Sedgwick paid her one month’s salary, but not before Courtney did a lot of methodical groundwork. “In my case it wasn’t worth hiring an insurance attorney because I was only asking for one month’s pay,” she says, “but I would have definitely hired a denied disability attorney if I was looking at more compensation. There wasn’t that much at stake.”Fortunately, Courtney has an analytical mind and thinks logically; she works as a business analyst. Even though she read on the LawyersandSettlements website and other sites online that most appeals are not in your favor, she was pro-active, fought back and appealed her case.
“I understood that if you are denied once, chances are slim that the insurance company’s decision will be overturned,” Courtney says. “But six weeks after I sent my appeal, I got a voice mail message from my case manager at Sedgwick and she said that my denial had been overturned - woohoo!”
Last May 2012, Courtney was hospitalized with severe asthma and during that time she was diagnosed with congestive heart failure. Her doctor told her to take a month off work, so Courtney applied for short-term disability. She points out that heart issues were not mentioned in the medical report…
“A nurse at Sedgwick (I found on the LawyersandSettlements website that they are the second-worst insurer for bad faith and wrongly denied claims) provided me with two main reasons for denial,” Courtney explains. “First, I was living with asthma and working (they didn’t technically say pre-existing) and second was about my blood oxygen saturation, which is how they test people who have breathing conditions. Mine registered 91 at the last appointment. She said that is normal for me because I am obese and have COPD. But in my appeal, I provided the insurer with earlier doctor’s records that showed a normal saturation level for me was 94, so they couldn’t say that 91 was my baseline.
“And I don’t have COPD. It wasn’t in my records so they couldn’t use that reason for denial - I have no idea where they even got that information. Incidentally, they considered the congestive heart failure a non-issue.
“After they denied me, I got all my medical records from my doctor - Sedgwick had copies of all the records. It took me a few days to get everything together before I filed an appeal and then I waited for their decision. Apparently there was supposed to be a peer-to-peer review (their independent medical examiner was supposed to talk with my doctor) but I don’t know if that ever happened. I do know that my denial was based on their assumptions.
READ MORE DENIED DISABILITY INSURANCE LEGAL NEWS
“The most important point I want to make is this: If you have been denied short- or long-term disability benefits, you should appeal and not be afraid, and if you aren’t an analyst like me, get an attorney.”
READER COMMENTS
ivannna santino
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Donette Boggess
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George Hovey
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cacentra freeman
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anonymous
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My treatment was so bad my foot bone rotted &
died and I developed CRPS an unfathomable constant burning, progressive autoimmune disease nicknamed the "suicide disease".
I am battling for treatment and required medications to stay alive. I live in intractable pain and have lost my career & 9 years of college . I am treated as a criminal, cannot get approvals and am being disrespected as if I am a crazy person.
I was a "high pot" & as an excellent mamange with my employeer before the fall and broken foot accident.
The battle continues and these Sedgwick GREEDY thieves will NEVER take my dignity. The do NOT tell the truth. The mail personal things to me using someone elses address , they have sent some woman's social security number to me with HER denial for treatment . I suppose she got my letter?
The have sent my IMEs with pages missing. They have hired unethical so called physicians only to make things up in their fake IME reports. This just goes on and on.
If you are a great person with a huge work ethic and have been treated like me, please know you are not alone. Stay strong .
Vogger
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They were sued by state of California for denying claims
My brother had a heart problem at his work at ( grocery store) he fainted fell down and was taken to hospital by ambulance where he had surgery. Upon recovery from surgery they got him up at hospital to walk.... Discovered his foot was broken and had become infected near bone ! He was in hospital over a month and Sedgwick refused to allow him to fill out LNI paperwork stating it was all pre existing . Hello he passed out at work on the clock on the job! According to Washington state law its on the job! However two months have gone by and the BS continues leaving him with no money to buy his Medication or pay his house payment not even food ! What's wrong with these people? State of wasington should be issuing a fine or penalty for non compliance
Randy Romero
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Mary Christine Muhlfeld
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Kristi Mabin
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Cassie Smith
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If therapist requests additional treatment you get transfered to a nurse case mgr who reviews everything with a medical director . Who first says ok to more physical therapy then 2 or less days rescinds treatment. For second opinion if you aren't in major city, they send you to a one time referral with someone who is only in area once a month.. love answering message. Will get back to you at my earliest convenience. Like the other person says they aren't trained. Think the nurse & med. Director are idiots graduated at the bottom of their class. Think it a way to stop from paying. A girl at work cut her leg doesn't know how. And no issues. But heaven forbid a real injury like soft tissue or worse they treat you like crap.
Heaven help them if they get hurt and have to deal with people that work for the company. The only heaviest thing they lift is their asses off their chair. When they go home. The doctors or pa's they use may have that degree but are just as stupid.
Melissa Szudy
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Kristal Singletary
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Christine
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Do I have to hurt myself and then that would be the ticket to getting this approved? I am really thinking I will need to get an attorney involved :( All I want to do is get better!!
no name
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Conni Douglas
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Private employee
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This company Sedgwick should be reevaluated by these Fortune 500 and 100 companies that they provide third party services to and really be strict on their ethics because Sedgwick is so greedy and cold hearted it's just not fair
Daphne Thomas
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James Wilson
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pattie h
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Because I was so confused, frightened, and unable to manage my daily affairs, I was never quite sure what was really happening. I could no longer be certain if it was me who failed to communicate, or complete and return their 'forms that were critical to their decision'. But it seemed to me like they kept making me do the same things over and over! I remember stressing the importance of details they would leave out or ignore the first time they rejected me, it was again left out when I was rejected the 2nd time.
Then, as someone else mentioned, it was suddenly about a "pre-existing condition" exclusion to deny me.
I finally reached out to the state Ombudsman for assistance and was eventually approved back my original application date, BUT I NEED TO SAY THAT THEIR RUNAROUND, DOUBLE-TALKING PROCEDURES ONLY ADDED INSULT TO INJURY!! I always felt like I was at their mercy to decide what was real, and what wasnt, and it was excruciating going through the same forms and detailed explanations again and again. I began to fear the mailbox.
But, on the positive side, once approved, and acknowledging my demands for another representative ( said the first guy reminded me of the movie "American Psycho" where the meticulously groomed wall street pencil pusher was a methodical serial killer with no remorse for the victims he coldly tortured and mutilated. Lol!
But it took a long time not to fear their calls, correspondence. I had been trained to expect failure and confusion from them.
I no longer experience the torture, and I'm treated with respect and humanity.
Susan Camden
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Elle
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Laurie J Briggs
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I have bronchotracheamalacia (an extremely rare disorder where your bronchial and trachea collapse). In 2008 stents were placed to hold my airways open. I had infections become more frequent and severe leading to other surgeries, fibromyalgia, common variable immunodifficiency. I resigned in 2011 to live with my sister as my health was failing and I thought it would be better to live closer to family. Because the complexity of my health and the rare disorder, few doctors knew how to treat it. Had I known in 2011 I should have filed for long term disability then, I would have. I took years later and other doctors, and now I have a slew of them besides the federal govt who say I am disabled. Help!