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.


Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Sedgwick Appeal Package

We work with you, your doctors, and other experts to submit a very strong Sedgwick appeal.

Learn more

Sue Sedgwick

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Sedgwick.

Learn more

Protect Your Benefits
Get Your Sedgwick Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Sedgwick Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Sedgwick Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Sedgwick Reviews
(648)

Policy Holder Rating

1 out of 5
Read 9 reviews
0%would recommend
5
0%
4
0%
3
0%
2
0%
1
100%
Timely Payments
1.2out of 5
Handling Claim
1.0out of 5
Customer Service
1.2out of 5
Dependable
1.1out of 5
Value
1.1out of 5
Showing 8 of 648 Reviews
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 >
Sedgwick

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 >
Sedgwick

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…
Sedgwick

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.
Answered Questions by Our Lawyers
(1)
Showing 1 of 1 Answered Questions

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 >
Helpful Videos
(896)
Showing 12 of 896 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips

Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >

Disability Denial Reason #1 – Paper Review & IME

At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >

How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial

At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultimate r... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases

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 un... Read More >

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 >

AT&T Employee Dealing With Sedgwick Has Horrible Disability Benefit Claim Experience

Our client, an AT&T employee for more than 40 years became disabled and unable to do her job due to cervical myeolapathy neck pain, chronic headaches and a torn rotator cuff in her shoulder. Her claim for short term disability benefits under the AT&T disability benefits plan has been nothing but a "headache". AT&T hires Sedgwick Claims Management to handle the administration of all disability benef... Read More >

Seven Surgeries and The Standard Still Denies Disability Insurance Benefits

Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >

Sun Life Wrongfully Denies Disability After Paying For 23 Months

We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for many years.  Her job was very physical as it required her to climb in and out of semi-trucks multiple times a day as well as operate them which was very strenuous. She went out of work in due to ongoing and severe debilitating right hip, low back, and bilateral knee pain... Read More >

Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed

Our client, a registered nurse for Dignity Health, found herself in a difficult situation after being diagnosed with lumbar spondylosis and left knee arthritis. She continued to work, however, struggled while attempting to work through chronic lower back pain and left lower extremity radicular symptoms on a daily basis. Sadly, her condition failed to improve and... Read More >

Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision

The claimant is an 64 year old former Corporate Attorney and at a prominent Florida business law firm who was forced to cease working in his highly successful and rewarding profession, job, and career on January 27, 2021, and to seek disability compensation under his policies with Lincoln due to severe symptomatology stemming from or following a viral COVID-19 i... Read More >

Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal

Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manage... Read More >
Disability Lawsuit Stories
(765)
Showing 8 of 765 Lawsuit Stories

Court Upholds Sedgwick's Denial of Benefits for Claimant with Chronic Fatigue Syndrome

In Griffin v. AT&T Umbrella Benefit Plan No. 3, Plaintiff worked for a few years for Wisconsin Bell, Inc. (Wisconsin Bell) as a premises technician. Wisconsin Bell is a participant in a disability plan administered by Sedgwick Claims Management Service, Inc. (Sedgwick). The Plan offered both short-term disability (STD) and long-term disability (LTD) benefits to qualifying participants.Participants... Read More >

Court Agrees with Sedgwick and Finds Plaintiff's ERISA Lawsuit is Time-Barred

The case of Allison Pfifer v. Sedgwick Claims Management Services, Inc., teaches claimants the importance of complying with the terms of their disability insurance policy. The specific terms at issue here are: 1) the need to support claims with substantial medical evidence; and 2) complying with contractual deadlines established by the insurance policy for short-term disability (STD) benefits an... Read More >

Court Remands to Sedgwick for Reevaluation of Its Denial of Claim for Disability Benefits

In Daniel T. Derichs v. AT&T Services, Inc., plaintiff, an employee of AT&T who suffered from post-traumatic stress disorder (PTSD), applied for short-term disability benefits. The plan administrator, Sedgwick Claims Management Services, Inc. (Sedgwick), denied Derichs’ claim. After exhausting his administrative appeals, Derichs filed this ERISA lawsuit.At issue was the correct definition of tota... Read More >

7th Circuit Recognizes Chronic Debilitating Effects Of Fibromyalgia

In Cathleen Kennedy v. The Lilly Extended Disability Plan, plaintiff Cathleen Kennedy, an executive Director of Human Resources, had a history fibromyalgia dating back many years. As an employee of Eli Lilly and Company, she was covered by The Lilly Extended Disability Plan (“the Plan”), which was administered initially by Anthem Life and Disability and later by Sedgwick Claims Management Services (... Read More >

Court Orders Sedgwick to Pay Disability Benefits to Claimant with Carpel Tunnel Syndrome Even though the Employer Offered Her Accommodations

Thornton v. Sedgwick is a fact-driven case in which a California district court ruled that Sedgwick “incorrectly determined in January 2014 that [plaintiff] was no longer eligible for disability benefits.” The plaintiff, Catherine Thornton, was a project manager for Southern California Edison (SCE) when she developed bilateral carpel tunnel syndrome, bilateral cubital tunnel syndrome and epicondylitis. She... Read More >

Court Finds Sedgwick Wrong to Deny Benefits Without Considering Claimant's Actual Job Duties

In McMillan v. AT&T Umbrella Benefit Plan No. 1, the plaintiff, who had worked for AT&T for nearly six years as a Senior IT Client Consultant, filed a claim for short term disability benefits based on multiple medical conditions, including his coronary disease, hypertension, diabetes and sleep apnea. The plan administrator for AT&T is Sedgwick Claims Managements Services, Inc. (Sedgwick).Althou... Read More >

Sedgwick Continues monitoring application for SSDI benefits even after terminating disability claim

Many claimants are unaware that disability carriers continue to monitor claimants' applications for Social Security disability benefits even after the carrier has ceased to pay benefits.A recent case out of the Middle District of Florida, which did not involve the law firm of Dell & Schaefer, serves as a reminder that your disability carrier often continues to monitor the status of your application for... Read More >

Sedgwick and AT&T sued as a result of SSDI Overpayment

A recent decision by a Federal Judge in a California ERISA Disability Lawsuit serves as a reminder to all individuals receiving disability benefits: If your disability policy allows for the insurance company to "offset" other income benefits and to collect for overpayments, you must always remember that eventually you may owe that money to the insurance company should they request it soon thereafter or at a la... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our attorneys for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We offer disability insurance attorney representation nationwide and we welcome you to contact any of our lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 850 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

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 insurance 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 phone, email, fax, or video conferencing sessions. 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 insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.

Helpful Resources