Appealing a Denial of Disability Benefits from Sedgwick

If your employer offers disability insurance as a part of your benefits package, obtaining the coverage may give you protection in case you suffer a disabling illness or injury. Disability insurance replaces a percentage of your regular income while you are unable to work after you have completed an elimination period. In some cases, a claim for disability benefits can be denied by the insurance company or the claims adjuster. If your claim is denied, you have the right to appeal. The experienced lawyers at Osterhout Berger Daley are proud to help people with their appeals.

Background on Sedgwick

Headquartered in Memphis, Tennessee, Sedgwick Claims Management Services Inc. was founded in 1969. The company has more than 14,000 employees. While Sedgwick is not an insurance company, it does offer a variety of different types of insurance claims administration, including workers compensation and disability.

Sedgwick works on behalf of employers that provide private insurance to their employees and even insurance companies that don’t have a large claims department. These companies and insurance companies hire Sedgwick for their claims management service, which gives them the ability to approve or deny short and long-term disability claims in the interests of their clients. While they claim that “taking care of people is at the heart of what [they] do”, there have been plenty of cases where they have worked against what was best for the people.

Understanding how Sedgwick manages disability claims

Most companies offer both short-term and long-term disability insurance. Short-term disability pays benefits for a limited duration according to the terms of your policy. Generally, a short-term disability policy will have a duration that is set in months. Some workers also opt to purchase long-term disability coverage. With this option, your long-term benefits may begin soon after your short-term disability benefits end so that you can go for less time without pay. The duration of your long-term policy will depend on the provisions of your policy but may last for multiple years.

With either plan, a disability claim has to be filed and approved in order to start receiving benefits. If your company offers disability insurance through an insurance company, the insurance company typically handles the claims. However, if your company offers private insurance and has hired Sedgwick for their claims management services, the disability claims will have to go through Sedgwick.

How do I file a short or long-term disability claim to Sedgwick?

To file a short or long-term disability claim with Sedgwick, you’ll first need to submit a request for disability. You can do this by calling your company’s Sedgewick representative. Your company’s representative will then send you a packet of forms that will need to be filled out as soon as possible. You’ll need to provide your personal information, your medical provider’s information, and an estimate of the time you’ll be away from work. Once you’ve sent the paperwork back to Sedgwick, you – and the company you work for – will be notified as to whether your disability claim was approved or denied.

What you need to know about Sedgwick’s claims process

According to Sedgwick, they serve 21,000 clients in multiple countries. While they do offer multiple services, their claims management service is the service with which they started their business. Presumably, they handle thousands of claims at any given time and have had to streamline their claims process. This can lead to things falling through the cracks, which can cause delays and, inevitably, wrongful denials.

What do I do if Sedgwick delays my claim?

If you find yourself in a situation where your disability claim has been denied, the first thing you should do is check on the status of the claim. If you can’t get any answers from Sedgwick, the next step is to contact a disability lawyer. A lawyer that is experienced in disability law can help you get to the bottom of what’s delaying your claim quickly so that you don’t have to wait any longer to receive your benefits.

What do I do if Sedgwick denies my claim?

Once again, the best thing to do if your disability claim is denied by Sedgwick is to contact a disability lawyer. The first step your disability lawyer will do is file an appeal to overturn the denial. You may be able to file an appeal yourself, but it’s beneficial to have someone on your side with experience in these cases.

Appealing a denial from Sedgwick

Sedgwick notifies claimants of denials by sending them notices in the mail. If you receive a denial letter, you should read it carefully. It will tell you why Sedgwick decided to deny your claim and explain how you can appeal the decision. There will be a listed deadline for filing your appeal, and it’s important that you follow it. If you miss the deadline, you will be barred from trying to seek your benefits again later. Ask Sedgwick to give you a copy of your claim file because it will have everything that the company gathered when it was investigating your claim.

When you come in for your initial appointment with the experienced disability team at Osterhout Berger Daley, your attorney will want to review your file and notice. He or she will then advise you on what you should do next. It is important that you do what your attorney suggests because he or she will make recommendations that may help you to win your appeal. You should continue keeping all of your doctor appointments, and your attorney may also want you to undergo additional tests and exams. Your lawyer may also want you to request statements from your former employer and your doctor about the functional limitations your condition causes for you. By continuing with your treatment and submitting to additional tests, you will be building a record that supports your claim. If your appeals within the company are ultimately denied, you will only be able to use the information that has been added to your record. It makes sense to add as much positive evidence for your case so that you may prevail.

Throughout your claim and appeal process, always remain honest about your symptoms and how they affect you. Don’t try to exaggerate your symptoms. Instead of helping your claim or appeal, being dishonest about the severity of your symptoms may instead make it much more difficult for you to win. Insurance investigators are trained to look for signs of malingering, and if they believe that you are malingering, it will be used as evidence against you. To learn more about the claim and appeal process, contact the knowledgeable disability lawyers at Osterhout Berger Daley today.