• Sedgwick Disability Benefit Claims

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

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.

Leave a comment or ask us a question

Questions About Hiring Us

Do you help Sedgwick claimants nationwide?

We represent Sedgwick clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Sedgwick disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Sedgwick. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Sedgwick.

How do you help Sedgwick claimants?

Our lawyers help individuals that have either purchased a Sedgwick long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Sedgwick:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Sherrie E.

Hi, it was a pleasure to work with Cesar, he was very honest and worked extremely hard on my case. I can’t say enough good about my experience with your law group. Thank you Danielle and Cesar!

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us