• Sedgwick Ignores Medical Records and Denies Disability BenefitsSedgwick Ignores Medical Records and Denies Disability Benefits
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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:

Other Terms of the LTD Plan included:

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

Relief Sought By The Plaintiff In The UnitedHealth And Sedgwick Lawsuit

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

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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There are 4 comments

  • Cherie,

    If you have not already filed an appeal of the denial of your STD benefits please feel free to contact our office to discuss how we may be able to assist you.

    Stephen JessupOct 2, 2014  #4

  • I too was turned down for short term disability by Sedgwick after initially being approved. I have major depression, anxiety, and chronic fatigue syndrome. After one month out the worker told me that I’d already been out a long time for someone with a mental health condition. She denied me two days after receiving 15 pages of information from my doctor. She requested additional info from my therapist who I just started to see on July 23, 2014 (the date she approved me to) and wanted her to provide documentation on my condition by July 30th. My therapist told me that she had dealt with them in the past and that she always defers to the medical doc as the paperwork is beyond her scope of expertise. I asked her to at least send in something saying she is seeing me and we are working on my issues. She failed to do so and that is what led to my denial. I filed an appeal which involved their psychiatrist speaking with my doctor, the denial was upheld as the Psychiatrist failed to see the seriousness of my condition. That wasn’t even the initial reason for the denial, it was because of my therapist failing to provided documentation. My condition is well documented. I have been institutionalized twice for months each time, spent time in a locked ward due to suicide attempts, and seen no less than 10 different therapists and 4 psychiatrists through the years. My mental health records are probably 6 inches thick. It’s terrible that my condition was even brought under question. I had to return to work in the middle of a med change and I’m currently at half time but it’s real hard, each day I never know if I’m going to be able to do what I have to do. I struggle with taking care of myself on a daily basis (such as bathing), and cleaning my home, some times I can’t get out of bed. I’m very afraid of what the future holds for me.

    Cherie W.Oct 1, 2014  #3

  • Cheri,

    You will need to speak with your company as to their procedures with respect to termination of employment. Please note that there does stand a chance they will terminate your employment while your appeal is pending.

    Stephen JessupJul 10, 2014  #2

  • I have been denied FMLA and Short term disability from Sedgwick. My employer is United Health Care. I have severe depression and anxiety and have my family physician, psychologist and psychiatrist treating me. I have tried a lot of medication some which have caused me to hallucinate, talk to myself, hear voices. I feel constant doom, irritability, chest pains etc. Today I received a letter from my supervisor that I am required to return to work in 2 days or it will be voluntary resignation. Can I wait for the appeal comes back or go to work? I cannot drive because of my medication and I live 25 minutes from work.

    Cheri Baumann HornischerJul 9, 2014  #1

FAQ

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We represent Sedgwick clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Sedgwick disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Sedgwick. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Sedgwick.

How do you help Sedgwick claimants?

Our lawyers help individuals that have either purchased a Sedgwick long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Sedgwick:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
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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.

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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.

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