Sedgwick Claims Management Services, Inc. Denies Disability Benefits to AT&T Employee After Receiving Social Security Disability Overpayment
Unfortunately for employees of AT&T, if you are disabled you will be forced to deal with Sedgwick Claims Management Services Inc. ("Sedgwick"). Sedgwick is a third party administrator that has been hired to administer and make claim decisions on AT&T short term and long term disability claims. The AT&T disability benefit plan is written with language that makes it very difficult for disability claimants to obtain benefits. Sedgwick is notorious for unreasonable claim denial and has been sued on numerous occasions. Despite an approval of SSDI benefits and a finding of disability by a doctor hired by Sedgwick, this claimant's disability benefits were still denied.
The Facts of the Sedgwick Disability Claim
The plaintiff was an employee of BELLOUTH TELECOMMUNICATIONS Inc (now known as AT&T, Inc due to the merger between BELLSOUTH and AT&T). By virtue of her employment with BELLSOUTH a Network Manager of Construction and Engineering, the plaintiff was a participant in the BELLSOUTH SHORT AND LONG TERM DISABILITY PLAN FOR MANAGEMENT EMPLOYEES, (now known as the AT&T Umbrella Benefit Plan No. 1) an employee welfare benefit plan that was administered by Sedgwick Claims Management Services Inc. (Sedgwick).
Claim for Short Term disability Benefits
On August 10, 2007, due to her medical conditions, including but not limited to post traumatic stress disorder, anxiety and major depressive disorder, the plaintiff stopped working. She became disabled as a result of these medical conditions and subsequently filed a claim for Short Term disability benefits under the abovementioned plan. Sedgwick approved her claim for short term disability benefits and the plaintiff began receiving short term disability benefits effective from August 20th 2007. According to the lawsuit, Sedgwick paid the plaintiff the maximum 52 weeks of short term disability benefits under the Plan, from August 20th 2007 to August 17th 2008 and withheld premium from after tax dollars for supplemental Long Term disability benefits purchased by the plaintiff.
Claim for Long Term disability Benefits
On May 9th 2008, the plaintiff was notified by Sedgwick that that continued benefit payments were contingent on the results of an Independent Medical Evaluation (IME).
As such, the plaintiff attended the IME scheduled for her on June 3rd 2008. The result of the IME supported the Plaintiff's continued disability. Hence, the plaintiff was approved for long term disability benefits on August 18th 2008.
On November 20th 2009, the plaintiff was approved for disability benefits from the Social Security Administration. From the payment of her retroactive Social Security Award, Sedgwick recovered from the plaintiff an overpayment of benefits amounting to $19,679.48. Despite the favorable IME and approval of her claim for Social Security Disability benefits, on April 28th 2010, Sedgwick notified the plaintiff that recent review of her claim showed that she may have some work capacity and continued benefits were contingent on a vocational review.
Long Term Disability Benefits
Thus, on June 8th 2010, Sedgwick terminated the plaintiff's long term disability benefits on the grounds that she did not satisfy the definition of disability under the Plan. The plaintiff appealed Sedgwick's termination of her disability benefits and improper withholding of taxes from her long term disability supplemental benefits by a letter dated November 22nd 2010. The plaintiff stated that despite her continuing disability consistently documented by her treating providers, medical literature, and other medical reports demonstrating that Ms. Arnold is unable to perform the duties of any occupation, Sedgwick upheld the termination of benefits on January 7th 2011.
The plaintiff alleged that Sedgwick had ignored some medical records and deemphasized others, including consistent reports of the plaintiff's treating physician, favoring her claim for disability benefits. She also argued that the decision to terminate her disability benefits was an abuse of discretion, a breach of the terms of the Plan, and was wrong, arbitrary and capricious and having exhausted all her administrative remedies is entitled to seek relief from the Court under ERISA.
Plaintiff Hires A Disability lawyer to File her Lawsuit
The case of Debra A. Arnold vs. AT&T, Inc., AT&T Umbrella Benefit Plan No. 1 F/K/A SBC Umbrella Plan No. 1, Bellsouth Long Term Disability Plan For Management Employees And Sedgwick Claims Management Services, Inc was a legal action under the Employee Retirement Income Security Act of 1974 (ERISA) and was filed at District Court for the Middle District of Florida. Acting through a Florida disability attorney, the plaintiff alleged that Sedgwick Claims Management Services Inc (Sedgwick) and the Plan Administrator for the AT&T Umbrella Benefit Plan had violated the provisions of ERISA in the denial of her claim for long term disability benefits.
The plaintiff alleged that she is entitled to these benefits under the Plan since she had:
- Satisfied all conditions to be eligible under the Plan; and
- Has not waived or otherwise relinquished her entitlement to these benefits.
- Hence, the plaintiff is requesting a judicial review of the denial of benefits in this case and declare that she is entitled to all benefits under the Plan, including:
- Payment of all back benefits with interest,
- The underpayment of benefits resulting from tax withholdings wrongfully withheld.
- Payment of all attorney's fees and costs associated with attempting to secure these benefits.
- Penalties payable in the amount of $110/day or other amount as to be determined by this Court as a result of the failure of Sedgwick and the Plan Administrator to provide the information requested.
- Any such other relief deem just and proper by the Court.
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.