Sedgwick Disability Help

Nearly Three Years Later, Sedgwick Finally Pays Walgreens' Pharmacist's STD and LTD Claim

After three long years of struggling with no income due to Sedgwick’s failure to approve her benefits, the claimant is finally awarded the disability benefits she was rightfully owed. The claimant worked for Walgreens for approximately 11 years and was a dedicated employee who loved her profession. In early 2011 she began to feel fatigued and experienced pain in her muscles and joints. She was very concerned for her health and sought help from several physicians and specialists in order to find some answers. Her doctors ran every test under the sun; they ordered blood work, CT scans, Lyme tests, MRI’s, which all came back negative. The claimant was examined and treated by eleven doctors within a 6 month period at the prestigious Mayo Clinic in Jacksonville, Florida, who all confirmed her diagnosis of Fibromyalgia.

Her condition continued to deteriorate and in September of 2011 she was no longer able to work as a pharmacist. At that point, her physicians notified her employer Walgreens of her inability to work due to severe, progressive Fibromyalgia with bodily pain, chronic fatigue, chronic daily headaches, papilledema secondary to pseudotumor cerebri, sleep and urinary dysfunction, neuromuscular pain, numbness and tingling of the bilateral upper extremities, frequent episodes of irritable bowel syndrome and secondary depression and anxiety. Sedgwick, a third party administrator hired by Walgreens to make claim determinations, failed to have her examined by a physician and merely conducted paper reviews of her medical records ignoring her treating doctor’s opinions that she was too ill to work in her occupation. The basis of Sedgwick’s denial of her claim was that she failed to provide objective evidence of her disability.

Judge Rules Sedgwick Was Wrong for Requiring Objective Proof of Fibromyalgia

Fibromyalgia is a type of muscular or soft tissue rheumatism that affects muscles and their attached bones and is also accompanied by fatigue, sleep disturbances, lack of concentration, changes in mood or thinking, anxiety and depression. Fibromyalgia can be severely disabling and can only be diagnosed by an examination of the patient. There is no objective test that exists that can show that a patient is suffering from Fibromyalgia other than performing a trigger point examination, which also relies on the patient’s subjective complaints. Therefore, it is impossible to provide objective proof of an illness such as Fibromyalgia when none exists. Therefore, it was improper for Sedgwick to require the claimant provide objective proof of her illness when Sedgwick knew it was impossible to do so.

In oral argument on the claimant’s summary judgment motion, Attorney Alters argued that Sedgwick’s demand for objective proof of the claimant’s was unreasonable and arbitrary and capricious. Sedgwick’s basis to deny the claim rested solely on the lack of objective evidence to support the diagnosis of Fibromyalgia. It is well established that there are no objective tests that exist to confirm or rule out whether someone is suffering from Fibromyalgia. A person can undergo MRI’s, EEG’s CT’s all day long, but none of these tests and studies can establish a diagnosis of Fibromyalgia. The Judge in this case agreed it was wrong for Sedgwick to require such objective evidence as it is impossible to provide, granted partial summary judgment in favor of the claimant and remanded the claim back to Sedgwick to conduct a proper review without requiring objective proof of her claim. The Judge further suggested that Sedgwick conduct an IME of the claimant by a rheumatologist to determine whether she was truly disabled.

Sedgwick Overturns Decision to Deny Benefits After Conducting Fourth Review

On remand, the claimant provided Sedgwick with additional medical records and several opinions from her treating physicians, including a rheumatologist, all supporting her inability to work. Sedgwick took the court’s advice and sent the claimant to a rheumatologist to conduct an independent medical examination. The rheumatologist who conducted the IME found that the claimant was clearly disabled as a result of fibromyalgia and stated as follows:

The patient’s condition required restrictions and limitations beginning from 09/19/13 through the present. Based on my evaluation on 04/20/14, the patient does have significant fatigue along with cognitive impairment and inability for sustained activity. Her Fibromyalgia is also complicated by frequent migraine headaches as well as other comorbidities like a depression and anxiety as well as other somatic symptoms of frequent urination from interstitial cystitis as well as interruption from irritable bowel syndrome.

Her restrictions and limitations have not changed since original disability date of September 2011. She has restrictions in lifting weights more than 10 pounds. She has restrictions in sustained sitting more than two hours at a time with a total of six hours in an eight-hour time period. She can stand only up to an hour at a time with a total of four hours in an eight-hour time period. She has difficulty in bending more than occasionally. She has also restrictions in reaching above the shoulder repeatedly and can do those maneuvers only occasionally. She has difficulty with repetitive movements involving the hands and she has difficulty reading constantly because of her neck pain. She has mental fatigue as well as cognitive dysfunction partly from the medication she is on and partly due to her Fibromyalgia conditions. Their restrictions and limitations have not changed since September 2011.

After conducting its fourth review of the claim, Sedgwick finally overturned its decision to deny the claimant’s benefits. Attorney Alters is in the process of filing a motion for attorney’s fees and costs and will take the position that the claimant had clear success on the merits of her claim and is entitled to fees. Attorney Alters will also continue managing her claim to help ensure she receives benefits as long as she remains disabled.

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Sedgwick Reviews

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Sedgwick

AT&T Was Great and Sedgwick Horrible

Reviewed by From a great job to a complete nightmare on March 20th 2024 Verified Policyholder | March 2024 date of disability

My Physician recommended that I take some time from a toxic environment after several deaths in my family coupled with AT&T trying to run tenured employees out of the door... read more >

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Lame

Reviewed by Dennis T. on December 11th 2023 Verified Policyholder | March 2022 date of disability

My experience with Sedgwick and personell is as follows: Unhelpful, unprofessional and an overall unpleasant experience.

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I was disabled 2003 by SS. I got SSDI 7 years too late.

Reviewed by Bunny on August 9th 2023 Verified Policyholder

I believe if Sedgwick would have moved on my Claim. They absolutely did everything not to answer my calls, change dates. I had already been through WV comp. Ins. Sold out,... read more >

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They falsify documents and avoid contact as much as possible.

Reviewed by Jeff Allsop on July 27th 2023 Verified Policyholder | February 2023 date of disability

They avoided sending the documents needed for the claim for two weeks. I had to escalate with a call from my company's HR and Sedgwick (the only way I was ever able to get... read more >

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Not getting paid

Reviewed by Cezes on June 15th 2023 Verified Policyholder | March 2020 date of disability

I been battling Sedgwick about my claim. I was to get paid today and I did not get paid.Sledges is the worse company I ever had to deal with. I been fighting with my b... read more >

Sedgwick

You have to be well versed in your rights when dealing with them

Reviewed by Lauren on June 3rd 2023 Verified Policyholder | May 2023 date of disability

I live in CA and have a very straightforward maternity leave case. Every adjuster is unaware of CA leave laws. They’ve gotten in wrong every time. You have to advocate f... read more >

Sedgwick

Sedgewich is the worst-immediate denial of all requests for treatment. Rubber stamps DENIED ALL RFA’s

Reviewed by J on May 31st 2023 Verified Policyholder | August 2023 date of disability

Sedgewich immediately denies all RFA. They’re ur team are THEMSELVES not a independent medical team…

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Very very slow to respond

Reviewed by Steve on May 31st 2023 Verified Policyholder | April 2023 date of disability

Very very slow to respond to reply to questions they put you on a timeline, but they can bend their timeline.

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Q: Sedgwick denied my STD appeal, is there anything I can do to get my money back?

Answered on June 15th 2023 by Attorney Gregory Dell

A: Vicky: You need to file a written appeal of your Sedgwick Disability Denial. Sedgwick will have someone review... Read More >

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Nearly Three Years Later, Sedgwick Finally Pays Walgreens' Pharmacist's STD and LTD Claim

After three long years of struggling with no income due to Sedgwick's failure to approve her benefits, the claimant is finally awarded the disability benefits she was rightfully owed. The claimant worked for Walgreens for approximately 11 years and was a dedicated employee who loved her profession. In early 2011 she began to feel fatigued and experienced pain in her muscles and joints. She was very concerned f... Read More >

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Reviews from Our Clients

S.S.

I am a physician in my 30s who was practicing in my hospital based medical specialty until my Multiple Sclerosis diagnosis began to severely limit my physical ability to work.

My husband and I were obviously in distress at these very unwanted life changes and frankly overwhelmed with the possibility of a long and traumatizing legal battle ahead of us. We knew we were legally entitled to benefits through the separate private individual and employer based ERISA disability insurance policies we had, but even cursory research and discussion with colleagues made it clear that insurance companies will strategize with their own legal teams to find ways to not pay out benefits. We found many before us who had fallen unwittingly into legal pitfalls that prevented them from ultimately obtaining benefits. We realized we needed to seek legal counseling.

We found Dell Disability Firm through their youtube channel where their associates have videos discussing the legal intricacies and latest developments in private disability law. I was impressed by their dedication to the field and reached out through their website to request a free consultation.

We were delighted to hear that Mr. Steven Dell himself would be willing to take our case and felt assured that we would be represented by the best of the best.

We have not been disappointed in our expectation and have, in fact, been consistently very impressed. Steven Dell is clearly both knowledgeable and wise about dealing with these issues but more importantly, has shown kindness and impeccable honesty at each step of the way.

Merlin has demonstrated a very high capacity for organizing and handling the endless myriad of documents and communications between us and the insurance companies. She has also been very compassionate, accessible and forthcoming in dealing with our many anxiety fueled emails and telephone calls to her and we are very grateful for her involvement.

For over 7 months, we have been working closely with Steven Dell and Merlin Bryan from Dell Disability Lawyers as they have guided us through the process of review and initial application for benefits from our two insurance policies (Hartford and Ameritas).

We are happy to announce we just received approval of claim from the Hartford insurance company.

At this time we are still working with this firm as we await the final decisions from Ameritas policy that we are hopeful will have a similar outcome.

As anyone with a chronic and progressive illness can tell you, time becomes a very precious commodity. Through their representation, Dell Disability Associates has allowed us to focus the majority of our time enjoying the time and function I have left while resting assured that our disability case laid in competent and caring hands.

The truth is that no amount of money can make up for what we have lost, but it is a huge comfort to have a team like Dell Disability Lawyers at our sides to help us ensure we will be able to continue to care for ourselves and our families.

We highly recommend Dell Disability Lawyers, Mr. Steven Dell and Ms. Merlin Bryan to handle your disability insurance claim.

Thank you Steven, thank you Merlin!

We will certainly plan on leaving another review for completeness once we have our final decision from Ameritas.

Paula B.

I have been working with Dell Disability Lawyers for the past 5 years concerning my disability as it pertained to my employer. I have been more than pleased with them the entire time. They have always kept me informed of any paperwork needing completed or any changes coming ahead. Nothing has been a surprise. I would recommend them to you to help with your disability case if you’re trying to dip into the policy you’ve been paying for.

Michael M.

I am a physician who has been disabled for over 10 years. During this time I have been represented by Cesar Gavidia and his assistant Danielle Lauria. Their representation on my behalf has allowed me to concentrate on dealing with my disability/disease process and all associated complications and not having to deal with all the things that are necessary in a disability claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you well served with this practice.

Dan P.

I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. Its a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff enough at Dell Disability for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

Jen S.

I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD claim. Going through the denial process on my own was going to get me sicker and knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia – Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Lawyer Alexander Palamara and RIGHT-HAND legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to Dell Lawyers, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell.

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell. They worked tirelessly to get the best outcome for me. I’m so glad that I found them!!

Carole S.

Exceptional efficient and professional service from Jay Symonds and Sonia Nogueira. They were both so helpful and knowledgeable and navigated me through a very stressful and difficult situation with New York Life.

K. S.

Awesome team. Jay and his team, Sonia and Francesca, truly care. This team is very Professional and quick to respond. Jay always provided answers in detail to my questions. I strongly recommend Jay Symonds.

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