Bartolic Law has helped many clients get their short-term and long-term disability claims approved by Sedgwick. In one case, Sedgwick denied the long-term disability claim of a clinical pharmacist suffering from Fibromyalgia. Clinical pharmacy work requires being on one’s feet for extended shifts. Sedgwick both overstated the client’s physical capacity and understated the demands of pharmacy work. We combined medical evidence of limitations with vocational evidence of the occupation demands. When Sedgwick requested an Independent Medical Examination, we attended with the client to document the duration, and prevent the IME doctor from making our client sit in the waiting room beyond the client’s documented capacity. We demanded the examination begin on time, or the examination would be forfeited. Shortly after the examination, Sedgwick approved the claim. In another case, Sedgwick asserted a 24-month mental health limitation applied to a formerly highly compensated client in an executive role, disabled by permanent damage from stroke. Like many insurers and claims administrators, Sedgwick imposed the limitation because the medical records documented depression and anxiety, secondary to the physical impairments. We persuaded Sedgwick the limitation does not apply and the client continues to receive monthly payments, as promised.
Sedgwick’s handling of your claim generally receives less scrutiny from a court than insurers receive, because it does not pay the claims itself. It purports to be a neutral third-party claim administrator, but its business model is dependent on reducing employers’ cost of disability benefits. This generally means more denials and faster benefit terminations.
Sedgwick must strictly follow all the processes and procedures of ERISA claims procedure regulation for its decisions to be upheld, and when you put the right lawyer on your side, you can often show Sedgwick falls short of these requirements. Sedgwick often gives too little consideration to favorable evidence, overlooks some evidence altogether, or fails to engage in the kind of dialogue ERISA requires to explain why your claim was denied and what you can do to show you are entitled to benefits.
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (N.D. Ill. Sept. 28, 2018) (holding insurance policy’s grant of discretionary authority is void under Texas law due to certificate being issued after effective date of regulation, and policy renewing after effective date, and holding Plaintiff was disabled from Any Reasonable Occupation where treating doctors certify she can sit at the occasional level, and insurer’s consultants opine Plaintiff can sit frequently, as weighing all evidence together would make capacity likely at low end of frequent range at best).
Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, 281 F. Supp. 3d 710 (N.D. Ill. Dec. 20, 2017) (holding plan was arbitrary and capricious in denying medical benefits for removal of spinal cord stimulator following a fall down the stairs and infection where plan argued the expenses were caused by the same injury as the car accident necessitating implantation of the stimulator years earlier)
Tassone v. United of Omaha Life Ins. Co., 264 F. Supp. 3d 867 (N.D. Ill. Aug. 30, 2017) (awarding client long term disability benefits denied by United of Omaha despite insurer’s doctor opining there was no objective evidence of functional impairment)
Suson v. PNC Fin. Servs. Grp., Inc., No. 15-CV-10817, 2017 WL 3234809 (N.D. Ill. July 31, 2017) (holding Liberty Mutual’s denial of client’s long term disability benefits was arbitrary and capricious where Liberty Mutual disregarded client’s carpal tunnel syndrome and relied on a vocational opinion to which client never had an opportunity to address before litigation)