• Sedgwick Disability Benefit 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.

Comments (3)

  • In Texas and fell at work and broke my wrist. On week six and I’m still having to have paperwork re-filled out by my treating physician. With FMLA deadlines of 5 business days. Receiving snail mail on the due date, informing me of the due date. I’ve driven over 180 miles for the sole purpose of paperwork with a BROKEN WRIST. And it looks like I’ll be adding at least 60 more miles on the SIXTH week. Sedgwick SUCKS!!! Meanwhile the claim cannot be approved until blah blah… blah blah…

    James S Aug 30, 2022  #3

  • I have a problem with Sedgwick and I need assistance

    Patricia Mar 31, 2022  #2

  • Almost the same thing happened to me! I have several mental health problems Iv been on medication for some since 2000, I was put on Lithium in 2008 / also run over by a truck in 2002, many broken bones & was made to get up and walk out of the hospital because the doctor said nothing was broken; only to find out a couple days later my hip was broken, my pelvic floor was broken & dislocated .. Iv had kidney problems since I was a small child, first surgery I was 6 years old, now I have to catheter myself twice a day/ the judge who denied my case did not have any of my records from my kidney doctors. Nothing was givin to him about my past mental health hospital stays nor suicidal attempts due to medication changing constantly.. He denied me based of 2 reasons, one I had never had physical therapy ( my orthopedic doctor had me seen twice in physical therapy & both times was told it would hurt me worse then help my disability because it’s ongoing and will only worsen and no way to recover and no surgery to help in any way possible. Second he denied saying I’d never been on a pain management treatment; no I have never been to a methodone clinic but after I was able to walk again and the pain medication was taken away back around 2005, I was one of the first patients ever to start the subutex and treatment and have been on this medication every since! And it does help 100% with pain, it was not made clear that I had severe anxiety , panic attacks & depression from PTSD symptoms Iv had since age 7 ; therefore the pain medication usually given (opioid medication) mixed with the anxiety medications & all the other medications I take daily would cause me to overdose in no time. I had a horrible so called attorney that only called me a hand full of times in 3 years and I never saw her once! She would get very aggravated explaining each step of the process we was going threw , like most people I did not and still don’t have the knowledge I wish I did concerning disability, when the judge denied my case after a 3 way phone conversation with my lawyer him and myself, I did not understand why or what to do; I thought the case was still going because he did not have all the information needed to properly evaluate my situation. I was told I could preform one job I remember, a laundry folder.. which no, I can not. I have tried my hardest to work but have had a hard time mentally and emotionally and then after 2002 it became physically impossible. My case was denied I’m 2021 in May I think. I have not been well enough since to even try; I stay fatigued and sick on my stomach it’s all I can do to make it to my own doctor appointments. I’m at a loss!

    Dawne S. Jan 12, 2022  #1

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