Disabled engineer from Philips Electronics North America sue Sedgwick Claims Management Services Inc. for denial of long term benefits claim

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:

The plaintiff also requested a trail by Jury and that the trial is held at Wichita, Kansas.

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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

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