Sedgwick Disability Claims

Posted on September 9, 2019 by cjblog

If you have a private disability insurance policy or receive benefits through your employer, you may be used to dealing directly with the insurance company. But Sedgwick Claims Management Services is a third-party claims administrator. That means that while they do not actually pay out benefits, other companies will use them to review, approve, or deny disability insurance claims. And many Sedgwick disability claims are denied.

Sedgwick Manages Both Short and Long-Term Insurance Claims

Disability insurance pays a portion of your regular income while you are unable to work. Short-term disability insurance typically provides benefits for a period of months before long-term disability benefits begin. Long-term disability benefits can last for years, in some cases, until retirement. The duration of your benefits will depend on the provisions laid out in your policy.

How Do Sedgwick Disability Claims Work?

If you file a disability claim with Sedgwick, be ready to supply medical records, reports from your physician(s) and other health care professionals, diagnostic test results, and information about the way your disability prevents you from working.

Read the claim form carefully when you prepare your claim. If you are missing information or have data that is incorrect, Sedgwick may deny your claim or reject it and return it to you.

When Sedgwick receives your claim, they will review it for completeness and accuracy. They will have members of their in-house team of doctors, nurses, and other medical professionals review your claim before ruling on it. But their claims process doesn't end there.

Sedgwick is proud of its ability to process claims quickly and efficiently. This may mean they train their claims examiners to find ways to keep insurance payouts low. Even if your claim is approved, Sedgwick may check in with you or your health care providers periodically looking for a reason to terminate your benefits.

What If Your Claim Is Denied?

If your claim is denied by Sedgwick, you will receive a letter stating the reason for the denial and how to file an appeal. Pay close attention to deadlines. Missing a deadline is one of the reasons Sedgwick may deny your appeal.

Despite Sedgwick’s claims of “compassion and respect” for its clients, they often do deny claims unfairly. One of the ways they may do this is to find errors in their initial claims review and terminate benefits after they’ve been approved. Some of the errors, or omissions, they may cite for terminating benefits are:

  • Failing to get all the necessary medical documentation
  • Denying benefits by claiming that the condition is pre-existing
  • Ignoring the advice of a physician who performs an exam and taking the word of a doctor that makes a decision based on reviewing records alone
  • Failing to consider the weight of a Social Security determination of disability
  • Neglecting to analyze the occupational skills of the claimant
  • Asking doctors to change their opinions
  • Terminating claims even though there has been no change in your condition
  • Applying the definition of disability incorrectly

If you find these errors were made in processing your claim, contact Sedgwick as soon as possible. It's also in your best interests to speak to an experienced Ocala LTD attorney, as the appeals process is time-sensitive.

We Can Help You File an Appeal

When you file an appeal, Sedgwick will review your case to determine if it has merit. They may request that you see an independent physician or provide additional information. They may also require you to have a functional capacity examination (FCE).

Your disability lawyer may ask you to undergo additional tests as well as request reports from your physician. Be sure you continue to keep your doctor appointments and follow through with any treatment plan your doctor prescribes. It is important to demonstrate you are compliant with all possible terms of your policy.

You should also be completely honest in all the information you provide in your claims packet. Don't try to exaggerate your symptoms. Claims representatives are trained to spot exaggerations, and if you are caught, it may impact your ability to apply for benefits in the future.

Learn More About Sedgwick Disability Claims and Appeals Today

An experienced Ocala disability attorney can ensure that you don't make costly mistakes that could delay or hurt your claim. If you need help with the Sedgwick disability claims process, or have questions about filing an appeal, contact CJ Henry Law Firm PLLC today.

This entry was posted in Blog by cjblog.