Sedgwick Disability Help

UnitedHealth Group, Inc. Recruiting Manager suffering from depression and anxiety denied benefits

A 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.

The plaintiff, John Doe, was employed by UnitedHealth Group, Inc., who provided short-term and long-term disability benefit plans to the Plaintiff. By virtue of his employment, the plaintiff was covered by UnitedHealth’s Short-Term and Long-Term Disability Group Policies.

The Facts of the Case Against UnitedHealth Group Long-Term Disability Plan and Sedgwick Claims Management Services

Plaintiff worked as a recruiting manager for UnitedHealth Group, Inc. beginning in 2006. UHG is a group of health care companies with its principal place of doing business being located in Minnesota.

Plaintiff was a participant of UHG’s short-term and long-term disability benefit plans.

Terms of the Plans include:

Short-Term Disability Plan provided income protection and pay benefits to disabled UHG employees for up to 180 days after the disability occurs.
The Plan was funded by UHG and administered by Sedgwick.
Long-Term Disability Plan provided income protection and pay benefits to disabled UHG employees after a 180-day waiting period and during their periods of disability up to certain maximum benefit periods.
For the first 24 months, the LTD plan was funded by UHG and administered by Sedgwick.

Other Terms of the LTD Plan included:

Participant is “Disabled” if he/she is unable to do the Material Duties of his/her Own Occupation due to a medical condition and is unable to earn at least 80% of his/her adjusted Earnings after inflation from working in his/her Own Occupation.
The “Medical Condition” needed to be proven with clear documentation from the Physician supporting Participant’s Disability.
Limited benefit payments to a maximum of 24 months for disabilities that were caused or contributed to by a mental disorder unless the patient was confined to a hospital at the end of the 24-month period, in which case, Participant would receive benefits as long as he/she remain hospitalized and under age 65.

Plaintiff developed anxiety and depression that became more severe as he worked with UHG. His mental health conditions were complicated further by the fact that he had to take many medications that were prescribed for his mental health conditions.

Plaintiff’s mental health providers recommended that he take a disability leave. As a result, Plaintiff left work after November 24, 2009.

Plaintiff applied for STD benefits and received them for the entire 180-day period of STD benefit entitlement.

Denial of UnitedHealth and Sedgwick Disability Benefits Claim

On November 23, 2010, Sedgwick terminated Plaintiff’s LTD benefits as of November 1, 2010 because the medical evidence no longer indicated that the Plaintiff was disabled. Sedgwick mentioned that Plaintiff had 180 days to file an appeal.

Plaintiff talked with Sedgwick’s representatives on November 23, 2010 and November 29, 2010, telling them the LTD plan required that he provide objective information to support his claim.

On or about December 2, 2010, Plaintiff submitted his appeal form to Sedgwick. Plaintiff included letters from both mental health providers that he was still disabled due to severe depression, which led to weight loss, poor appetite, poor energy, poor concentration, and feelings of hopelessness and helplessness.

On or about December 22, 2010, Sedgwick had a board certified psychiatrist to review the Plaintiff’s report. This doctor’s report on the Plaintiff was made on or about December 30, 2010, agreeing that the Plaintiff was disabled from full-time work, but also stating that the Plaintiff was capable of part-time work.

Sedgwick’s doctor’s addendum on January 3, 2011 added that the Plaintiff has been compliant with treatment of his condition except for turning down a referral to an IOP program that could accelerate improvement in the Plaintiff’s mental health symptoms.

On January 17, 2011, Sedgwick upheld the termination of the Plaintiff’s LTD benefits mainly due to the fact that Plaintiff turned down a referral to an IOP program that could accelerate improvement in the Plaintiff’s mental health symptoms. Sedgwick alerted Plaintiff that he could file a second appeal.

On or around January 25, 2011, Plaintiff was found disabled by the Social Security Administration and awarded SSDB benefits as of May 2010. Plaintiff notified Sedgwick of this development.

On February 4, 2011, Plaintiff filed second appeal to Sedgwick.

On February 7, 2011, Sedgwick notified Plaintiff that it had made a mistake in stating that the Plaintiff had the right to a second appeal, as Plaintiff’s plan did not provide for a two-level appeal process.

On February 8, 2011, the revised appeal denial letter to the Plaintiff no longer allowed for a second appeal.

On or about February 9, 2011, Sedgwick and Allsup recovered $12,030.00 from Plaintiff because of the receipt of SSDI benefits for periods of time that coincided with Plaintiff’s receipt of LTD benefits.

Disability Lawyer Files Lawsuit Against UnitedHealth And Sedgwick

According to this lawsuit, Plaintiff claims that

He should have received LTD benefit payments from Sedgwick according to the terms of the LTD plan.
Sedgwick denied the Plaintiff those benefits, causing it to be in breach of the Plan and ERISA for failing to provide those benefits.

Relief Sought By The Plaintiff In The UnitedHealth And Sedgwick Lawsuit

Due to Sedgwick’s actions, Plaintiff requests the following relief from the Court:

Pay Plaintiff all past due LTD benefits, along with interest.
Reinstate Plaintiff to the LTD plan.
If there is time left on the 24-month period for mental illness benefits, the Plaintiff should receive the monthly LTD benefits according to the terms of the Plan.
Plaintiff should receive costs, disbursements, and other expenses connected to this lawsuit, as well as reasonable attorneys’ fees and experts’ fees.
All other relief that the Court judges to be just and proper.

In the above referenced case our firm did not represent the Plaintiff and had no involvement in the case. The plaintiff in this case was or is represented by a Minnesota Disability Lawyer that is not in any way affiliated with our firm. The information in this post comes from our review of a Complaint that was filed in Federal Court as a public record. This post has been modified from a previous version.

Did you find this helpful?

Helpful (0)Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options

Submit a Strong Sedgwick Appeal Package

We work with you, your doctors, and other experts to submit a very strong Sedgwick appeal.

Learn more

Sue Sedgwick

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Sedgwick.

Learn more

Protect Your Benefits

Get Your Sedgwick Disability Application Approved

We help claimants throughout the entire application process.

Learn more

Prevent a Sedgwick Disability Benefit Denial

We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Sedgwick Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Sedgwick Reviews

(660)

Policy Holder Rating

Write a Review

1 out of 5

Read 11 reviews

Write a Review

100%

Timely Payments

1.2out of 5

Handling Claim

1.0out of 5

Customer Service

1.2out of 5

Dependable

1.1out of 5

Value

1.1out of 5

Showing 8 of 660 Reviews

Sedgwick

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 >

Sedgwick

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 >

Sedgwick

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 >

Sedgwick

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 >

Sedgwick

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 >

Sedgwick

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 >

Write a Review See All Reviews

Answered Questions by Our Lawyers

(1)

Showing 1 of 1 Answered Questions

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 >

Ask Our Lawyers a Question See All Answered Questions

Helpful Videos

(910)

Showing 12 of 910 Videos

See All Videos

Disability Benefit Tips

(331)

Showing 8 of 331 Benefit Tips

Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >

Disability Denial Reason #1 – Paper Review & IME

At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >

How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial

At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultimate r... Read More >

See All Benefit Tips

Dell Disability Cases

(375)

Showing 8 of 375 Dell Disability Cases

Sedgwick Reinstates Long Term Disability Claim Following Appeal

Like many disability claimants, our client’s experience in dealing with Sedgwick was less than a pleasurable experience. After finding himself unable to continue to perform the very physically demanding duties of his occupation as a Traveling Field Engineer for Avaya due to Chronic Pain stemming from multiple lumbar and thoracic spine conditions he filed a claim for short and long term disability benefits un... Read More >

Nearly Three Years Later, Sedgwick Finally Pays Walgreens' Pharmacist's STD and LTD Claim

After three long years of struggling with no income due to Sedgwick's failure to approve her benefits, the claimant is finally awarded the disability benefits she was rightfully owed. The claimant worked for Walgreens for approximately 11 years and was a dedicated employee who loved her profession. In early 2011 she began to feel fatigued and experienced pain in her muscles and joints. She was very concerned f... Read More >

AT&T Employee Dealing With Sedgwick Has Horrible Disability Benefit Claim Experience

Our client, an AT&T employee for more than 40 years became disabled and unable to do her job due to cervical myeolapathy neck pain, chronic headaches and a torn rotator cuff in her shoulder. Her claim for short term disability benefits under the AT&T disability benefits plan has been nothing but a "headache". AT&T hires Sedgwick Claims Management to handle the administration of all disability benef... Read More >

Seven Surgeries and The Standard Still Denies Disability Insurance Benefits

Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >

Sun Life Wrongfully Denies Disability After Paying For 23 Months

We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for many years. Her job was very physical as it required her to climb in and out of semi-trucks multiple times a day as well as operate them which was very strenuous. She went out of work in due to ongoing and severe debilitating right hip, low back, and bilateral knee pain... Read More >

Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed

Our client, a registered nurse for Dignity Health, found herself in a difficult situation after being diagnosed with lumbar spondylosis and left knee arthritis. She continued to work, however, struggled while attempting to work through chronic lower back pain and left lower extremity radicular symptoms on a daily basis. Sadly, her condition failed to improve and... Read More >

Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision

The claimant is an 64 year old former Corporate Attorney and at a prominent Florida business law firm who was forced to cease working in his highly successful and rewarding profession, job, and career on January 27, 2021, and to seek disability compensation under his policies with Lincoln due to severe symptomatology stemming from or following a viral COVID-19 i... Read More >

Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal

Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manage... Read More >

See All Dell Disability Cases

Disability Lawsuit Stories

(765)

Showing 8 of 765 Lawsuit Stories

Court Upholds Sedgwick's Denial of Benefits for Claimant with Chronic Fatigue Syndrome

In Griffin v. AT&T Umbrella Benefit Plan No. 3, Plaintiff worked for a few years for Wisconsin Bell, Inc. (Wisconsin Bell) as a premises technician. Wisconsin Bell is a participant in a disability plan administered by Sedgwick Claims Management Service, Inc. (Sedgwick). The Plan offered both short-term disability (STD) and long-term disability (LTD) benefits to qualifying participants.Participants... Read More >

Court Agrees with Sedgwick and Finds Plaintiff's ERISA Lawsuit is Time-Barred

The case of Allison Pfifer v. Sedgwick Claims Management Services, Inc., teaches claimants the importance of complying with the terms of their disability insurance policy. The specific terms at issue here are: 1) the need to support claims with substantial medical evidence; and 2) complying with contractual deadlines established by the insurance policy for short-term disability (STD) benefits an... Read More >

Court Remands to Sedgwick for Reevaluation of Its Denial of Claim for Disability Benefits

In Daniel T. Derichs v. AT&T Services, Inc., plaintiff, an employee of AT&T who suffered from post-traumatic stress disorder (PTSD), applied for short-term disability benefits. The plan administrator, Sedgwick Claims Management Services, Inc. (Sedgwick), denied Derichs’ claim. After exhausting his administrative appeals, Derichs filed this ERISA lawsuit.At issue was the correct definition of tota... Read More >

7th Circuit Recognizes Chronic Debilitating Effects Of Fibromyalgia

In Cathleen Kennedy v. The Lilly Extended Disability Plan, plaintiff Cathleen Kennedy, an executive Director of Human Resources, had a history fibromyalgia dating back many years. As an employee of Eli Lilly and Company, she was covered by The Lilly Extended Disability Plan (“the Plan”), which was administered initially by Anthem Life and Disability and later by Sedgwick Claims Management Services (�... Read More >

Court Orders Sedgwick to Pay Disability Benefits to Claimant with Carpel Tunnel Syndrome Even though the Employer Offered Her Accommodations

Thornton v. Sedgwick is a fact-driven case in which a California district court ruled that Sedgwick “incorrectly determined in January 2014 that [plaintiff] was no longer eligible for disability benefits.” The plaintiff, Catherine Thornton, was a project manager for Southern California Edison (SCE) when she developed bilateral carpel tunnel syndrome, bilateral cubital tunnel syndrome and epicondylitis. She... Read More >

Court Finds Sedgwick Wrong to Deny Benefits Without Considering Claimant's Actual Job Duties

In McMillan v. AT&T Umbrella Benefit Plan No. 1, the plaintiff, who had worked for AT&T for nearly six years as a Senior IT Client Consultant, filed a claim for short term disability benefits based on multiple medical conditions, including his coronary disease, hypertension, diabetes and sleep apnea. The plan administrator for AT&T is Sedgwick Claims Managements Services, Inc. (Sedgwick).Althou... Read More >

Sedgwick Continues monitoring application for SSDI benefits even after terminating disability claim

Many claimants are unaware that disability carriers continue to monitor claimants' applications for Social Security disability benefits even after the carrier has ceased to pay benefits.A recent case out of the Middle District of Florida, which did not involve the law firm of Dell & Schaefer, serves as a reminder that your disability carrier often continues to monitor the status of your application for... Read More >

Sedgwick and AT&T sued as a result of SSDI Overpayment

A recent decision by a Federal Judge in a California ERISA Disability Lawsuit serves as a reminder to all individuals receiving disability benefits: If your disability policy allows for the insurance company to "offset" other income benefits and to collect for overpayments, you must always remember that eventually you may owe that money to the insurance company should they request it soon thereafter or at a la... Read More >

See All Lawsuit Stories

Reviews from Our Clients

Keith G.

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.

Kyle D.

Jay Symonds and his assistant, Sonia helped me tremendously. The insurance company that worked for my former employer did everything they could to make my life literally miserable. That all changed when I hired Jay. He and Sonia fought for my rights and forced the insurance company to pay what they should have.

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.

Wesley D.

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!

View All Reviews (503)