SEDGEWICK CMS LONG TERM DISABILITY CLAIM DENIED AFTER 16YRS OF PAYMENTS MEMPHIS Tennessee

I was employed by AT&T at the point of divestiture in December of 1983. I was forced to cease my employment due to failing health in December of 1993. I was granted LTD as well as SS benefits and allowed to go on to "live" my life. The "company" name as well as the "administrators" changed many times over the years, the most recent players being AT&T and Sedgewick CMS. The checks and periodic reviews of my "case" were frequent no matter who was the administrator.

I am sure all of you who are/were AT&T employees know the drastic decrease in the coverage we are getting for medical as well as prescription coverage that took place in the past 5 years. Between my deductables and co-pays I was forced to find some part time work just to be able to get my medications and keep my doctors door open. It was very difficult to find an employer who would even consider me at less than 20hrs a week but I did.

I found a job working 16hrs a week for $8 an hour...and that is all I do. Work, pace myself,get ready for the next 4 hour shift and pay my bills..its a good life but then I really dont ask for much. In the spring of 2007 I had the misfortune of getting a new case manager with Sedgewick CMS. The previous case manager had been collecting my pay information and getting records from my doctors office.

I made so little money that I was in no danger of compromising my SS benefits. The new case manager suddenly seemed very interested in the vast amounts of money I was making and why I needed it and how often I went to the mall and if I could still drive. (There is a brand new mall in my area that has been open for 3 yrs. I have never been there nor have I been to any mall in over 5 yrs. I do most shopping on line--including groceries.)

I think you all know where I am going with this. The barrage of calls to my doctors office started. He answered their questions so many times in so many ways until they could manipulate his intention to suit their needs. Despite accurate and current medical information to support my continuing disability Sedgewick was claiming they were not getting what they were requesting. (BTW--they keep a documented log of every call to them, from them, from you and about you. They are required to provide you with all documentation used in considering their actions against you--just be prepared for reams of paper and a good shot to the blood pressure!!)..then they started harassing my part time employer.

Even though I was sending them copies of every check stub all along they were requiring payroll documentation, copies of my resume, copies of other HR documents they had no business asking for, copies of evaluations...In mid April of 2008 Sedgewick CMS declared me healed and free of physical defect--able to earn gainful employment and even provided me with a list of all the wonderful, high paying jobs I could get in this economy! I didnt get written notification of this decision for 3 weeks after they stopped my pay.

When I questioned the case worker on how this could happen she just huffed and said that I had already made $XXX for the year and was making $26 an hour! I pointed out that her numbers were way off...that the yearly figure she was using included my disability money from AT&T and that made that figure wrong--and that I was making $8 an hour--not $26..."oh well" was the attitude and the ball was in my court. I was frantic, terrified, violated and just downright panic stricken.

I live alone. I support my entire household on just my income..pitiful as my $627 a month is from the great AT&T it is a third of my income and I was devastated. I called the union only to discover that they were mildly interested--dont represent non-dues paying members and said "good luck with that!"....I called all of the lawyers in the yellow pages and nobody was interested. They said that the litigation is so cumbersome and so tedious that it could run well into the thousands in legal fees and either way those fee's were not able to be recovered. I tried my local legal aid office seeing as how I was now at an income level well below poverty level. The response was that they do not have anyone on their staff that could deal with such an issue--oh, and BTW--"good luck with that!"

....To cut to the chase--I contacted an old friend who happens to be a semi retired lawyer...by the grace of God and the mercies of my friend and his partner they agreed to talk to me and see if there was any way to deal with this. Our consultation resulted in them agreeing to take my case pro bono but this offer was contingent on me getting a few things done before they would start. We talked about what we needed to do in order to prepare the most effective appeal and to avoid having to take it to an ERISA level.

One of the things was an "IME" (independent medical evaluation)..another weapon was a medical evaluation from every doctor who specializes in my specific areas of disability...another was to contact my local Department of Vocational Rehabilitation and see if they would do an assesment of my abilities for gainful employment. This was a daunting challenge for me. The IME can run in the range of $3500 as can the reports and paperwork that I would be asking for from each of the doctors--some of whom I had never met.

Again..by the grace of God I was able to meet all of the challenges and the results were so much better than I could ever have expected. All of the independent doctor reports were complete, accurate and left no gray area. When I had my visit with the Department of Vocational Rehabilitation I was set up with the IME (for free!!) and they also set me up to be able to do my part time job from home. The IME was very intense and very comprehensive and again--no gray area. As elated as I was to get the documentation was as sobering as it was to be in the right.

The other firms that turned me down were not kidding when they even ball park estimated what a task this would be. There were hours and hours of pouring over the paperwork that was sent when I requested my records. I had to request the specific Summary Plan Description that addressed my situation several times. Sedgewick CMS said that although it was this document that was used in their decision to deny my long term disability--that they did not have the document and that it was held in the archives of sacred documents "over" at AT&T.

Problem is that nobody there knew what I was asking for and I either got sent another 3 library boxes of "SPD'S" or the helpfully transfered me to "long term disability"...guess who?? Sedgewick CMS...It was a never ending hell of passwords, password resets, voice response units and dial tones...but finally....we submitted our appeal. My lawyers were so awesome and so honestly incensed at this ludicrous situation --but life is not fair..Sedgewick had 30 days to "reconsider" their position and they were not even obliged to send a note or make a phone call if they were going to deny the appeal..They just could because they can.

We prevailed. What can I say? I could never have prepared or presented this case without legal help and a legal letterhead and a lawyer that knew just what buttons to push...and I know that from now on Sedgewick (or whomever is the administrator for AT&T) will be on me like "white on rice"...Oddly --the reinstatement was in November 2008 (back pay to April) and I have yet to hear from Sedgewick asking for paystubs etc. I have a new caseworker..per my request...and I will not be lulled in to any conversation or false sense of security ever again. It was just a nightmare but it is possible to prevail--just dont count on any help from CWA--I was a steward and a due's paying member all my working life--I feel as victimized by them as I was by Sedgewick and AT&T. keep on writing, keep on pushing...

Grandmama
MILWAUKEE, Wisconsin
U.S.A.

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