Sedgwick Disability Help

Sedgwick Disability Denial of AT&T Employee Reversed Once Again

What will it take for Sedgwick to stop wrongfully denying disability benefits to AT&T employees? AT&T appears to want to bury their head in the sand and act like they don’t know what Sedgwick is doing. We personally think AT&T is happy with the conduct of Sedgwick as the more denials; the more AT&T can keep its money.

The disability denial lawsuit discussed below is an example of the lengths Sedgwick Claims Management will go to in order to deny a claimants benefits. A claimant may have an extraordinary amount of objective medical support including opinions from qualified physicians stating that he or she is disabled and unable to work as well as positive MRI’s and CT scans, yet the plan administrator (Sedgwick) can completely ignore such evidence and fabricate their own opinions that are completely contrary to the information stated in the records. Since this occurs often, it is extremely important to ensure that you retain an attorney with the experience to ensure that the administrative record is complete before the case ends up in a court of law. Once the final appeal is filed and the administrative records is closed, no additional information may be added or presented to the court. Had the Plaintiff in the case described below failed to retain an attorney to ensure that all of his medical records and doctors opinions were submitted during the appeals process as well as ensured that he underwent additional objective medical testing, the Court may not have ruled in his favor.

In this instance, AT&T and Sedgwick failed to get away with their abusive treatment of the claimant. Often times, companies get away with this behavior as many claimants feel they are powerless over these large companies and do not believe they can win. They give up, return to work in a disabled condition, or attempt to file an appeal on their own, which is exactly the outcome the insurance companies are hoping for. However, this abusive behavior can be curtailed with the help of a disability insurance lawyer whose role is to help ensure that the insurance company does not abuse its discretion and the claimant receives the disability benefits they are rightfully owed.

Northern District of California Court Orders AT&T to pay STD benefits to Claimant

In June of 2012, the Northern District of California granted Plaintiff’s motion for summary judgment. Plaintiff was a Retail Sales Consultant for AT&T who received STD benefits as a result of severe knee pain due to arthritis. His employer required him to be on his feet 8 hours a day and would not allow him to sit during that 8-hour shift. He was initially approved for STD benefits, but his benefits were later terminated when Sedgwick, the Claim Administrator, determined that he was no longer disabled.

Three Reasons The Sedgwick Disability Denial Was Abusive And Unreasonable

The Court ruled that AT&T abused its discretion in terminating Plaintiff’s benefits based on the following reasons:

It Was Illogical To Deny Continued STD Benefits Where the Medical Evidence Showed No Change in Plaintiff’s Condition
AT&T initially found Plaintiff to be disabled based on his physicians medical records and opinions that he could not work due to severe knee pain. According to the Court, the updated medical records did not reflect any significant change in Plaintiff’s symptoms. To the contrary, the Plaintiff’s physicians reported continued knee pain stating the Plaintiff could only work 4 hour shifts and might need a chair- an accommodation that was not available. In addition an MRI supported the diagnosis of arthritis as well as degeneration. The Court held that none of the updated medical records offered any reasonable basis for concluding that Plaintiff’s condition had improved compared to the initial periods of STD benefits. AT&T tried to justify cutting off the Plaintiff’s benefits by claiming he was no longer disabled. After reviewing all of the medical records, the court determined that the Plaintiff’s knee had not gotten better it in fact had gotten worse.
The Denial was Arbitrary Because Peer Review Physician (AT&T’s hired doctor) did not Explain Why he Rejected the Findings of the Treating Physician Who Examined the Plaintiff
The plan administrator based its denial of Plaintiff’s appeal on a paper review of the record by the peer review physician. The peer review physician failed to explain why he disagreed with the conclusions of all the physicians and care providers who examined the Plaintiff. The peer review physician also failed to speak with any of Plaintiffs treating doctors and left messages stating that if they did not return his call within 24 hours their opinions would be disregarded. The Court ruled that the plan administrator may not arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician.
The Denial was Arbitrary Because the Plan Administrator Failed to Conduct an Independent Medical Examination and Ignored Plaintiffs Subjective Complaints of Pain
According to the Court, a plan administrator cannot get away with ignoring and/or rejecting a claimants subjective complaints of pain without a principal reason, especially when there is objective proof of a disease that could cause such pain. In this case, the Plaintiff complained of severe knee pain which was universally documented in his physicians’ records and underwent an MRI that revealed degenerative changes as well as arthritis. AT&T completely disregarded the Plaintiff’s complaints of pain and MRI results stating that he was perfectly capable of returning to his regular occupation. Furthermore, the Court stated that the plan had the right to arrange for an independent medical evaluation, but chose not to do so, relying on its hired physician’s paper review of the claimant to make the determination that he was no longer entitled to benefits.

Based on all of the considerations above, The Court concluded that the Plan abused its discretion when it terminated Plaintiffs STD benefits. The Court remanded for an award of benefits retroactive to the effective date of denial for the full 22 week period for which benefits would have been available as well as attorney’s fees and costs.

This case was not handled by Attorneys Dell & Schaefer. However, this is an example of how important it can be to retain an experienced disability attorney to ensure that your administrative record is complete. Without effective counsel, the above decision could have been very different. Contact our firm for a free consultation to discuss your disability insurance claim.

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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 >

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

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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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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

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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

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 Lawyers through their YouTube channel where their partners 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 Lawyers 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 insurance claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability insurance claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you will be 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. It’s 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 at Dell Disability Lawyers enough 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 insurance claim. Going through the denial process on my own was going to get me sicker and I 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 Attorney 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 them, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell Disability Lawyers!

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell Disability Lawyers. 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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