Total Knee Replacement, Yet Sedgwick Still Denies AT&T Employee’s Disability Claim

The unreasonable Sedgwick Claims Management disability denial of AT&T employees appears to be a daily occurrence. Recently, it seems as if Sedgwick does not feel the need to comply with ERISA regulations.

The latest claims handling technique appears that Sedgwick will decide to deny a claim and then notify an AT&T employee via phone. Sedgwick will then set the claimant for a compulsory medical exam as they claim that the medical records of the claimant don’t support the inability to work. The doctors used by Sedgwick are usually the same doctor they have used for past disability insurance or worker compensation claims.

The paragraph below is a recent message we received from an AT&T employee with a disabling knee condition:

Sedgwick placed me in Administrative Denial status as of March 31, 2012. My total knee replacement surgery was Feb. 21, 2012 with a prior knee surgery October 6, 2011. I am still on Percocet for pain, have swelling, inability to sleep, must use an assisting walking device, can’t sit for any length of time without increased pain. They have me scheduled for an IME with Dr. John L. Kihm, who only does IME work. Of course, he will state I can return to work. How am I to drive 50 miles round trip, sit for 7.5 hours, take pain medication and perform my job function. Ironically, another AT&T employee, who works at the same AT&T center (Pensacola, FL) had total knee replacement and did not have to return to work until three months of recovery had passed. I only got a phone call from Sedgwick about the IME appointment and it was left on voice mail. Nothing certified mail. This is the second time they have done this to me. My mental health is low because of this abuse and it is not helping my recovery. There must be a way to allow me to get well before returning to work.

As disability insurance lawyers that have reviewed hundreds of Sedgwick disability claim denials, we question whether AT&T has instructed Sedgwick to deny the majority of disability claims. By denying disability benefits, Sedgwick essentially strong arms a claimant to return to work in order to save their job and avoid bankruptcy.

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There are 6 comments

  • Sam,

    I just decided to do some internet research on this and my case if similar to yours. I had surgery on both of my feet. I am still on crutches and my Dr. extended my disability for another 6 weeks as he only does 6 weeks max. at a time and AT&T Disability Center only approved 3 weeks. Even though EDD is accepted, my extension of 6 weeks that my doctor said was necessary. This just happened today and I am extremely upset, I thought the same thing you did. What training do these people have that makes them think they can go against a doctor?

    ElizabethJun 28, 2013  #6

  • Sam,

    You can contact the California Department of Insurance and file a complaint about Sedgwick. You can find the contact information at insurance.ca.gov/contact-us. Thanks for sharing your comments about Sedgwic’s pathetic claim handling.

    Gregory DellSep 12, 2012  #5

  • I have had a similar case. I have the state disability form with medical codes and a separate doctors note saying 12 more weeks of crutches. Sedgwick approved only 4 weeks. I do not understand how they are able to do this when the people working there aren’t even college educated, let alone medical board certified. It seems like the only medical documents the uneducated phone jockeys are able to understand is “employee can return to work”, its funny how they can magically read that note… Who should I write letters to in the state of CA to complain?

    SamSep 11, 2012  #4

  • Tammy,

    We agree with you, that just about every Sedgwick / ATT denial sounds very similar. Good luck with your lawsuit and please keep us posted about the outcome of the claim.

    Gregory DellAug 16, 2012  #3

  • I am just in disbelief that Sedgwick CMS and AT&T / Bellsouth has gone so long without being investigated because it is clear that the denial rate for STD and LTD claims are ASTRONOMICAL! I currently have a case pending in Federal Court against AT&T / Bellsouth and CWA for STD denial, Disability Discrimination, and FMLA violation. All of the stories sound so similar that it is surprising there is no pending class action suit.

    Just to give a little information in regards to my case. I was sent to the IME by Sedgwick and their IME requested accommodations and me not to return to that job. Sedgwick then decided after 23 days that they would deny me STD anyway then in turn say that I was exaggerating my disabilities. In addition, Sedgwick sent the denial letter to my local department stating the IME said I was capable of doing my job. Not only did they lie about what the stated, they gave a totally DIFFERENT IME’S name that I’ve never seen or heard of.

    TammyAug 15, 2012  #2

  • This is a follow up on my total knee replacement short term disability claim as an employee of AT&T with Sedgwick CMS as third party administrator. I received written notice for an IME exam on April 3 with the scheduled appointment for April 5. The examiner was to be Dr. John L. Kihm. I immediately called Sedgwick to inform them that the notice was not in compliance with Florida law which requires at least 7 days written notice. I received a call from MES, the IME scheduling arm of Sedgwick, on April 4 telling me the appointment had been canceled and would be rescheduled with “another” doctor. Later the same day, Barbara from Sedgwick called asking why I cancelled the appointment. I stated the law requirements and she proceeded to attempt to have me answer the reason as a transportation problem, etc. I never deviated from the reason that notice was not provided per law. I am sure she was trying to get me to say something that could later be used against me.

    It is now April 24 and I have not received any notice of an IME exam. So, how is an IME going to determine my status both as of early April and the date of exam?

    Finally, FL. law is very clear about requirements of an IME. This Dr. Kihm literally states on his website that he stopped surgical practice 12 years ago and only performs “independent medical exams”, has his own airplane and can fly to various states. The law requires a physician to be current in surgical practice, affiliated with hospitals and/or a professor at an accredited institution. A review of his license clearly indicated he does not meet the requirements yet Sedgwick obviously contracts his services.

    I spent a great amount of time researching law and am now filing complaints with boards related to Sedgwick and physicians. This does not require waiting for two appeals to process.

    Report Sedgwick to the governing boards after being able to cite statutes they are violating. Far too many people have lost everything due to this company. However, keep in mind that the decision to use these thugs was, in my case, made by AT&T. This has to be reported by all in each instance. Stop the abuse through persistant complaints to regulatory boards because politicians will not be of any help.

    CharlesApr 24, 2012  #1