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Court Remands to Sedgwick for Reevaluation of Its Denial of Claim for Disability Benefits

In Daniel T. Derichs v. AT&T Services, Inc., plaintiff, an employee of AT&T who suffered from post-traumatic stress disorder (PTSD), applied for short-term disability benefits. The plan administrator, Sedgwick Claims Management Services, Inc. (Sedgwick), denied Derichs’ claim. After exhausting his administrative appeals, Derichs filed this ERISA lawsuit.
At issue was the correct definition of total disability under the clause of the policy that read, “You are considered Totally Disabled when, because of illness or injury, you are unable to perform all of the essential functions of your job…” Specifically in question was whether the clause meant a claimant was disabled only if they could not perform “any” of their essential job duties, a definition proposed by Sedgwick, or disabled if they could perform some, but not all the essential functions of their job, as proposed by Plaintiff.

The Court held that the Plaintiff’s definition made the most sense and found Plaintiff would be disabled if he proved that “he was unable to perform any particular essential function of the job.” The Court remanded to Sedgwick with instructions to reevaluate Plaintiff’s claim using this definition and to do so within a reasonable time.

Court Determined Plaintiff’s Interpretation of “Unable to Perform all of the Essential Functions” of His Job Duties is Correct

The Court found the policy language ambiguous and noted that ambiguities in policy language are interpreted against the entity responsible for drafting the language at issue, in this case that was Sedgwick. After much analysis, and consideration of decisions made by other district and circuit courts, the Court determined that the inclusion of the specific language “essential functions” of the job meant that if defendant could not perform even one essential function, he would be unable to continue to perform the job as a whole and would therefore meet the definition of disabled. The Court noted that this definition is “more reasonable and more in keeping with the plan’s clear purpose of providing benefits to those who can no longer perform their jobs.”

Sedgwick Did Not Consider Plaintiff’s Disability Under the Correct Definition

Sedgwick argued that it evaluated Plaintiff’s claim under both definitions, including the one adopted by the Court. The Court disagreed for several reasons:

This case was not handled by our office, but we thought it could be helpful to those who are fighting for their disability benefits against insurers who are using the wrong definition for disability as the term is used in the particular policy. If you have questions about this, or any other aspect of your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free case consultation.

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FAQ

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.

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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.

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