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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).

Although his job duties required detailed cognitive functioning and traveling to various job sites across the United States, none of Sedgwick’s independent physician advisors (PA) who reviewed plaintiff’s claim for benefits considered those aspects of his job duties. They relied on his job duties “as sedentary with sitting, typing and talking requirements.” Quoting a case it relied on for precedent, the court noted that, on this record, “there is simply no way to tell whether the reviewers were applying a correct conception of the [plaintiff’s job duties]… or some other conception.” As such, the court remanded with instructions for Sedgwick to reevaluate and consider plaintiff’s ability to perform the essential functions of his own job according to his job description.

Plaintiff’s Job Description

Sedgwick initially determined that McMillan’s job involved only sitting, typing and talking. Eventually, Sedgwick contacted plaintiff’s former supervisor for details about what his job duties entailed. The supervisor gave an extended description and included the note that “it is a cognitive position as it requires memory and thought about software installation, setup and client interactions.” The supervisor added that there was “associated travel on occasion” that could include trips to any other state and often required air travel.

Despite this detailed job description, and the fact it was included with the medical records sent to the PAs to review, none of them mentioned the cognitive or travel aspects of the job requirements when determining that the plaintiff was not disabled from performing the essential duties of his own occupation.

Plaintiff’s Treating Physicians Versus Sedgwick’s Physician Advisors

One of plaintiff’s treating physicians reported that plaintiff had “lack of concentration, poor memory, inability to multitask, difficulty with complex problem-solving.” A neuropsychologist did an assessment and noted the results of testing showed he had “disruptions in cognitive ability.” She attributed this to oxygen deprivation from his sleep apnea.

Another treating physician sent Sedgwick a report in support of plaintiff’s appeal from the denial of short term disability benefits stating specifically, “it was clear he was experiencing some cognitive dysfunction that is impairing his ability to work.” The doctor went on to explain the physiology of sleep apnea and how it was causing plaintiff’s impairment.

Each physician advisor relied on the job description of “sitting, typing and talking” and ignored the required cognitive functioning and travel requirements of the job. Sedgwick argued that the advisors all had a copy of the detailed job report in the file that was provided to them and that should be sufficient evidence that they relied on it when determining plaintiff was not impaired from performing his job duties. The court, fortunately for the plaintiff, disagreed with Sedgwick.

Oklahoma Court’s Reversal and Remand

The court held that on the record, it could not “conclude that Sedgwick’s denial of benefits is predicated on a reasoned basis.” It then determined that, instead of the court awarding plaintiff benefits, a remand was the appropriate remedy. Sedgwick “failed to make adequate factual findings regarding McMillan’s ability to perform the certain essential functions of his job.” Since the court determined this was the duty of Sedgwick and not the duty of the court, it remanded to Sedgwick for further proceedings.

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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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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.

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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 >

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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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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?

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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.

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

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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.

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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.

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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.

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