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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.

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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.

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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.

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Marna L. (Tennessee)

When the letter arrived from the insurance company that they would no longer be making payments to my disabled spouse our world came to a stop. This is a devastating moment. Rather shocking since we had complied with all the requirements. Shortly, thereafter I started researching to find the best legal firm to represent my spouse. After reading the numerous ads for legal firms I came across Dell & Schaefer. Read the material, listened to the you tube and read the booklet. The process was fast once I place the call.

Attorney Jay Symonds returned my call. He was amazing and talked me through the process. He went through the details as to what would be needed several times. He has patience which is needed when dealing with people under stress. Mr. Symonds was open to different types of communication and at odd times of the week and day. He was understanding of my time as a full time caregiver. Through the process Mr. Symonds and his staff stayed in contact with me. End Result: My spouses insurance was reinstated. We are very grateful to Jay Symonds and his team.

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