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.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

View videos, articles, resolved cases and claimant reviews about your specific disability insurance company.

Leave a comment or ask us a question

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

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us