Free Consultation 877.583.2524
We do not handle social security disability claims
logo celebrating

Nationwide Leaders in Disability Insurance Law

shook hands

Court Finds Sedgwick Claim Determination To Be Arbitrary And Capricious

Tuesday, June 28th, 2011

A Federal Judge in New Jersey has determined that a decision to terminate long term disability insurance benefits to a claimant suffering from lupus, rheumatoid arthritis and other conditions was arbitrary and capricious. The Court undertook an analysis that accounted for a number of case specific factors, taking guidance from the United States Supreme Court’s holding in Met Life v. Glenn. Sedgwick is a third party administrator who does not insure the benefits, but rather handles claims for employers as the administrator.

The Court noted that Sedgwick’s failure to comply with the ERISA regulations requiring appropriate notification of what is necessary to perfect a claim, along with the failure to consider all relevant medical conditions, and the failure to consider the SSDI award were factors weighing in favor of a finding of arbitrary and capricious conduct. The Court also found that Sedgwick’s requirements of proof not contained in the policy, along with a changing of claim position without new information further supported a finding of arbitrary and capricious conduct.

On the other hand, the Court did not credit the use of repeat offender paper reviewing physicians as having any weight, noting that their was no evidence of bias presented to support the argument. However, by correctly weighing the totality of circumstances, the Court held that the decision to terminate the claim was improper, and ordered a portion of the back benefits to be paid, while remanding the claim back for further consideration.

Connor v. Sedgwick Claims Management Services

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications

Categories

Archives

Ready To Talk?

Fill out the form to request a FREE legal consultation

Sorry, we do not handle SSDI/Social Security claims.

Frankel & Newfield does not currently handle any Social Security Disability Insurance claims.

CLOSE

*Required fields are marked

I have read the disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

CLOSE

This is about a Social Security Disability claim.

Ipad image

Download Our Free eBook

FILING A DISABILITY INSURANCE CLAIM

Secrets the Disability Insurance Companies Don't Want You to know!

Sign Up for our mailing list to receive disability insurance law updates

Your information is 100% secure and will never be shared with anyone

HELPING THE DISABLED NATIONWIDE

No matter where you are nationwide, we are here to help.

We have the resources and support to take on the largest insurance companies.

Contact us today for our nationwide service.

Contact Us
Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri
Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina
South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
CHAT