• Sedgwick Ignores Medical Records and Denies Disability BenefitsSedgwick Ignores Medical Records and Denies Disability Benefits
  • Sedgwick Claims Management Services Disability Benefit ClaimsSedgwick Claims Management Services Disability Benefit Claims
  • Third Party Administrator Role in Disability Insurance ClaimsThird Party Administrator Role in Disability Insurance Claims

North Carolina Court Determines That Sedgwick Abused Their Discretion And Wrongfully Denied Disability Benefits For BellSouth Employee

A BellSouth Customer Service Assistant, with the help of his North Carolina Disability Attorney, was forced to file a lawsuit against Sedgwick after being denied continued disability benefits.

History of the Claim

Mr. D. was employed as a customer service assistant for BellSouth Telecommunications (“BellSouth”) and was a participant in the Short Term Disability (“STD”) Plan, which was administered by Sedgwick, for BellSouth employees. In October 2008, Mr. D sought STD benefits after his doctor determined that Mr. D could no longer work due to significant mental health impairments. Sedgwick initially approved and paid Mr. D STD benefits for his mental health disorders beginning in September 2008. However, in July 2009, Sedgwick terminated Mr. D’s benefits.

Following two unsuccessful appeals of Sedgwick’s denial of benefits (and the exhaustion of his administrative remedies), Mr. D, through his disability attorney, sued Sedgwick in federal court arguing that Sedgwick had wrongfully terminated his short-term disability benefits.

After reviewing the substantial medical evidence presented by Mr. D in support of his claim for benefits, the North Carolina court determined that Sedgwick abused their discretion and wrongfully denied short term disability benefits for the following reasons:

In reaching its decision, the court explained that there was “overwhelming evidence in the record showing [Mr. D]’s disability.” First, none of the four professionals who actually interacted with Mr. D concluded that Mr. Dr. could return to work. Mr. D’s treating physician, who had observed Mr. D over many years, had diagnosed Mr. D with Obsessive Compulsive disorder, Panic Anxiety Disorder with mild Agoraphobia, Bipolar I Disorder, Generalized Anxiety Disorder, delusional ideation and paranoia and hyper vigilance. Sedgwick arbitrarily refused to credit this evidence. Second, a vocational case manager concluded that Mr. D was not employable and issued a statement expressing her concern for “the safety and welfare of [Mr. D] and his co-workers and supervisors if [Mr. D] were to return to work.” Sedgwick again refused to credit this evidence.

Instead, Sedgwick retained a psychologist to perform an Independent Medical Evaluation (“IME”) of Mr. D who concluded that Mr. D exaggerated and over-reported complaints and symptoms. He reached this conclusion through an examination described by other psychologists to be inaccurate and the incorrect analysis to be used. Sedgwick ignored this criticism and instead relied almost exclusively on the IME provider’s questionable determination that Mr. D had exaggerated his symptoms.

The court explained that Sedgwick had improperly relied on the IME provider’s conclusion and that there was substantial credible medical evidence to support Mr. D’s claim. The court ultimately concluded that Sedgwick had wrongfully denied Mr. D short-term disability benefits.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

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.

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   *****

Connie A.

I was recommended to Dell & Schaefer via another attorney. I was not sure of what the process would require of me at the time. I was hesitant to follow through because of my disruption in communicating skills and the frustration of dealing with the insurance company on my own. Ms. Alters and Sonia Nogueira are so very understanding and companionate though working diligently to resolve my issue.

I felt as if they had my best interest at heart. I appreciated the continual communication and explaining of the process and where it could possibly go. I would highly recommend this firm, Ms. Alters and her team to anyone who feels they have done all they could do, because as I found there was a lot more that this talented firm accomplished.

Read 424 reviews

Speak With An Attorney Now

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