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Court Finds Sedgwick Wrong to Deny Benefits Without Considering Claimant’s Actual Job Duties

Attorney Gregory DellAuthor: Attorney Gregory Dell

In McMillan v. AT&T Umbrella Benefit Plan No. 1, the plaintiff, who had worked for AT&T for nearly six years as a Senior IT Client Consultant, filed a claim for short term disability benefits based on multiple medical conditions, including his coronary disease, hypertension, diabetes and sleep apnea. The plan administrator for AT&T is Sedgwick Claims Managements Services, Inc. (Sedgwick).

Although his job duties required detailed cognitive functioning and traveling to various job sites across the United States, none of Sedgwick’s independent physician advisors (PA) who reviewed plaintiff’s claim for benefits considered those aspects of his job duties. They relied on his job duties “as sedentary with sitting, typing and talking requirements.” Quoting a case it relied on for precedent, the court noted that, on this record, “there is simply no way to tell whether the reviewers were applying a correct conception of the [plaintiff’s job duties]… or some other conception.” As such, the court remanded with instructions for Sedgwick to reevaluate and consider plaintiff’s ability to perform the essential functions of his own job according to his job description.

Plaintiff’s Job Description

Sedgwick initially determined that McMillan’s job involved only sitting, typing and talking. Eventually, Sedgwick contacted plaintiff’s former supervisor for details about what his job duties entailed. The supervisor gave an extended description and included the note that “it is a cognitive position as it requires memory and thought about software installation, setup and client interactions.” The supervisor added that there was “associated travel on occasion” that could include trips to any other state and often required air travel.

Despite this detailed job description, and the fact it was included with the medical records sent to the PAs to review, none of them mentioned the cognitive or travel aspects of the job requirements when determining that the plaintiff was not disabled from performing the essential duties of his own occupation.

Plaintiff’s Treating Physicians Versus Sedgwick’s Physician Advisors

One of plaintiff’s treating physicians reported that plaintiff had “lack of concentration, poor memory, inability to multitask, difficulty with complex problem-solving.” A neuropsychologist did an assessment and noted the results of testing showed he had “disruptions in cognitive ability.” She attributed this to oxygen deprivation from his sleep apnea.

Another treating physician sent Sedgwick a report in support of plaintiff’s appeal from the denial of short term disability benefits stating specifically, “it was clear he was experiencing some cognitive dysfunction that is impairing his ability to work.” The doctor went on to explain the physiology of sleep apnea and how it was causing plaintiff’s impairment.

Each physician advisor relied on the job description of “sitting, typing and talking” and ignored the required cognitive functioning and travel requirements of the job. Sedgwick argued that the advisors all had a copy of the detailed job report in the file that was provided to them and that should be sufficient evidence that they relied on it when determining plaintiff was not impaired from performing his job duties. The court, fortunately for the plaintiff, disagreed with Sedgwick.

Oklahoma Court’s Reversal and Remand

The court held that on the record, it could not “conclude that Sedgwick’s denial of benefits is predicated on a reasoned basis.” It then determined that, instead of the court awarding plaintiff benefits, a remand was the appropriate remedy. Sedgwick “failed to make adequate factual findings regarding McMillan’s ability to perform the certain essential functions of his job.” Since the court determined this was the duty of Sedgwick and not the duty of the court, it remanded to Sedgwick for further proceedings.



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