Complaint Review: Sedgwick CMS - Memphis Tennessee

It appears that the DoL is actively checking into Sedgwick, at least to as it pertains to AT&T. If you would like info on how/who to contact, join us on the Yahoo Group Classactionsedgwick.

I wanted to add that the "appeal specialist" at Sedgwick was Pam Nourvle and the manager that responded to the Texas Board of Insurance was Pam HagEstad who claims that Sedgwick didn't act arbitrarily or capriciously, although they have no evidence in my file that my condition improved.

I received a copy of the plan text for AT&T's disability program. They state that they delegate all authority to a third party to administrate the plan (Sedgwick CMS in this case). Sedgwick is left to interpret the plan however they want, etc. Sedgwick says that their decisions are final. However, ERISA does consider AT&T the plan administrator. Also, Sedgwick claims to not be the fiduciary, so how can they make the final decision if they are not the fiduciary? According to ERISA, the persons who OPERATE the plan are the fiduciary. It seems to me that neither party wants to take the blame for decisions that are made in regard to the plan. It also states that the only way a decision can be overturned is if it was made arbitrarily or capriciously, which I think in my case it was. Sedgwick CMS, of course, denies this. I have started a discussion group on Yahoo Groups if anyone wants to join.

If AT&T continues to allow Sedgwick to run roughshod over legitimate claimants and ignore and abuse ERISA and other regulations, it is only a matter of time before AT&T will find themselves accountable in both civil litigation and regulatory scrutiny and penalties. AT&T simply does not have 'plausible deniability', I have heard too many stories of them being informed of Sedgwick's abuses. They have significant responsibility for Sedgwick's behavior and WILL be held accountable! Illegitimi non carborundum!!!!! 3Neurons

I am a little confused as why you are required to work with an injury just because the Workman's Comp hasn't been approved. Does that prevent you from using Short-term disability? I'm really not familiar how Workmen's Comp works. Sedgwick's response to the Texas State Board of Insurance was mostly an "in your face" "AT&T is self-insured and Sedgwick is a third party administrator" Since the long term disability is covered under ERISA they don't have to go by any rules. I did find out, though, that Sedgwick is not the plan fiduciary...so, I suppose that AT&T is the fiduciary. They claim to have reviewed my complete file, however, ignoring what my real disability is. True, they had three doctors to review the file, but none of them are experts in the area of my disability. Two of them even indicated that there was a lot of objective documentation of my disability, but really their hands were tied because they could only say if I was disabled from the stand point of their expertise. I worked in Ft Worth 10 years with SBC/the new AT&T. Hang in there, because in the end, you will win and they will have to back off.

Sedgwick CMS' only intent is to serve the master. Sedgwick will send you back to work even against your MD's Advice on limited duty. They will claim that they have developed a return to work program that will allow you to return to full time work gradually, with no real medical review. After you return to work and are unable to perform the Essential Functions of your position, you can then be terminated by your employer and lose all benefits. Fortunately many employers are not slime bags and do care about their employees, but many don't. Sedgwick CMS is spreading like a cancer throughout state and local governments as well. Here in California Sedgwick CMS administers the benefits for the University of California system, and as told to me by UC employees, wields significant power. For example if you go to a UC Hospital and Sedgwick CMS is administering your claim, the UC Hospital can be subject to undue pressure as Sedgwick is their benefits provider as well. In my case after spinal surgery that prevented me from permanent paralysis my surgeons nurse continually told me that Sedgwick CMS was pressuring her and that they administered the benefits of thousands of people in the UC System. I was also told that my employer had 50K employees in the UC Health plan and that the UC System had a vested interest in cooperating with Sedgwick CMS. I finally had to leave the UC Health system as my surgeons nurse called me four months after my surgery and said that I wasn't working hard enough to get better and that she had reported to Sedgwick CMS that I could work four hours a day. At that time I was still taking pain medicine, couldn't get out of bed or go to the bathroom without assistance or walk any distance without assistance. It might also be noted that my first MD in the UC Health system quit being my MD because he claimed that Sedgwick CMS had tried to coerce an alternate diagnosis from him and he suggested that I call an attorney and get a new doctor. Not only is it terrible that sick people have to be tortured by these thugs, it is incomprehensible that in the case of the State of California, the tax payers are footing the bill.

I too work for ATT and am now in the middle of Sedgwicks hands. Previously they did great just a few months ago with a workers compensation claim where I had strained a muscle on the job. I was on light duty for three weeks, but they weren't required to pay for any missed work. Now I'm back in their system because I was recently injured again, only this time it's going to be more serious and intensive to insure it doesn't lead to permanent damage. I have "hyperelastic" tissues through out my body. Many have seen the guys who can pull their faces six inches from their head, but mine is much more mild. Well because of this I have a bad tendency of slipping joints. This has caused shifted ribs and neck bones due to the toolbelt I had been caring and now I suffer from nerve irritation that has a strong possibility of becoming nerve damage if it isn't addressed. Right now I'm concerned, due to the posting I just read, because I'm waiting on Sedgwick to call me back to confirm my new workers compensation claim. At the moment I have to attend work as scheduled doing more light duty, but the light duty they have me doing is a direct irritation of the already apparent damage. The longer I stay here, waiting on Sedgwich to quit playing phone tag, the more pain I'm in and the more damage is done. I will keep updates as things move along, I don't believe I'll be able to continue coming in, and if I don't I face disciplinary action up to dismissal because it hasn't been cleared on workers compensation yet, due to the lack of communication between Sedgwick and myself. Best of luck to you, I hope things work out. More to come.