Short Term Disability nightmare.

Discussion in 'Fibromyalgia Main Forum' started by Manwithfibro, Feb 17, 2011.

  1. Manwithfibro

    Manwithfibro New Member

    Long story but I was out on STD via FMLA due to a chronic illness (Fibromyalgia). I came back 3 days a week in May 2010 and eventually 4 days a week in August. The claims administrator (Sedgwick) denied my claim beginning August 1st due to lack of medical records even though they were sent 7 times. They kept losing them on purpose. I filed appeal with comprehensive medical records and letters from my providers. In December 2010, their examiner doctor had a consult with my doctor and they approved it from August 1st thru November 15 and December 21 thru March 21st. The time in-between, I tried to go back full time but crashed hard and my health deteriorated. Anyways, the claims admin. says my STD is suspended awaiting hours clarification from my employer despite being given timecards and having my HR contact them with the hours. I am STILL in limbo and have not been paid. This is from over 6 months ago as August is 6 months ago. How can I get this claims Admin (Sedgwick) to finally pay my approved appeal? I called the other day and now they claim I am not even in their system. Another tactic of fraud by Sedgwick. They have been awful. They have lost records 7 times, called the police on me to see if I was at work (I am assuming they hired them outside their normal job) and other downright bullying. It is now late February and I haven't seen a dime. What can I do to get this paid? I am frustrated and being sick, don't have energy to constantly fight with them. Thanks
  2. rockgor

    rockgor Well-Known Member

    It's no wonder you are frustrated. I think you need some legal help. Find an atty.
    Check the yellow pages where you live. There may be various bar associations
    listed that can give you a referral. If not, call the State Bar Association.

    You can also check the net to find attorneys who deal w/ claims against

    In addition to suing for unpaid benefits, you may have a case for bad faith
    on the part of the ins. carrier. This allows for recovery of punitive damages.

    You can also file a complaint w/ the state agency that regulates insurance
    companies. This may not do any good, however. Some years ago the Los Angeles Times
    reported that in California, the State Ins. Commission had not taken any
    action against a carrier in the past ten years.

    If you are not already doing so, start keeping a file of all correspondence to and
    from the carrier plus a record of any phone calls: to whom did you speak, what
    was said, date and time. Do not exchange e mails w/ the carrier. You want a
    paper trial.

    Good luck
  3. Janalynn

    Janalynn New Member

    I swear, insurance companies do everything in their power NOT to pay.

    Wanna get somewhere? Call Good Morning America. They'll investigate your whole story - put everything right out there in the open, on National television. They're the ones that got Cigna to pay up on a bunch of claims they denied. I swore if I ever needed help, they are the ones I was going to contact.

    Are you in America? =)

    I'm very sorry you're going through this battle. It's just SO wrong. I think they really count on people not fighting, just being so tired, that they'll just give up. You can't do that. Whatever contact you have with them - make sure it's documented, times/who you spoke with etc./ keep fax confirmations, send certified, receipt requested letters etc.

    Keep us posted on your progress. Hopefully you'll get paid soon!!!