AT&T employee with back injury sues Sedgwick for denial of short term disability benefits
Disability Lawyer Sues Sedgwick Claim Management Services
In the case of Richard Shane Burnett Vs Sedgwick Claim Management Services, Inc. D/B/A AT&T Integrated Disability Service Center, filed at the District Court for the Middle District of Florida, the plaintiff Richard Shane Burnett alleged that he is eligible for short term disability (STD) benefits under an employee benefit plan provided by his employer.
The Alleged Facts Of Sedgwick Disability Denial
The plaintiff was a former employee of the BellSouth Advertising and Publishing Corporation that operated under the name “AT&T Real Yellow Pages” at Tampa, Florida. He alleged that he was at all times a participant in a STD Plan called “the AT&T Umbrella Plan No. 1” under the BellSouth Short Term Disability Plan for Non-Salaried Employees program. Sedgwick Claim Management Services, Inc (SEDGWICK) acted as the Claims Administrator and operated under the name of “AT&T INTEGRATED DISABILITY SERVICE CENTER”. Accordingly, the plaintiff to the best of his knowledge and belief stated that the above mentioned plan was not insured and is funded from one or more of AT&T affiliated companies.
Following back injuries that he sustained at work, the plaintiff filed a claim for STD benefits on January 13th 2010. The plaintiff alleged that these injuries had resulted in several physical restrictions and limitations that prevented the plaintiff for performing the duties of his occupation or any other occupation.
The Claim for Benefits and Appeals to the Denial of Benefits
SEDGWICK, while operating under the name of or on behalf AT&T INTEGRATED DISABILITY SERVICE CENTER, evaluated the plaintiff’s claim for benefits and formally denied the plaintiff’s claim on February 5th 2010. An appeal was made to SEDGWICK regarding the February 5th 2010 denial but was also denied.
The plaintiff made a second appeal to SEDGWICK which was again denied by SEDGWICK on December 30th 2010. According to the lawsuit, SEDGWICK had denied the plaintiff’s claim for benefits on the grounds that he did not fulfill the Plan’s definition of disability at the time of its initial decision and the two subsequent appeals.
Legal Remedies Sought By The Plaintiff In The Lawsuit
The plaintiff alleged that he had exhausted all his administrative remedies as required under the Plan and as informed by SEDGWICK. The plaintiff argued that he was not provided or was deprived access to a copy of the STD plan. The plaintiff alleged that a request to the Plan Administrator to provide the copy of the Plan documents or Summary Plan description had yielded no result. As such, the plaintiff contended that he is unable to state the precise amount of benefits that he is entitled to under the STD plan.
The plaintiff asserted in the lawsuit that he is entitled to the benefits mentioned above because:
- The plaintiff has met the definition of disability under the plan.
- The plaintiff has met all the conditions for benefits eligibility.
- The plaintiff has not waived or relinquished his rights to the benefits.
As such the plaintiff is seeking the following relief from the Court:
- A declaration that the plaintiff is entitled to STD benefits from January 14th 2010 and continuing (or for other such period as permitted under the STD Plan).
- An accounting of benefits owned to the plaintiff with SEDGWICK to produce the factors and figures necessary to render such accounting.
- An award of benefits plus interest at the legal rate from the date it became due until the date it is paid.
- An award of reasonable attorney fees and costs incurred.
- For such other and further relief as this Court deems just and proper, including but not limited to:
- A declaration that the plaintiff’s claim continue after the last date of benefits awarded without the requirement by the plaintiff to file a new claim for benefits.
- Remand the plaintiff’s claim to the Plan Administrator for further action to address continuing benefits under the STD Plan and for purpose of processing a claim for Long Term Disability benefits for the period following the expiration of the plaintiff’s eligibility for STD benefits.
- An order to SEDGWICK to inform the plaintiff’s former employer or any other necessary entity that benefits in this action were properly paid through the date of this Court’s Order for the purpose of coordinating or reinstating any ancillary benefits which should properly be paid or for which coverage should be awarded as a result of the plaintiff’s receipt of disability benefits under the Plan.
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