Sedgwick

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Los Angeles and San Francisco ERISA Disability Insurance and ERISA Claim Attorneys Fight Sedgwick Claim Denials

At McKennon Law Group PC, we aggressively and competently pursue insurers who wrongfully deny your benefits claims, including through third-party administrators like Sedgwick Claims Management Services, Inc.  At McKennon Law Group we have a strong reputation for effective prosecution of policyholder claims, in part, because we have experience working for and against companies like Sedgwick.  McKennon Law Group PC’s founder, Robert J. McKennon, represented insurance companies 24 years, which is part of the reason we successfully settle insurance claims.

Sedgwick handles claims for short and long term disability and other forms of employment leave, such as sick time, vacation and state, federal and municipality leave such as Family and Medical Leave.  Unlike pure insurance companies, which often both insure and administer the claims, Sedgwick is referred to as a “third-party administrator” or a “TPA.”  Thus, insurers and employers with group benefits plans hire companies like Sedgwick to deal with the claims handling process, often self-insuring.  Sedgwick handles the entire claims process from start to finish, including initiating the claim, evaluating the claim and ultimately deciding the claim.  Sedgwick is the largest TPA in the nation, across all lines of business and Sedgwick manages a significant portion of employer benefits claims (typically governed by ERISA), including disability and absence management services.

Like most third-party administrators, Sedgwick is aware of the insurer’s financial motive to deny claims, even though Sedgwick will not be the one ultimately responsible for paying the life, long-term disability and other claim for benefits.  We see many Sedgwick administered claims at McKennon Law Group and we have had much success in pursuing benefits for Sedgwick’s wrongfully denied claims.

How does Sedgwick Deny Life and Disability Insurance Claims?

Sedgwick denies claims for a variety of reasons, including the following:

  • Sedgwick asserts that there is insufficient evidence to support the life or disability claim
  • Sedgwick asserts that the claimant did not provide adequate medical support for the life or disability claim
  • Sedgwick claims the insured did not provide documentation or proof of loss evidence in a timely manner
  • Sedgwick asserts your illness or injury that is the subject of the claim is a pre-existing condition
  • Sedgwick asserts the insurance application contained materially false information, and thus the policy can be rescinded
  • Sedgwick overreads the value of improper surveillance to suggest that the claimant is not totally disabled
  • Sedgwick finds the claimant’s policy has lapsed for failure to pay premiums
  • Sedgwick determines an exclusion in the life or disability policy precludes coverage for the claim

What Should Disability or Life Insurance Claimants Look for When Sedgwick Denies a Claim?

  • Sedgwick improperly investigating the claim
  • Sedgwick improperly obtaining opinions from unqualified persons/supposed experts you have never met in person
  • Sedgwick improperly interpreting medical records
  • Sedgwick improperly hiring third party companies to get biased “independent” medical reviewers and examiners (also known as peer reviewers)
  • Sedgwick failing to schedule or request that you attend an in-person medical examination, despite having the authority to do so
  • Sedgwick inappropriately refusing to acknowledge subjective evidence of disabling conditions such as mental disorders, autoimmune disorders, fibromyalgia, and chronic fatigue syndrome because there is no objective evidence of the condition
  • Sedgwick improperly asserting a pre-existing condition
  • Sedgwick improperly attempting to rescind the policy
  • Sedgwick unsuitably denying a claim, intending to wear the claimant down to a lower settlement
  • Sedgwick over-relying on improper surveillance evidence, through in-person surveillance or via social media such as Facebook, twitter and other such platforms, to conclude a claimant can work
  • Sedgwick improperly failing to engage in a meaningful dialogue with the claimant or former employee
  • Sedgwick ignoring findings of disability by other government agencies, such as the California Employment Development Department or the Social Security Administration

If you feel you have a wrongfully denied claim for disability, life or other insurance involving Sedgwick, the McKennon Law Group will fight hard for your benefits 

If you feel that your claim for life, long-term disability, long-term care, or other insurance benefits has been wrongfully denied, call the McKennon Law Group today.  Having an aggressive and experienced disability, health and life insurance attorney is the most crucial decision you can make for the success of your insurance claim.  If your claim for health, life, accidental death or dismemberment, short-term disability or long-term disability insurance has been wrongfully denied or suddenly terminated, fill out a free consultation form or call (949) 387-9595 to schedule a free consultation with the attorneys of the McKennon Law Group PC, several of whom previously represented insurance companies and are exceptionally experienced in handling ERISA and non-ERISA, bad faith insurance claims.   We are exceptionally experienced in handling ERISA and non-ERISA, bad faith insurance claims.