Sedgwick CMS Disability Claim Attorney
Sedgwick Claims Management Services is a third party administrator handling long term disability (LTD) claims for insurance companies and companies. They don’t sell or provide disability insurance.
They just handle claims for those companies that do provide disability insurance. So Sedgwick will be hired by a company or insurance company providing LTD insurance, and will handle claim applications, the entire claims process, and LTD appeals.
If Sedgwick is handling your claim with your own company or insurer, it is Sedgwick you will deal with. It is Sedgwick that will decide whether you receive benefits or not.
If your application for LTD benefits are denied by Sedgwick, call us immediately to schedule your denial letter review. You do not have a lot of time for an appeal, so contact us right now. We do not charge any fees unless you recover disability benefits they wrongfully denied you.
How Sedgwick denies your ERISA LTD claims
Sedgwick has more than 14,000 employees in 275 offices.
On their website they claim they provide cost effective claims management. Think about it. The insurance company has to pay them money. How is it cost effective unless Sedgwick denies more applications for LTD care then the insurer would?
That means they developed special strategies and techniques to help employers or insurance companies pay out less in long term disability benefits.
It may seem like their strategy is, deny the claim unless they have to approve it. Spend all the resources necessary, pull out every trick in the book, to try and prove you are not disabled.
Sounds far fetched? In 2010, Sedgwick purchased Factual Photo. Factual Photo was a provided nationwide investigative services for employers, insurers and claims managers. They specialized in spying on workers’ compensation, disability and other employment related claimants.
They went and bought a company whose sole purpose was to acquire video and evidence that claimants were fraudulently applying for benefits
The ERISA LTD Claims Process With Sedgwick
If your company and/or long term disability insurance company uses Sedgwick CMS as their claims administrator, Sedgwick will be responsible for reviewing, managing, and processing the claim. They will ultimately decide whether your benefits should be paid.
The process is similar to other companies. You will out a questionnaire, authorize them to get your medical records, your doctor will fill out some questionnaires. After the documentation is provided, Sedgwick will review your file.
Then they will either approve, or deny your application.
If your claim is denied, you will be allowed to appeal within a strict time period. Sedgwick handles the appeal. They will either have the file re-reviewed by a different person (maybe a physician), or they may require you undergo a medical exam or a functional capacity evaluation. The results from the exam or evaluation will carry a lot of weight in their decision.
Appealing A Denial Of Your Sedgwick LTD Denial
If your claim for benefits is denied or terminated, you must move fast. You only have a certain number of days to complete your appeal. You must first request Sedgwick’s internal “step processes” This manual prescribes how Sedgwick examiners’ must take in reviewing and deciding your claim.
Despite this manual, Sedgwick is constantly violating their own rules. These violations include:
- Failure to obtain all medical records;
- Improperly applying the pre-existing condition exclusion;
- Rejecting the opinions of treating physicians, while giving non-examining physcian opinions great weight;
- Terminating an existing claim even though there hasn’t been a change in your medical condition;
- Terminating a claim even though there was no change in your disability;
- Not adequately considering a favorable Social Security disability determination;
Free Review Of Your Sedgwick LTD Denial
You must immediately address the denial or termination of your benefit. You have a set time limit to appeal the denial. This is set by your LTD policy, but is usually 180 days from the date of denial.