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Sedgwick And AT&T Disability Denial Scheme Exposed In ERISA Lawsuit

On May 14, 2012, the U.S. District Court for the Northern District of California issued an order on a very hot topic for ERISA Disability Lawsuits. The issue concerns how much “Discovery” a denied person is able to obtain from the Disability Insurance Company while litigating a case.

Frequently, the lawyers for the disability insurance companies claim that the Plaintiffs should be allowed no discovery other than access to the administrative claim file. This old argument was turned on its head in 2008 when the U.S. Supreme Court ruled in Metropolitan Life Ins. Co. v. Glenn that limited discovery was allowed in ERISA cases. The recent ruling from the Northern District of California in John Doe v. AT&T Western Disability Benefits Program illustrates how courts are beginning to allow such discovery in today’s ERISA disability denial cases.

To first understand how this ruling and other recent rulings will affect our clients and others similarly situated it is important to understand what exactly discovery is. Very simply, “Discovery” is a pre-trial tool in which each party can obtain evidence from the opposing party using devices such as requests for the production of documents, requests for admissions, and requests that the opposing side answers interrogatories (written questions). The documents and answers provided to the questions posed in discovery can lead to evidence that can favor the plaintiff when the case goes before the Judge for trial.

In most ERISA disability cases, the Plaintiff / Claimant’s discovery request is restricted only to “unearth the existence of possible conflicts of interests under which the defendant may operate or of procedural errors that may have undermined the fairness of the plaintiff’s hearing.” What exactly the Plaintiff is allowed to ask for under these restrictions was the question that was answered in this recent California disability claim.

The Case involved a former employee of AT&T, Inc. who brought suit challenging his Short Term Disability Benefits denial under the AT&T Western Disability Benefits Program. The Disability Attorney representing the plaintiff desired answers and documents to determine if the defendant had a “conflict of interest.” For instance, the Plaintiff requested the number of claims and appeals in 2009 and 2010 that NMR (the “independent” company who provided the physicians who conducted the medical review of the medical documentation) had provided medical reviews for, as well as the total numbers that resulted with NMR approving and denying disability claims/appeals. The Plaintiff also requested the total amount of money that had been paid to the 3rd party administrator Sedgwick Claims Management as well as NMR in 2009 and 2010 for services related to the Disability Plan’s Administration. Finally, the Plaintiff sought any documents relating to the Plaintiff’s claim or appeal that was received or created by the Defendant, Sedgwick or NMR. Sedgwick has been hired by AT&T to administer all of the short term and long term disability insurance claims. Unfortunately the policy language in the AT&T policy is terrible and Sedgwick is notorious for denying numerous claims.

The Court found that each of these requests were relevant because it could show a stingy claims granting history as well as an economic interest in denying claims by AT&T, Sedgwick and NMR. The Court also found that the interrogatories posed must be answered as the Federal Rules of Civil Procedure “mandates that a party responds to interrogatories with “the information available to it.'” Likewise, the Court also found that the Federal Rules also requires that “a party produce relevant, non-privileged documents in its “possession, custody, or control.'” AT&T attempted to argue that some of these documents were not available to it or were not in its possession, custody or control. The Court, however, disagreed and pointed to the Agreement/Contract between AT&T and Sedgwick (and Sedgwick’s subcontractors) that granted “control” and “ownership rights over such information and documents” to AT&T.

While the outcome of this ruling is specific to the facts of this case, this ruling, like many others that have recently been issued by other courts, show that the Courts are slowly promoting the idea that discovery is reasonable in ERISA Disability Denial Cases.

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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 >

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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.

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 >

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

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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

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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