UnitedHealth Group, Inc. Recruiting Manager suffering from depression and anxiety denied benefits

A disability attorney recently filed a federal ERISA lawsuit against both UnitedHealth Group Long-Term Disability Benefit Plan (UHG) and Sedgwick Claims Management Services (Sedgwick) after the client was wrongfully denied long term disability benefits.

The plaintiff, John Doe, was employed by UnitedHealth Group, Inc., who provided short-term and long-term disability benefit plans to the Plaintiff. By virtue of his employment, the plaintiff was covered by UnitedHealth’s Short-Term and Long-Term Disability Group Policies.

The Facts of the Case Against UnitedHealth Group Long-Term Disability Plan and Sedgwick Claims Management Services

Plaintiff worked as a recruiting manager for UnitedHealth Group, Inc. beginning in 2006. UHG is a group of health care companies with its principal place of doing business being located in Minnesota.

Plaintiff was a participant of UHG’s short-term and long-term disability benefit plans.

Terms of the Plans include:

  • Short-Term Disability Plan provided income protection and pay benefits to disabled UHG employees for up to 180 days after the disability occurs.
  • The Plan was funded by UHG and administered by Sedgwick.
  • Long-Term Disability Plan provided income protection and pay benefits to disabled UHG employees after a 180-day waiting period and during their periods of disability up to certain maximum benefit periods.
  • For the first 24 months, the LTD plan was funded by UHG and administered by Sedgwick.

Other Terms of the LTD Plan included:

  • Participant is “Disabled” if he/she is unable to do the Material Duties of his/her Own Occupation due to a medical condition and is unable to earn at least 80% of his/her adjusted Earnings after inflation from working in his/her Own Occupation.
  • The “Medical Condition” needed to be proven with clear documentation from the Physician supporting Participant’s Disability.
  • Limited benefit payments to a maximum of 24 months for disabilities that were caused or contributed to by a mental disorder unless the patient was confined to a hospital at the end of the 24-month period, in which case, Participant would receive benefits as long as he/she remain hospitalized and under age 65.

Plaintiff developed anxiety and depression that became more severe as he worked with UHG. His mental health conditions were complicated further by the fact that he had to take many medications that were prescribed for his mental health conditions.

Plaintiff’s mental health providers recommended that he take a disability leave. As a result, Plaintiff left work after November 24, 2009.

Plaintiff applied for STD benefits and received them for the entire 180-day period of STD benefit entitlement.

Denial of UnitedHealth and Sedgwick Disability Benefits Claim

On November 23, 2010, Sedgwick terminated Plaintiff’s LTD benefits as of November 1, 2010 because the medical evidence no longer indicated that the Plaintiff was disabled. Sedgwick mentioned that Plaintiff had 180 days to file an appeal.

Plaintiff talked with Sedgwick’s representatives on November 23, 2010 and November 29, 2010, telling them the LTD plan required that he provide objective information to support his claim.

On or about December 2, 2010, Plaintiff submitted his appeal form to Sedgwick. Plaintiff included letters from both mental health providers that he was still disabled due to severe depression, which led to weight loss, poor appetite, poor energy, poor concentration, and feelings of hopelessness and helplessness.

On or about December 22, 2010, Sedgwick had a board certified psychiatrist to review the Plaintiff’s report. This doctor’s report on the Plaintiff was made on or about December 30, 2010, agreeing that the Plaintiff was disabled from full-time work, but also stating that the Plaintiff was capable of part-time work.

Sedgwick’s doctor’s addendum on January 3, 2011 added that the Plaintiff has been compliant with treatment of his condition except for turning down a referral to an IOP program that could accelerate improvement in the Plaintiff’s mental health symptoms.

On January 17, 2011, Sedgwick upheld the termination of the Plaintiff’s LTD benefits mainly due to the fact that Plaintiff turned down a referral to an IOP program that could accelerate improvement in the Plaintiff’s mental health symptoms. Sedgwick alerted Plaintiff that he could file a second appeal.

On or around January 25, 2011, Plaintiff was found disabled by the Social Security Administration and awarded SSDB benefits as of May 2010. Plaintiff notified Sedgwick of this development.

On February 4, 2011, Plaintiff filed second appeal to Sedgwick.

On February 7, 2011, Sedgwick notified Plaintiff that it had made a mistake in stating that the Plaintiff had the right to a second appeal, as Plaintiff’s plan did not provide for a two-level appeal process.

On February 8, 2011, the revised appeal denial letter to the Plaintiff no longer allowed for a second appeal.

On or about February 9, 2011, Sedgwick and Allsup recovered $12,030.00 from Plaintiff because of the receipt of SSDI benefits for periods of time that coincided with Plaintiff’s receipt of LTD benefits.

Disability Lawyer Files Lawsuit Against UnitedHealth And Sedgwick

According to this lawsuit, Plaintiff claims that

  • He should have received LTD benefit payments from Sedgwick according to the terms of the LTD plan.
  • Sedgwick denied the Plaintiff those benefits, causing it to be in breach of the Plan and ERISA for failing to provide those benefits.

Relief Sought By The Plaintiff In The UnitedHealth And Sedgwick Lawsuit

Due to Sedgwick’s actions, Plaintiff requests the following relief from the Court:

  • Pay Plaintiff all past due LTD benefits, along with interest.
  • Reinstate Plaintiff to the LTD plan.
  • If there is time left on the 24-month period for mental illness benefits, the Plaintiff should receive the monthly LTD benefits according to the terms of the Plan.
  • Plaintiff should receive costs, disbursements, and other expenses connected to this lawsuit, as well as reasonable attorneys’ fees and experts’ fees.
  • All other relief that the Court judges to be just and proper.

In the above referenced case our firm did not represent the Plaintiff and had no involvement in the case. The plaintiff in this case was or is represented by a Minnesota Disability Lawyer that is not in any way affiliated with our firm. The information in this post comes from our review of a Complaint that was filed in Federal Court as a public record. This post has been modified from a previous version.

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Sedgwick Reviews

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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.

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 >

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 >

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 >

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 >

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…

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.

Denial of treatment for injuries that therefore become a permanent disability.

Reviewed by Anonymous on December 28th 2022   Verified Policyholder | October 2022 date of disability
Sedgwick denies claims, or ignores them. They refuse to heed doctor referrals and refuse to compensate for work related injuries and expenses. They want you to go away.
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