Do you need a Sedgwick disability denial attorney? Marc Whitehead & Associates law firm is dedicated to fighting claims management companies like Sedgwick CMS against wrongful denials of disability insurance claims.
If you work for a Fortune 500 company or another larger business, your long-term disability claim may have been handled by a third-party administrator (TPA) like Sedgwick Claims Management Services. Sedgwick is one of the largest of such administrators in the country. It works for large and small insurance companies, as well as for self-insured businesses; it does not work for employees like you.
It is the insurance company that has a contractual responsibility to fulfill valid long-term disability claims. However, when Sedgwick is the administrator, it – and not the insurance company – will make decisions about your claim and internal appeals. Even though Sedgwick is a TPA, you have the right to appeal its disability denial. A Sedgwick disability claim attorney at Marc Whitehead & Associates can help. Call us today so we can review your denial and evaluate your options.
What Is a Third-Party Administrator?
It is not uncommon for individuals to feel like they are being stonewalled by a gatekeeper when dealing with a TPA. As an employee and an insurance policyholder, your contractual relationships are with your employer and the insurance company that is obligated to honor your claims. However, most dealing with claims may go through an administrator like Sedgwick.
Your employer may have chosen a TPA for the cost savings and efficiency that can come with outsourcing claims processing. The TPA often brings expertise that the company lacks internally. Working with the TPA can feel impersonal and dissatisfying. However, the administrator must still follow the laws that apply to the employer and the insurance policies they administer. That means that if the TPA denies your disability claim, you have the same right to appeal as if the insurance company itself had made the decision.
Why Does Sedgwick Deny Long-Term Disability Claims?
When Sedgwick is acting on behalf of an insurance company, it can deny a disability claim for any reason that the insurance company itself could give. Some of the common allegations that have formed the basis of Sedgwick disability claims denials include:
- Incomplete documentation of the medical condition
- Claimed disability is caused by a pre-existing condition
- Possible qualification for other disability benefits
- Conflicting medical opinions by doctors hired by Sedgwick
If Sedgwick justified denying your claim with these or any other reasons, it is important to address the denial as quickly as possible. This may seem like a daunting task when you have mounting medical bills and cannot continue working, but there is help available. Speak with a Sedgwick disability claim lawyer to protect your right to appeal.
How Can a Sedgwick Disability Denial Attorney Help?
You have the right to pursue your own appeal but if you do not follow proper procedures, you could forfeit your rights. You also risk omitting important information, which could lead to a second denial or a smaller award than you are entitled to. Whether or not you retain a Sedgwick disability denial attorney, consider speaking with one as soon as possible.
Once you file an appeal, Sedgwick will take another look at your case. It may ask for additional information, which could include a visit to an independent doctor (who actually works for Sedgwick) and/or submitting to a functional capacity evaluation. You may be required to comply with these requests but it helps to have an advocate scrutinizing the process to ensure your rights are protected.
You need to submit all evidence as a part of the appeal process; you could be barred from presenting additional documentation later. Therefore, your attorney may ask you to cooperate with additional tests or obtain other documentation to support your claim. Your lawyer will also make sure you meet the necessary deadlines so that you don’t forfeit the right to pursue your claim.
Speak with Disability Denial Attorney To Get Your Benefits
Fighting a Sedgwick disability claim denial may seem like an uphill battle but it is one you do not need to tackle alone. The long term disability attorneys at Marc Whitehead & Associates are committed to helping people fight wrongful denials by claims management administrators like Sedgwick. If your disability claim has been denied, call our firm to discuss your case with an attorney.
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