Archives: Sedgwick Claims

Sedgwick Claims Management is notorious for abusing its discretion when determining whether a claimant qualifies for disability benefits. The most common ways in which Sedgwick abuses its discretion includes, the failure to consider treating doctors’ opinions, failure to consider a favorable determination by the Social Security Administration, failure to speak to treating doctors regarding the claimants’ disabling conditions, failure to have the claimant examined and relying solely on paper reviews of paid doctors. A court in the Northern District of California addressed some of these very issues resulting in a very favorable outcome for the Plaintiff.
Continue Reading Plaintiff Awarded Benefits when Sedgwick Abuses its Discretion

As disability insurance attorneys that help disability claimants nationwide it is frustrating when we see a repetitive trend of denial tactics by the same company. We are contacted multiple times every day from people denied benefits by Sedgwick Claims Management. Here is a recent denial of disability benefits story we received from a claimant that was denied by Sedgwick:

Continue Reading A Common Sedgwick Short Term Disability Denial Story

A Puerto Rico court rules in favor of the claimant and finds that denial of her STD benefits made her ineligible for LTD benefits, thereby exhausting her administrative remedies for LTD benefits. Continue Reading Sedgwick and Walgreens Deny STD benefits, But Puerto Rico Court Rules That Pharmacist Can Seek LTD Benefits without Exhausting ERISA Appeal

Quite often, insurance companies create a maze of entities that could confuse the most cautious policy holders. One entity may own the fund. Another entity may administer the fund. So who should a plaintiff sue when these corporate entities conspire to break a promise to pay disability benefits? Fortunately, skilled disability lawyers know these insurance company tricks and can figure out who is ultimately responsible for a wrongful denial of disability benefits. Sometimes, it depends on bringing the right claim against the right party.

The case of Franklin v. AT&T Corporation is a prime example. The plaintiff worked at AT&T as a systems analyst for eleven years. She had long-term disability benefits under the AT&T Long Term Disability Plan for Management Employees ("the Plan") that were administered by Metropolitan Life Insurance Company ("MetLife’). Sedgwick Claims Management currently handles all AT&T disability claims. In 1999, the plaintiff filed for and received the long-term disability benefits arising from a number of causes including Crohn’s disease, breast cancer, chemotherapy, chills, night sweats, nausea and depression.

Three years later, MetLife reevaluated the plaintiff’s eligibility for long-term disability benefits. MetLife had demanded that the plaintiff apply for Social Security disability insurance benefits and, when she obtained them, reimburse the Plan for all the social security benefits she received when the Social Security Administration agreed she had been totally disabled since 1999. Soon after cashing the check, MetLife determined that the plaintiff was not in fact totally disabled and stated she could return to full-time work in other occupations. This conclusion led MetLife to deny the plaintiff’s claim for continued long-term disability benefits.

The plaintiff sued, arguing that her long-term disability benefits were wrongfully denied by MetLife and the Plan. Both defendants filed a number of motions. MetLife challenged the plaintiff’s ability to hold the insurance company accountable for its role in denying coverage because AT&T had fired MetLife as the plan administrator more than a year and a half before the plaintiff filed suit. The Plan claimed that the denial was within its discretionary authority.

The Court Awards Disability Benefits for What MetLife Did

A federal court in Dallas ruled that the plaintiff was entitled to long-term disability benefits and that MetLife was entitled to be dismissed from the lawsuit as it was merely the administrator. The plaintiff could only recover the disability benefits from the Plan because it had not brought a claim against MetLife for breach of the duty of good faith and fair dealing, which requires Texas insurance companies to treat policy holders in a certain manner. Nonetheless, MetLife’s actions were the central focus of why the court held the Plan responsible. The court specifically noted:

  • MetLife had distorted the opinions of treating physicians when it characterized the plaintiff as able to return to full-time work;
  • MetLife had not given adequate consideration to the determination for Social Security purposes that the plaintiff was totally disabled; and
  • Though relying on the availability of leave under the Federal Medical Leave Act to claim that the plaintiff could be absent from work to accommodate her illness, MetLife failed to recognize that, as a new employee, the plaintiff was not eligible for leave under the FMLA for twelve months.

While MetLife wasn’t financially responsible to the plaintiff in this case, other companies may think twice before employing MetLife as a plan administrator in the future. The federal court held that MetLife had "cherry-picked" facts in the administrative file to support its position and, for this reason, MetLife had acted in an arbitrary and capricious manner. These wrongful actions persuaded the federal court to order the Plan to reinstate the plaintiff’s long-term disability benefits. Ironically, the plaintiff could have prevailed against MetLife as well (above and beyond the disability benefits recovered against the plan) had the plaintiff’s lawyer brought a claim for breach of the duty of good faith and fair dealing.

Franklin v. AT&T Corp., No.03:08-CV-1031-M, 2010 WL 669762 (N.D. Tex. Feb. 24, 2010) 

Disability Blog & Cases:
Boeing Employee Suffering From Severe Chronic Back Pain Sues Aetna For Denial Of ERISA Benefits

An Oregon disability lawyer has filed a lawsuit in the District Court of Oregon against The Boeing Company Employee Benefit Plan (Boeing) and Aetna Life Insurance Company (Aetna). The Plaintiff, Susan A, worked as an assistant to the Vice President and General Counsel of The Boeing Company. Due to her employment, Plaintiff was protected by Boeing’s Employee Benefit Plan.


Disability Blog & Cases:
Unum Disability Denial With Medical Record Review Only

Can Unum deny disability claims and appeals by merely conducting paper reviews of a claimant’s medical records? Yes, apparently they can.


Disability Blog & Cases:
Sedgwick And AT&T Disability Denial Scheme Exposed In ERISA Lawsuit

On May 14, 2012, the U.S. District Court for the Northern District of California issued an order on a very hot topic for ERISA Disability Lawsuits. The issue concerns how much “Discovery” a denied person is able to obtain from the Disability Insurance Company while litigating a case.


FAQ: Appeals & Lawsuits:
If my long term disability benefits are governed by ERISA and I win at trial, does the insurance company have to pay me for the remainder of the policy life, or a lump sum amount?

Should your case go to trial under an ERISA governed disability plan and you win the insured is only entitled to an award of disability benefits that have not been paid by the insurance company. This is further contingent on whether the insurance company denied your claim under the “own occupation” or “any occupation” definition of disability…

The Plaintiff, Christopher L., with the help of his Texas Disability Attorney, has filed this lawsuit against Sedgwick Claims Management Services , Inc. (Sedgwick), Administrator of the Hewlett-Packard (HP) Company Disability Plan.

In Christopher L. v. Sedgwick Claims Management Services, Inc., Plaintiff has filed this lawsuit to regain all short-term and long-term disability payments that were wrongfully terminated.

Plaintiff’s Rights of Disability Benefits Under The Plan

Plaintiff is a 44 year old man who is a citizen and resident of Tomball, Texas. Sedgwick was responsible for funding and administering the Plan, which Plaintiff was entitled to the benefits of based on his employment with HP as a Project Manager.

Plaintiff was forced to cease work on April 25, 2008 due to bipolar disorder, schizophrenia, chronic fatigue, diabetic neuropathy, memory loss, sleep issues, fibromyalgia, depression, vision problems, high blood pressure, and sunlight sensitivity.

Plaintiff filed applications for short term and long term disability benefits. Plaintiff’s claim for short term disability benefits were granted by Sedgwick. Plaintiff later filed for long term disability benefits, which were initially granted by Sedgwick on December 1, 2008.

Sedgwick Changes Decision And Denies Future Long Term Disability Benefits

On August 20, 2010, Sedgwick denied further long term disability benefits to the Plaintiff. Plaintiff had 180 days to appeal this decision. The disability standard to apply in order to approve or deny a claim was being unable to perform "Any Occupation." If the application was approved, the Plan would pay a monthly benefit of $4,351.72.

Plaintiff requested an administrative review of the denial of benefits on December 6, 2010. Plaintiff included medical records to show his total disability, and thus, his argument for being approved for further long term disability benefits. In addition, the Social Security Administration issued a fully favorable decision on Plaintiff’s claim for disability benefits under Title II and Title XVI of the Social Security Act.

Despite this, Sedgwick upheld its original denial on March 17, 2011. Sedgwick also informed Plaintiff that he had exhausted all administrative remedies. Due to this, Plaintiff has filed this lawsuit against Sedgwick.

Lawsuit Filed Against Sedgwick

Plaintiff filed a lawsuit against Sedgwick because Sedgwick discounted the opinions of Plaintiff’s treating physicians, of others, and of the documented limitations that the Plaintiff suffers from due to his medical conditions, thereby preventing him from fulfilling the duties of any occupation and entitling him to the long term disability benefits as detailed under the Plan.

Plaintiff claims that Sedgwick failed to give proper weight to the evidence submitted to them regarding Plaintiff’s condition and his inability to work. Plaintiff also claims that Sedgwick did not properly define disability as outlined in the terms of the Plan, calling it "unreasonable, arbitrary, and capricious." Plaintiff claims that Sedgwick failed to fulfill its contractual obligations to provide disability benefits to the Plaintiff.

The Relief Sought

Plaintiff wants a judgment against Sedgwick for the following:

  • All short term and long term disability benefits that have not been paid as of yet
  • All future short term and long term disability benefits according to the terms of the Plan for so long as the Plaintiff meets the terms of the Plan
  • All reasonable attorney fees and expenses due to the filing of this lawsuit
  • All other relief that the Court deems just and proper 

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.

Disability Blog & Cases:
Court Takes Sun Life To Task For Denial Of Disability And Life Insurance Benefits Of Man With Brain Tumor

The widow of a claimant, who died from a malignant brain tumor, brought this lawsuit with the help of her Colorado Disability Lawyer after Sun Life refused to award cancer disability benefits.


Disability Blog & Cases:
CIGNA Disability Claim Denial: A Claimant’s View

Every day disability claimants around the country contact our disability attorneys about a CIGNA disability claim. Many individuals tell us similar stories about the manner in which their CIGNA disability claim has been handled. We wanted to share with you a recent comment that was posted on our website about a CIGNA denial.


Disability Blog & Cases:
Sedgwick Terminates PNC Compliance Specialist’s Long Term Disability Benefits

Recently, a former Compliance Specialist for PNC Financial Services Group was unsuccessful in her lawsuit again her former employer and Sedgwick. This case is a strong reminder that even though a claimant has been awarded disability benefits from the Social Security Administration, it does not mean that the Long Term Disability Insurance Provider must also award disability benefits.

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Are Independent Medical Evaluation (IME) Providers Really “Independent”?

After being twice denied continued disability benefits, an Addiction Medicine Physician, with the help of his California Disability Attorney, was forced to file a lawsuit against Hartford.


Disability Blog & Cases:
North Carolina Court Determines That Sedgwick Abused Their Discretion And Wrongfully Denied Disability Benefits For BellSouth Employee

A BellSouth Customer Service Assistant, with the help of his North Carolina Disability Attorney, was forced to file a lawsuit against Sedgwick after being denied continued disability benefits.


Disability Blog & Cases:
American Red Cross Worker Sues Reliance Standard Life Insurance Company For Wrongful Termination of Long Term Disability Benefits

In Joanne C. Vs Reliance Standard Life Insurance Company, the Plaintiff seeks the reinstatement of her long term disability benefit payments as defined by the terms of the Plan.


Disability Blog & Cases:
Two Takes on Fibromyalgia

A representative from the American Chronic Pain Association and a Fibromyalgia physician recently appeared on a local news station to discuss Fibromyalgia and methods for treating Fibromyalgia.


Disability Blog & Cases:
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.

Disability Blog & Cases:
Standard Motor Products Employee file an ERISA Lawsuit against Prudential Insurance for denied disability benefits

Claiming ERISA (Employee Retirement Insurance Security Act) violations, Jacqueline Musgrove and her Kansas disability attorney filed a lawsuit against Prudential Insurance Company of America on July 1, 2011 for her long term disability benefits. As an assembler of electronic automotive parts, Musgrove worked for Standard Motor Products from September 28, 1988 until March 22, 2010. In March 2010, Musgrove was no longer able to perform her job duties due to “chronic lower back and left lower extremity pain.”


Disability Blog & Cases:
UnitedHealth Group, Inc. Recruiting Manager suffering from depression and anxiety denied benefits

A Minnesota 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.


Disability Blog & Cases:
Liberty Life Assurance Company of Boston sued under ERISA in three different cases for denial to pay disability benefits

Recently, three federal lawsuits were filed under the Employee Retirement Income Security Act (ERISA) against the Liberty Life Assurance Company of Boston. In all three cases that were filed through the respective plaintiffs’ disability attorney, Liberty was alleged to have improperly denied the plaintiffs their claims for disability (LTD) benefits.

Disability Blog & Cases:
Prudential Insurance Company of America recently sued three times under ERISA for denying disability benefits

Three different lawsuits were recently filed under the Employee Retirement Income Security Act (ERISA) against the Prudential Insurance Company of America in Federal Courts by attorneys in Kansas, Oklahoma, and Pennsylvania for failing to pay disability benefits.


Disability Blog & Cases:
Delta Air Lines Customer Service employee files lawsuit against Sedgwick Claims Management Services, Inc. for denial of disability benefits

An employee of Delta Air Lines and his California disability attorney recently sued Sedgwick to recover disability benefits under the Delta Family-Care Disability and Survivorship Plan. The employee charged the insurer of illegally denying him his short term and long term disability benefits as provided for in his insurance plan and thus, neglecting to uphold its duties in approving his claim.