Sedgwick Disability Help

Sedgwick Reinstates Long Term Disability Claim Following Appeal

Like many disability claimants, our client’s experience in dealing with Sedgwick was less than a pleasurable experience. After finding himself unable to continue to perform the very physically demanding duties of his occupation as a Traveling Field Engineer for Avaya due to Chronic Pain stemming from multiple lumbar and thoracic spine conditions he filed a claim for short and long term disability benefits under his employer’s plan, which was administered by Sedgwick CMS.

The Initial Denial of Benefits

In reviewing his initial application for benefits Sedgwick had our client undergo an Independent Medical Examination. Despite a plethora of objective medical evidence, such as MRIs and physical examinations noting restriction and limitations, Sedgwick’s doctor indicated that there were no “objective medical exam findings” to support his inability to perform the duties of his job. In light of Sedgwick’s IME doctor’s opinion, Sedgwick denied our clients short and long term disability claims. Upon receipt of the denial letter he contacted Dell Disability Lawyers and spoke with Attorney Stephen Jessup.

The First Appeal

Attorney Jessup requested a complete copy of our client’s claim file from Sedgwick to assess the level of review conducted by Sedgwick and to determine what information would be needed to strengthen our client’s claim on appeal. The largest glaring inadequacy noted in Sedgwick’s review came in its evaluation of our client’s occupational duties. The only reference to our client’s job description was a four line blurb that gave a generalized overview of his duties as a field engineer. As his policies defined his “own occupation” to mean how it is performed in the national economy, Attorney Jessup turned to various governmental occupational information resources to gather additional information with respect to the physical demands of our client’s occupation. Admittedly, many occupations fall within “sedentary” and “light” demand level, but according to the Department of Labor our client’s occupation was in the Very Heavy demand level. Sedgwick turned a blind eye to this and instead reviewed his claim as if it only entailed his ability to do desk work.

Attorney Jessup then arranged for our client to undergo a Functional Capacity Examination to verify his inability to perform “Very Heavy” work and to further eradicate Sedgwick’s position that there was a lack of objective evidence to support an inability to perform his occupational duties. The results of the testing clearly documented our client was not able to return to his occupation as a Field Engineer. Following receipt of this report our client’s administrative appeal was finalized with additional Attending Physician’s Statements and updated diagnostic testing and then submitted to Sedgwick.

Approximately two months after the appeal was submitted, Attorney Jessup was advised by Sedgwick that it was overturning the denial of our client’s claim for short term disability benefits. Although this was certainly positive news Attorney Jessup quickly focused his attention to the status of the long term disability claim, which had been appealed at the same time as the short term disability claim. Two weeks after notice that the short term disability claim had been approved, Sedgwick sent a letter indicating that our client’s long term disability claim had been denied.

The Appeal for Long Term Disability Benefits

In denying the long term disability claim it became clear that Sedgwick’s sole focus was to discourage our client from pursuing his rights under this employer’s policy. However, he and Attorney Jessup were not deterred and prepared an appeal of the long term disability denial. Attorney Jessup argued that the same information used by Sedgwick to approve our client’s claim for short term disability was the same information now being used to deny benefits for long term disability benefits despite the information being contemporaneous to the period of long term disability. The lack of logic in Sedgwick’s denial was appalling, and Attorney Jessup set out to systematically address each and every contradiction in Sedgwick’s denial. Following the submission of the long term disability appeal Sedgwick was again left with little choice but to approve our client’s claim for long term disability benefits.

If history is any indicator we are confident that this will not be the last attempt by Sedgwick to try to deprive our client of his benefits.

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Sedgwick Reviews

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Sedgwick

Don't trust them, they like to play games

Reviewed by Bob on November 14th 2024 Verified Policyholder | June 2024 date of disability

They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >

Sedgwick

Worst Company Ever

Reviewed by RobRob on September 23rd 2024 Verified Policyholder | August 2024 date of disability

If something happens to you at work you better hope you die, my son is going through HELL because this company is handling his work comp. NO RETURN PHONE CALLS, TEXTS, EMA... read more >

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.

Sedgwick

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 >

Sedgwick

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 >

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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 >

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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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Reviews from Our Clients

Keith G.

They were very professional with their responds and on time with keeping you inform about everything with your case. I would recommend My lawyer Stephen Jessup, he was on point with everything, thank you. You guys are awesome people to work with. God bless you guys.

Keith L.

I was not able to work as a physician for about 14 months due to neck/back issues. Even though I had 3 medical doctors explicitly state that I was not to work AT ALL as a physician at that time, New York Life (NYL) Disability Insurance denied my long term disability claim (which apparently they deny a high percentage of people similar to me- only they know why they do this to so many- I have my own suspicions). I was in pain from my medical issues and so frustrated with NYL considering I had many bills coming due. I then decided to call Dell Disability Lawyers. One of their attorneys, Alex Palamara, spoke to me on the phone right then to hear and understand my story and then offer ways he could help. Long story short, within a few months of me returning back to work, he was able to persuade NYL to pay me my long term disability claim. He (and his kind assistant, Tabitha) were always very helpful, informative, and available to me. I feel quite certain that NYL would NEVER have paid me what was appropriate based on my insurance agreement/ contract with them without the help of Alex. I highly recommend him/Dell Disability Lawyers. If you find yourself in a similar situation of disability insurance denial of your own personal/group policy, especially if you are a medical provider/physician like me, then consider contacting them for advice/direction PRIOR to appealing your claim on your own.

Kyle D.

Jay Symonds and his assistant, Sonia helped me tremendously. The insurance company that worked for my former employer did everything they could to make my life literally miserable. That all changed when I hired Jay. He and Sonia fought for my rights and forced the insurance company to pay what they should have.

If you have a disability claim hire Jay as if you go it alone the insurance company will screw you. Jay and Sonia will fight for everything you are entitled for. I couldn’t recommend them more highly.

Frank R.

I cannot say enough positive things about my experience with Dell Disability Lawyers. Attorney Stephen Jessup and Amanda offered an opportunity to provide clarity on a complex issue regarding my disability claim. Mr. Jessup offered advice on an offset to my claim after my insurance company asked for additional information from Social Security. With counsel from Mr. Jessup, I was able to address the outstanding issue with the Social Security office and provide my insurance company with the required documentation to address their concerns. Mr. Jessup always responded in a timely manner with expert advice and offered the opportunity for follow up. I strongly recommend Dell Disability Lawyers to those seeking legal counsel for disability matters.

Wesley D.

I have been able to help others as a soldier, a police officer, and a pharmacist. I needed help forcing the insurance company to keep their commitment to take care of me and my family. I called Dell. Alex, Tabitha, and their entire team were very compassionate, extremely patient, and extraordinarily knowledgeable. Many thanks Dell!

Samar A.

My husband had applied for Long Term Disability and was denied. We sought out Rachel Alters at Dell Disability Lawyers to help us with our appeal. Rachel and her team were so diligent and meticulous in every aspect of the process. The process was seamless, and we never had any doubts that she would get it done and that she did! We are forever grateful to Rachel and Catherine for all of their determination and tenacity to get us the outcome we needed and deserved.

We could not recommend better representation and are indebted to them for making us whole again. Thank you so much Rachel and team!

Jam

Alex Palamara is one of The Best lawyers in the world and Dell Disability Lawyers are the Best by Far. Alex and his Assistant Tabitha helped me get the compensation I needed for a Horrific Disabling heath condition I’ve been dealing with for over a year. Alex and his team were so professional and caring. They treated me like I was there own family. Alex Knowledge, Expertise and skills as a Lawyer is among the Best of the Best in his field and I would HIGHLY recommend that if you ever have any issues with any Insurance Company over your Disability issues, please don’t hesitate to seek out Dell Disability and Alex Palamara. They truly are Amazing and caring. Thank God for them. Outstanding Job Alex and Tabitha

G.T.

9 years ago when I had to apply for disability benefits from my private disability policy the insurance company ignored my inquiries until Dell and Schaefer represented me and I have received the benefits without interruption til my policy expired at age 65. I have appreciated not having to deal directly with the insurance company and having attorney Greg Dell and assistant Danielle Lauria handle all communications which included monthly progress reports. I thank them for their efforts on my behalf and highly recommend them to all those in need of disability benefits.

Misty A.

I’m so thankful I chose to reach out to the attorneys at Dell. They have always been quick to respond to any and all questions I have had. The anxiety I had while dealing with Lincoln Financial on my own has decreased immensely since Alex and Danielle took my case. They were able to get my LTD denial reversed and I am so very grateful!

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