requests in writing to the undersigned and do not call us requesting any information as we don’t trust Sedgwick. We will respond accordingly. If AT&T / Sedgwick are denying benefits, please provide a formal denial letter so that Ms. XXXX can comply with the appeal guidelines. We are demanding that payments are sent immediately. If you are seeking any additional information please send your request in writing.
On a daily basis we receive phone calls from disability claimant’s nationwide that have been denied either short term or long term disability benefits. We have identified a pattern of unreasonable disability claim denials by Sedgwick. We will continue to prosecute claims against Sedgwick and we welcome the opportunity to provide a free consultation regarding any long-term disability insurance claim.
Disability Attorneys Dell & Schaefer handle long term disability claims throughout the country and represent hundreds of claimants against every major long-term disability insurance company in multiple states.