Sedgwick Disability Help

Federal Judge orders Sedgwick Claims Management to pay disability benefits to PNC Financial Services Group, Inc's Collection/Recovery Team Manager

Disability claimants need to be extremely cautious when dealing with Sedgwick Claims Management Service Inc. (Sedgwick). From our law firms’ experience of handling thousands of disability insurance claims, Sedgwick is one of the top three most difficult companies to deal with. Unfortunately, Sedgwick will capitalize on any opportunity to deny a claimant their disability benefits. This case discusses the unreasonable conduct used by Sedgwick to wrongfully deny disability benefits.

Following denial of claims for disability benefits and exhaustion of all administrative remedies, a beneficiary of a disability benefits insurance plan have an option under the Employee Retirement Income Act (ERISA) to file a civil action for judicial review of a claim. The case of Beverly A. Haisley vs. Segdwick Claims Management Service Inc, PNC Financial Services Group, Inc and the PNC Financial Services Group, Inc. Long Term Disability Plan is a good example of how the Court will review a Sedgwick disability claim denial.

The Facts of the Case Against Sedgwick Claims Management Service Filed by a Disability Lawyer

Working as a collection/Recovery team manager for the PNC Financial Services Group, Inc’s, the plaintiff suffered from anxiety and depression following the death of her mother. It was stated that the plaintiff was also suffering from Peripheral Neuropathy around the same time. The plaintiff filed for short term disability benefits and was awarded disability benefits from June 5th 2007 to October 2nd 2007.

Upon the expiry of her short term disability benefits, the plaintiff applied for transition to long term disability benefits on October 11th 2007. The plaintiff was initially approved to receive long term disability benefits by a Sedgwick’s long term disability case worker on November 30th 2007. However, upon the recommendation of a Sedgwick’s supervisor, the approval was later formally suspended on December 20th 2007 due to “a lack of current treatment information on file supportive of continuing total disability.” Despite providing additional information to support her claim, Sedgwick formally denied the plaintiff’s claim for long term disability benefits on February 28th 2008 based on the results of peer reviews conducted by Sedgwick.

The plaintiff appealed through her Pittsburgh Pennsylvania disability attorney Sedgwick’s decision to deny her claim for long term disability benefits on May 7th 2008. Based on the recommendations of two physiatrists engaged by Sedgwick, the plaintiff’s appeal was denied on June 23rd 2008. The plaintiff was also informed that no further information would now be considered and the administrative record of her claim was now closed. On October 16th 2008, the plaintiff filed legal action against Sedgwick alleging violations under the Employee Retirement Income Security Act (ERISA).

Legal Issues before the Pennsylvania District Court

The District Court had to consider several issues before it in this case. First was the issue of who the plaintiff can sue as the both Sedgwick and the PNC Financial Services Group, Inc argued that the Plan should be the proper defendant.

Second, the district court had to consider the argument of Sedgwick that the plaintiff’s claim was time-barred by the terms of the Plan.

The third issue which the District Court had to consider was whether Sedgwick had acted arbitrarily and capriciously in its denial of the plaintiff’s claim for long term disability benefits.

The Plan Administrator as the Proper Defendant

The District Court ruled that the plaintiff was only seeking benefits from the assets of the Plan and the legal claim against Sedgwick was “essentially a claim that is only nominally asserted against the Plan Administrator and is, for all practical purpose s, a claim made against the relevant plan itself.” The Court ruled that the exercise of control over the administration of benefits was the “defining feature” of the proper defendant here.

Timeliness of the Plaintiff’s Claim

Sedgwick had argued that the plaintiff’s claim was time-barred as she did not apply for long term disability benefits within 90 days of when Total Disability began (June 5th 2007) as required by the terms of the Plan. The Court ruled that Sedgwick now could not rely on the 90 days limitation period as it HAD initially approved the plaintiff’s claim for long term disability benefits on November 30th 2007 and hence waiving the defense of untimeliness by failing to assert it as a basis for denying a claim in the first place.

Conduct of Sedgwick as Arbitrary and Capricious

The court ruled that Sedgwick had acted arbitrarily and capriciously during its decision making process due to several factors:

The reversal of Sedgwick’s initial approval for long term disability benefits claim without any additional medical evidence. The inconsistent treatment of the same medical information deemed sufficient for the initial approval but later judged as insufficient weigh heavily in the plaintiff’s favor.

The fact that Sedgwick did not conduct an independent medical examination on the plaintiff but instead relied on a file review of specific impairments or limitations not amendable to considerations by means of a file review. This had risen “questions about the thoroughness and accuracy of the benefit determination.”

The failure by Sedgwick to address the plaintiff’s receipt of Social Security Disability Benefits in its denial of the plaintiff’s claim for long term disability benefits. This had “suggested procedural unreasonableness” given the circumstance that the plaintiff was encouraged to apply for Social Security Disability Benefits in the first place. The Court pointed out the Social Security Administration standard for determining total disability is more stringent that the less demanding standard employed by Sedgwick.

Determining the Appropriate Remedy

Upon concluding that Sedgwick had acted arbitrarily and capriciously, the Court had to determine the appropriate remedy in this case. Here, the Court makes a distinction between the initial denial of benefits to a termination of benefits. To restore the status quo in this case, the Court ruled that the benefits should be reinstated as Sedgwick’s termination of its claim approval was arbitrary and capricious.

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Sedgwick Reviews

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Don't trust them, they like to play games

Reviewed by Bob on November 14th 2024 Verified Policyholder | June 2024 date of disability

They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >

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Worst Company Ever

Reviewed by RobRob on September 23rd 2024 Verified Policyholder | August 2024 date of disability

If something happens to you at work you better hope you die, my son is going through HELL because this company is handling his work comp. NO RETURN PHONE CALLS, TEXTS, EMA... read more >

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AT&T Was Great and Sedgwick Horrible

Reviewed by From a great job to a complete nightmare on March 20th 2024 Verified Policyholder | March 2024 date of disability

My Physician recommended that I take some time from a toxic environment after several deaths in my family coupled with AT&T trying to run tenured employees out of the door... read more >

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Lame

Reviewed by Dennis T. on December 11th 2023 Verified Policyholder | March 2022 date of disability

My experience with Sedgwick and personell is as follows: Unhelpful, unprofessional and an overall unpleasant experience.

Sedgwick

I was disabled 2003 by SS. I got SSDI 7 years too late.

Reviewed by Bunny on August 9th 2023 Verified Policyholder

I believe if Sedgwick would have moved on my Claim. They absolutely did everything not to answer my calls, change dates. I had already been through WV comp. Ins. Sold out,... read more >

Sedgwick

They falsify documents and avoid contact as much as possible.

Reviewed by Jeff Allsop on July 27th 2023 Verified Policyholder | February 2023 date of disability

They avoided sending the documents needed for the claim for two weeks. I had to escalate with a call from my company's HR and Sedgwick (the only way I was ever able to get... read more >

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Not getting paid

Reviewed by Cezes on June 15th 2023 Verified Policyholder | March 2020 date of disability

I been battling Sedgwick about my claim. I was to get paid today and I did not get paid.Sledges is the worse company I ever had to deal with. I been fighting with my b... read more >

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You have to be well versed in your rights when dealing with them

Reviewed by Lauren on June 3rd 2023 Verified Policyholder | May 2023 date of disability

I live in CA and have a very straightforward maternity leave case. Every adjuster is unaware of CA leave laws. They’ve gotten in wrong every time. You have to advocate f... read more >

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Q: Sedgwick denied my STD appeal, is there anything I can do to get my money back?

Answered on June 15th 2023 by Attorney Gregory Dell

A: Vicky: You need to file a written appeal of your Sedgwick Disability Denial. Sedgwick will have someone review... Read More >

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They were very professional with their responds and on time with keeping you inform about everything with your case. I would recommend My lawyer Stephen Jessup, he was on point with everything, thank you. You guys are awesome people to work with. God bless you guys.

Keith L.

I was not able to work as a physician for about 14 months due to neck/back issues. Even though I had 3 medical doctors explicitly state that I was not to work AT ALL as a physician at that time, New York Life (NYL) Disability Insurance denied my long term disability claim (which apparently they deny a high percentage of people similar to me- only they know why they do this to so many- I have my own suspicions). I was in pain from my medical issues and so frustrated with NYL considering I had many bills coming due. I then decided to call Dell Disability Lawyers. One of their attorneys, Alex Palamara, spoke to me on the phone right then to hear and understand my story and then offer ways he could help. Long story short, within a few months of me returning back to work, he was able to persuade NYL to pay me my long term disability claim. He (and his kind assistant, Tabitha) were always very helpful, informative, and available to me. I feel quite certain that NYL would NEVER have paid me what was appropriate based on my insurance agreement/ contract with them without the help of Alex. I highly recommend him/Dell Disability Lawyers. If you find yourself in a similar situation of disability insurance denial of your own personal/group policy, especially if you are a medical provider/physician like me, then consider contacting them for advice/direction PRIOR to appealing your claim on your own.

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If you have a disability claim hire Jay as if you go it alone the insurance company will screw you. Jay and Sonia will fight for everything you are entitled for. I couldn’t recommend them more highly.

Frank R.

I cannot say enough positive things about my experience with Dell Disability Lawyers. Attorney Stephen Jessup and Amanda offered an opportunity to provide clarity on a complex issue regarding my disability claim. Mr. Jessup offered advice on an offset to my claim after my insurance company asked for additional information from Social Security. With counsel from Mr. Jessup, I was able to address the outstanding issue with the Social Security office and provide my insurance company with the required documentation to address their concerns. Mr. Jessup always responded in a timely manner with expert advice and offered the opportunity for follow up. I strongly recommend Dell Disability Lawyers to those seeking legal counsel for disability matters.

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I have been able to help others as a soldier, a police officer, and a pharmacist. I needed help forcing the insurance company to keep their commitment to take care of me and my family. I called Dell. Alex, Tabitha, and their entire team were very compassionate, extremely patient, and extraordinarily knowledgeable. Many thanks Dell!

Samar A.

My husband had applied for Long Term Disability and was denied. We sought out Rachel Alters at Dell Disability Lawyers to help us with our appeal. Rachel and her team were so diligent and meticulous in every aspect of the process. The process was seamless, and we never had any doubts that she would get it done and that she did! We are forever grateful to Rachel and Catherine for all of their determination and tenacity to get us the outcome we needed and deserved.

We could not recommend better representation and are indebted to them for making us whole again. Thank you so much Rachel and team!

Jam

Alex Palamara is one of The Best lawyers in the world and Dell Disability Lawyers are the Best by Far. Alex and his Assistant Tabitha helped me get the compensation I needed for a Horrific Disabling heath condition I’ve been dealing with for over a year. Alex and his team were so professional and caring. They treated me like I was there own family. Alex Knowledge, Expertise and skills as a Lawyer is among the Best of the Best in his field and I would HIGHLY recommend that if you ever have any issues with any Insurance Company over your Disability issues, please don’t hesitate to seek out Dell Disability and Alex Palamara. They truly are Amazing and caring. Thank God for them. Outstanding Job Alex and Tabitha

G.T.

9 years ago when I had to apply for disability benefits from my private disability policy the insurance company ignored my inquiries until Dell and Schaefer represented me and I have received the benefits without interruption til my policy expired at age 65. I have appreciated not having to deal directly with the insurance company and having attorney Greg Dell and assistant Danielle Lauria handle all communications which included monthly progress reports. I thank them for their efforts on my behalf and highly recommend them to all those in need of disability benefits.

Misty A.

I’m so thankful I chose to reach out to the attorneys at Dell. They have always been quick to respond to any and all questions I have had. The anxiety I had while dealing with Lincoln Financial on my own has decreased immensely since Alex and Danielle took my case. They were able to get my LTD denial reversed and I am so very grateful!

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