In the case of Andrew Gary Sigai V Sedgwick Claims Management Services, Inc. and Philips Electronics North America Corporation, as Administrator of the Philips Electronics North America Long Term Disability Program, the plaintiff Gary Sigai, through a disability attorney, filed a lawsuit against Sedgwick Claims Management Services, Inc (Sedgwick CMS) at the District Court for the District of Kansas.
The Alleged Facts of the Sedgwick Disability Benefit Denial
The plaintiff, a highly qualified individual with a Bachelor of Science degree, a Master’s Degree and a Ph.D. in Chemistry, was an engineer working in the fluorescent product development department Philips Electronics North America Corporation (Philips). One of the perks of the plaintiff’s job included participation in the Philips Electronics North America Corporation Long Term Disability Program (LTD Plan). The LTD plan was administered by Philips with Sedgwick Claims Management Services (Sedgwick CMS) as the Claims Administrator.
Prior to working with Philips, the plaintiff already had a prior history of heart attack. However, towards early 2007, the plaintiff began experiencing more health problems including difficulty in regulating his diabetes and blood sugar levels. He would frequently experience “shakes” and have to sit down at his desk and lower his head. Even slight physical activities like walking through his work area will tire the plaintiff and would require him to sit down. In addition, he had to frequently take naps through his lunch hour in order to be able to complete his work day.
As a result of his health problems, the plaintiff was forced to stop working on April 30th 2007. Subsequently, he applied for social security disability benefits with the Social Security Administration (SSA) and was determined to be disabled and eligible for social security disability benefits by the SSA on February 26th 2010. The Social Security Administrative Judge determined that the plaintiff was unable to perform any past relevant work, and that there are no jobs that exist in the economy which the plaintiff could perform.
The plaintiff’s multiple medical issues prior to him leaving Philips’ employment included Coronary artery disease, Diabetes, Hypercholesterolemia, Hypertension, Lung disease and Sleep Apnea. On May 20th 2010, the plaintiff submitted a claim for LTD benefits under the above mentioned LTD plan. His claim was however denied by Sedgwick CMS on May 21st 2010. In response, the plaintiff submitted an appeal November 12th 2010. This appeal was also denied by Sedgwick CMS on January 17th 2011. With this denial, the plaintiff stated in the lawsuit that he had exhausted all his administrative remedies.
Relief sought by the Plaintiff
The plaintiff alleged in that the actions of the LTD Plan Administrator and Sedgwick CMS constituted a violation under ERISA and entitled the plaintiff to declaratory relief from the Court and/or the enjoining of the actions of the Plan Administrator and Sedgwick CMS which violate the terms of the Plan and properly enforce the terms of the Plan. As such, the plaintiff requests the Court for the following relief:
- Judgment in the plaintiff’s favor and against the LTD Plan Administrator and Sedgwick CMS in an amount in access of $75,000.00;
- A declaration that the plaintiff is eligible for LTD benefits under the terms of the Plan and enforce the terms of said Plan;
- An Award of reasonable attorney fees and costs;
- Any other further relief deem fair and equitable by the Court.
The plaintiff also requested a trail by Jury and that the trial is held at Wichita, Kansas.