Marc Whitehead & Associates law firm is dedicated to fighting claims management companies like Sedgwick CMS against wrongful denials of disability insurance claims.
Sedgwick Claims Management Services, Inc. – Sedgwick CMS – is what is known in the insurance industry as a Third Party Administrator (TPA). Sedgwick does not actually sell or provide disability insurance.
Rather, insurance companies and employers subcontract Sedgwick to handle disability claim applications and the entire claim management process, including deciding whether to award or deny benefits and handling all disability appeals.
You may work for a company who uses Sedgwick to administer short and long term disability benefits. If so, you will most likely deal with Sedgwick and not the insurance company and not your employer. Sedgwick CMS will be the “third party” who will review your claim, send you forms, correspond with you, and decide if you are disabled.
Sedgwick CMS Does Not Assume Financial Risks
If benefits are awarded, Sedgwick does not handle payment of benefits. That is left to the insurance company, or the employee benefits plan. It will be your insurance company’s or your employer’s money being paid out when a claim is approved.
If you feel your claim was wrongly denied by Sedgwick, contact our law firm to discuss your case at no charge.
Problems with Sedgwick CMS Disability Claims
Based in Memphis, Tennessee, Sedgwick is possibly the largest TPA in the US. Sedgwick CMS has offices throughout the U.S., as well as in Canada, the U.K. and Ireland. But bigger does not always mean better.
Cases of erroneous and wrongful denials of disability claims under Sedgwick’s management are common. The following are examples of the type of bad faith practices, abuse of discretion and delay and deny tactics displayed by Sedgwick:
- After the initial claim is approved, unreasonably terminating benefits at a later time
- Losing documentation; failing to send paperwork in a timely manner
- After contacting the treating doctor, failing to allow him or her reasonable time to respond before denying the claim
- Insisting the claimant return to work regardless of the disabling condition
- Failure to conduct an independent medical examination
- Misrepresenting the definition of “Disability” as it is defined in the disability policy
- Writing to the physician to request they alter their opinion
- Failing to properly communicate with claimants, ignoring calls and emails, and otherwise delaying the claims process
- Refusing to acknowledge the insured’s actual job duties and transferable skills
- Failing to perform a full and fair review of a claim – for instance, Sedgwick may rely on third party vendors to perform paper-only reviews of a claimant’s medical evidence (with no examination in person)
- Ignoring medical records and rejecting the opinions of treating doctors
- Alleging documentation “does not substantiate” the severity of a disabled party’s impairment
If you have experienced similar problems with your disability claim under Sedgwick’s management, contact us.
Is Your Sedgwick CMS Disability Claim Governed by ERISA Law or State Insurance Laws?
When Sedgwick denies your rightful benefits, it is imperative that you speak to an experienced disability lawyer that works explicitly with all aspects of disability insurance law. Here’s why:
Sedgwick CMS manages
- short and long term employee disability benefit plans through an insurance provider
- short and long term self-funded group disability plans
- individual disability insurance claims
Employee disability benefit plans are governed by the complicated Federal employee benefits law known as ERISA. You need to appeal such denials immediately, in accordance with the internal appeal process as set forth in your policy. The time frame to appeal is usually only 180 days.
Sedgwick is also often the administrator and decision-maker for self-funded group disability plans. This type of benefit plan is generally paid by the employer. In most cases, ERISA still applies because it pre-empts the state law for self-insured plans.
Sedgwick also manages individual disability insurance policies. Claim disputes of this nature are governed by State law. This involves contract, tort and consumer protection laws – a much different scenario than an ERISA-based claim.
Contact Our Sedgwick Disability Claim Attorneys Now
We can assist with every stage of the disability claim process. If you are dealing with a disability claim denial managed by Sedgwick CMS, we can help you develop a well-prepared and effective disability appeal, or pursue your claim in litigation.
If you are filing an initial claim and must deal with Sedgwick, find out how we can help you submit a rock-solid initial disability application.