Sedgwick manages short-term disability claims for many Fortune 500 and other companies, and regularly denies disability claims for a number of reasons. Often, they have little to do with your short or long-term disability claim, but a lot to do with your short and long term disability policy. That doesn’t make it any easier when your short term disability policy claim is denied. We have seen a rise in the last few weeks and months in the number of people contacting our law firm when their short term disability insurance claim has been denied. Sedgwick Claims Management Services is one of the largest third party administrators, companies that manage disability and life insurance claims for large insurance companies. This third party claims management company works for the insurance company or directly for your employer if you work for a self-insured business. That means that Sedgwick’s success is measured in how much it can minimize the money an employer or disability company will have to pay for your claim. Large companies who use Sedgwick’s services include Fortune 500 companies, like Target, General Electric (GE), Delta Airlines, and AT&T. Sedgwick also helps large and mid-sized disability and life insurance companies that don’t wish to take on the cost of running their own disability claims department. Your claim denial is part of their business plan – – to minimize costs and exposure for their client – your employer.
Sedgwick’s disability claim denials are often based on: Insufficient evidence to support the claim. You may have spent hours going through all of your medical documents, contacting your doctor’s office, getting reports from radiology departments, lab results, etc. How could this third party adjuster possibly think the evidence is insufficient? Our disability insurance attorneys are accustomed to this response from Sedgwick. We also know the information you have put together is not the same as what we would compile for Sedgwick. We focus on your restrictions and limitations, and not just a diagnosis. Our years of experience with disability insurance claims put you at a distinct advantage in navigating this process. We prepare the information that we know Sedgwick is looking for when it comes to short term disability claims and to bridge the claim to long term where appropriate. Short term disability claim denials become long-term disability denials. Short-term disability claimants find it hard to believe their claim is being denied by Sedgwick Management Services. It’s often not a huge claim, and it’s often only for a short time. But that’s not how Sedgwick sees it.
Sedgwick is focused on whether or not a short term claim becomes a long term disability claim. The long term disability benefits are always going to be more costly, so if a short term claim can be contained, the exposure is lower for the insurance company. By making it easier for your short term claim to be denied, Sedgwick earns its compensation in two ways. No benefits for a short term claim often make you ineligible for a long term claim. It’s far easier to deny a long-term claim when the short-term disability claim has been denied. Your medical records are not at the heart of the claims process, although it certainly seems like they should be. It seems that way to us also. What if Sedgwick is relying on reports from doctors who have never examined you? Sedgwick Claims Management Services is not the only third party claims management company to employ this tactic. Having a doctor review your medical records, or even only a select portion of your medical records, is not uncommon in the disability claims arena. Sedgwick relies upon a cadre of doctors for hire, who are paid for their opinions, and whose opinions are designed to please those who employ them. They avoid discussing evidence, or they selectively review materials, to arrive at a pre-determined conclusion that no disability exists. Another tactic that Sedgwick relies on is having your medical record reviewed by a doctor or nurse who has no experience in your disability, even if you are under the care of a prominent expert in the field. This is not proper, but occurs with great regularity. Don’t forget that the doctors or nurses who are reviewing your medical records are paid by Sedgwick. It is impossible to separate this built-in conflict of interest to the disability claims process, and many courts have recognized the impact this has on final outcomes.
Disability insurance companies use surveillance of all kinds to deny claims, and so do third party management companies like Sedgwick. That includes videotaping you as you go to doctor or treatment appointments. Accusing you of going out and about is another standard tactic used to try to undercut your credibility and draw a wedge with your doctors. Keep notes about when and where you go so you will be able to disprove the accusations and support your claim. What can you do to protect your short and long term disability claim? Don’t wait to take action. There is a very small window of time for you to respond to a claim denial. Once the deadline runs out, you could lose the right to appeal your claim permanently. Talk with one of our attorneys about your disability claim. Our disability insurance law firm invites you to call us for a free consultation to discuss your denied claim. We know that insurance companies have cost in mind, not the impact that their denials can have on hardworking people and their families. We have devoted our entire careers to helping individuals who have been denied at the time the insurance benefits are needed most. Call our office for your free consultation at 877.583.2524 to learn how we can help you with your claim today. If Sedgwick Claims Management Services has denied your claim, a free consultation with our firm will help you understand what you are up against, what options you have, and help you make an informed decision going forward.
Jason Newfield is a founding partner of the disability insurance law firm Frankel & Newfield. He has spent the majority of his legal career advocating for the rights of disabled workers. He has lectured other professionals, worked on a Federal Advisory committee, and published many articles in the field of disability insurance claims and litigation.
Secrets the Disability Insurance Companies Don't Want You to Know!