• Sedgwick Disability Benefit Claims

Xerox employee is denied her long term disability benefits and sues Sedgwick and Xerox

An employee of Xerox Corporation files a lawsuit against Sedgwick Claims Management Services, Inc., Sedgwick Claims management Services, Inc., and The Prudential Insurance Company of America for disability benefits. An employee with Xerox for 10 years, Andrea Calhoun brought a lawsuit against her employer and Sedgwick under the Employee Retirement Income Security Act of 1974 (ERISA) 29 U. S. C. § 1001, et seq. “seeking to overturn a denial by the Defendant” of her long term disability benefits.

Calhoun’s Disabling Conditions

Calhoun, a victim of “degenerative joint disease in her left knee, fibromyalgia, left shoulder scapula dyskinesia, and recurrent abdominal and pelvic pain,” became disabled and unable to perform her job in March 2009. Calhoun filed her disability application with Sedgwick, the administrator of Xerox’s employee disability plan, and provided them with medical evidence that documented her diagnosis, which included radiographic reports, her doctor’s physical examination findings, and physical residual functional capacity evaluators from an orthopedic physician who was treating her. She also was armed with an MRI and findings from her treating rheumatologist. All of these symptoms came to a head in February 2008, when Calhoun’s MRI revealed a left knee medial meniscus tear and long full thickness chondral fissue that involved the patellar apex, which was preventing her from carrying out her job.

Calhoun continued working though injured until March 3, 2009 and on March 10, 2009 Calhoun underwent surgery to repair some of the knee damage, and subsequently attended physical therapy until August 2009. Not able to fully recuperate from the surgery and with continued pain from her damaged knee and other symptoms, Calhoun applied for, and was awarded, long term disability benefits from Sedgwick on August 13, 2009.

In November, 2009, Calhoun’s fibromyalgia flared, and in January 2010, Calhoun’s rheumatologist noted that Calhoun exhibited “tenderness with palpitation over the trochateric and subdeltoid bursa and soft tissue swelling over her clavicle,” conditions “consistent with myofascial pain.” Shortly after this diagnosis, Sedgwick terminated Calhoun’s long term disability benefits, stating that Calhoun’s “disability conditions were not supported by objective medical evidence. Just two days after the termination of her benefits, Calhoun’s doctor recommended further knee surgery and in the process did an MRI, which revealed that Calhoun’s left shoulder had an AC joint separation. And, a month later, Calhoun’s’ doctor diagnosed her with “chrondromalacia patella of the knees bilaterally, reduced range of motion on flexion and extension, tenderness to palpitation, over the lumbosacral and thoracic spines, scapula, and lateral aspects of the hips and tenderness on the patella and medial aspects of the left knee.”

Calhoun’s Condition Worsens

Needless to say, Calhoun immediately appealed Sedgwick’s termination of her long term disability benefits. However, Sedgwick upheld its termination decision in April 2011. Then in June 2010, Calhoun was checked by her physician regarding her fibromyalgia and it was noticed that she had “significant muscle pain and weakness, and multiple tender points, as well as subjective swelling, numbness and tingling.” Two days after this evaluation, Calhoun again appealed the termination of her Sedgwick benefits, only to be denied again in October 2010.

Continuing to suffer from numerous symptoms of her various conditions, Calhoun is unable to work, has exhausted all administrative appeals for her disability benefits, has provided objective evidence of her diagnosed conditions, and has hired a disability lawyer to represent her in this lawsuit.

Calhoun And Her Disability Lawyer File A Lawsuit Against Sedgwick

In her Complaint, Calhoun and her disability attorney allege that Sedgwick “without justification, has failed and refused to properly and adequately review [Calhoun’s] medical information, has refused to revise its determination that [Calhoun] is not entitled to long term disability benefits, and has failed and refused to grant [Calhoun] continued benefits to which she is entitled under the Plan.”

Calhoun and her disability attorney ask the United States District Court of the Southern District of Ohio Eastern District to hear her case and rule that Sedgwick provide Calhoun with all “benefits and related restitution” under her Sedgwick policy and any other relief the Court deems appropriate and just.

Comments (9)

  • Gayle, thank you for sharing your experience and encouraging those who feel there is no hope in dealing with insurance companies.

    Stephen Jessup Jul 1, 2021  #9

  • I sued both Sedgwick and Prudential I order to obtain my long term and extended long term disability payments. I won the suit with Sedgwick (only with the aid of an attorney), and by stating that I would request my attorney call senior staff (from the CEO AND DOWN) to be deposed.

    When my time with Sedgwick was coming to an end, I had already hired an attorney and was ready to start with Prudential. They only denied me once. My attorney sited case law for every medical condition. Prudential has been paying me since 2013, but only with the support from an attorney. Many people give up because they don’t have the financial means (or feel they don’t) to pursue their claim. In my estimation 2/3 rds of income was better than no income. The attorney took 1/3 monthly, and I received 2/3’s. There was no charge (other than small administrative charges) if the case was not won. Go with an attorney, it’s the only way to have your claims paid. The job of Sedgwick and Prudential is to consistently deny, in the hopes that one will give up.

    Gayle Jul 1, 2021  #8

  • Segwick is an absolutely terrible company to deal with. I was given wrong information by them several times and had to refute their claim. I am now on a second try in the appeal process. They put a lot of stress on a person in disability, instead of helping them get through it.

    Unkown Oct 28, 2015  #7

  • Deborah,

    You may want to consult with an employment/labor attorney to discuss what rights you may have following your termination.

    Stephen Jessup Jun 18, 2014  #6

  • I filed for an extension on my FMLA from Sedgwick. I have had 3 surgeries and got MRSA while in the hospital. I was denied the extension so I appealed, I sent all the doctors notes and the mylagrahm report saying I needed another surgery, but because no date of surgery was indicated I was denied again. I was trying to get Sedgwick to approve my long term disability. Subsequently I lost my job and all insurance. I was waiting on a surgery date because I hoped Sedgwick would put me on long term disability and I would have insurance to pay for it. Subsequently I lost my job, because I didn’t return to work when Sedgwick said I should, but I was on so much pain medication I couldn’t even drive. I believe my employee is in cahoots w/ Sedgwick.

    Deborah Allgood Jun 17, 2014  #5

  • Me too have been dealing with their nonsense. They are very rude and told me they will deny my claim. They don’t care about us. We should unite, let’s unite and sue Sedgwick.

    Unknown Oct 2, 2013  #4

  • I too am having problems with Sedgwick & feel that actions should be taken. Nobody should have to deal with this much stress especially when trying to battle medical/health issues! It is forgotten WE PAY SEDGWICK FOR THEIR SERVICES as well, we should be treated as patrons and humans not an inconvenience! What they’re doing is illegal and manipulative! It needs to stop!

    Melissa May 31, 2013  #3

  • I too am having the same problems with Sedgwick. They are the worst Co. I have ever had to deal with. Can anyone help me?

    Xerox Emp. Mar 10, 2013  #2

  • I agree on what you’re saying that sometimes there are few sympathetic Dr’s anymore. After my ankle injury at work and surgery (diagnosis: distal tibia), there is a darkened mark left on my the top of my foot and there is a tingling feeling on the nerve but the Dr cannot even determined what causes it so he said just to massage it with lotion and it would go away. (huh?) My knee was also affected so the Physical Therapist told me that I have to buy an arch support because they said that the arch of my foot was almost gone but when I told the Dr this, he kind of disbelief that I need an arch support? I am in LOA since Dec 2009 and I’m still hurting but he released me 4 hours for regular work (lifting 50-100 lbs of luggages and loading/unloading airplanes) and saying that after 4 weeks, no more restrictions, how will he know that ahead of time since I’m the one that is hurting? I cannot even stayed standing and walking for a long period of time without having pain. Because of this work status release with restrictions, my company gave me a “transitional duty” but I declined it and they stop my compensation and state benefits. Now, without any income, I will have to pay my benefits that I cannot cancel unless they terminate my employment. I need to support my family. So I filed a claim today against my short term disability that I have been paying through pay deductions and hoping to get approved. If not, I will contact you.

    Cecilia Burrell Aug 16, 2011  #1

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