Sedgwick Disability Benefit Claims: How an Attorney Can Help You Get the Benefits You Deserve

If you cannot work because of a physical or mental disability, you may be eligible for disability benefits. These benefits are designed to provide financial assistance to individuals who are unable to work due to a disability. One of the largest disability benefits administrators in the United States is Sedgwick. If you have a disability and are having trouble getting the benefits you need from Sedgwick, a disability attorney can help.

Sedgwick Disability Benefits Overview

Sedgwick is an independent company that provides disability management services to employers, insurance companies, and other organizations. They are one of the largest third-party disability administrators in the United States. If you are unable to work due to a disability, your employer may have a disability insurance policy administered by Sedgwick that can provide you with benefits.

How Sedgwick Differs from Traditional Insurance Companies

You might be wondering how dealing with a third-party claims administrator like Sedgwick is different from working directly with a traditional insurance company. The main difference lies in who actually manages your claim. While insurance companies underwrite and fund disability policies, organizations like Sedgwick handle the day-to-day claims process on behalf of your employer or insurer.

Instead of paying your benefits from its own funds, Sedgwick works as an intermediary. They review applications, collect medical records, process paperwork, and communicate decisions—but the actual benefit payments typically come from your employer’s plan or the insurance carrier funding the policy. For most applicants, the claims process and the types of information required are very similar, regardless of whether Sedgwick or an insurance company is handling the file.

However, since Sedgwick is working on behalf of another organization, communication and timelines might sometimes feel different. You may find that the procedures, forms, or points of contact differ compared to working directly with an insurer like MetLife, Prudential, or Unum. Nonetheless, the ultimate goal remains the same: to determine if you are eligible for disability benefits under the terms of your employer’s plan.

Sedgwick’s disability benefit programs include short-term disability (STD), long-term disability (LTD) and other disability-related programs.

Here’s how it usually works:

• Pre-Disability Earnings: Your benefit is typically based on your earnings before you became disabled.
• Plan Percentage: Most policies set a specific percentage, such as 60% of your pre-disability wages.
• Maximum Limits: There may be a cap on the monthly amount you can receive, even if the percentage would come out higher.

For example, if your pre-disability income was $5,000 per month and your plan pays 60%, your monthly benefit would be $3,000—unless your policy sets a lower maximum. It’s important to review your employer’s disability policy or contact Sedgwick directly to confirm exactly how your benefits are determined.

The Sedgwick Disability Benefit Claims Process

If you need to file a disability claim with Sedgwick, you will need to follow their specific claims process. This process typically involves completing a claim form and submitting medical documentation to support your claim. Sedgwick will then review your claim to determine if you are eligible for disability benefits.

There are two main ways to start your claim:

• By Phone: You can call Sedgwick directly at (800) 845-7739 to request the necessary forms be mailed to you.
• Online: Alternatively, you can initiate your disability claim through Sedgwick’s online platform.

Because Sedgwick generally manages employer-backed disability claims, you can also reach out to your employer’s human resources department for more detailed guidance and to confirm your eligibility or obtain additional instructions.

Be sure to complete all forms accurately and include thorough medical documentation, as this information is crucial for Sedgwick to evaluate your claim. Once your application is submitted, Sedgwick will review the provided information and make a determination regarding your benefits.

Unfortunately, the claims process can be complex and overwhelming. Sedgwick may deny your claim for a variety of reasons, including insufficient medical documentation or a lack of evidence that your disability prevents you from working. If your claim is denied, you may be able to appeal the decision.

How Long Do You Have to File an Appeal After a Sedgwick Disability Claim Denial?

If Sedgwick denies your disability claim, it’s important to act quickly—there are strict deadlines for filing an appeal. For most disability policies governed by ERISA (the Employee Retirement Income Security Act), you typically have 180 days from the date you receive a denial letter to submit your appeal.

If your plan is not governed by ERISA—such as certain private or individually purchased policies—the timeframe to appeal can be much shorter. Depending on the terms of your policy, you might have only 30, 60, or 90 days to file your appeal.

Missing these deadlines could jeopardize your ability to secure benefits, so be sure to check your denial letter and policy documents carefully to determine the specific timeframe that applies to your situation.

Sedgwick Federal Court Case Summaries

The court cases summarized here are intended to help you understand how federal courts decide ERISA long-term disability claims.

• Conner v. Sedgwick – Court Finds Claim Denial Was Reasonable and Supported
• Sapp v. AT&T – Court Rules That Sedgwick’s Decision Was Reasonably Supported
• Godmar v. Sedgwick – Decision to Deny Claim Was Arbitrary and Capricious
• Filthaut v. AT&T – Court Rules STD Denial Meets “Arbitrary and Capricious” Standard

How an Attorney Can Help You with Sedgwick Disability Benefits Claims

If you are having trouble getting the disability benefits you need from Sedgwick, an attorney can help. An experienced disability lawyer can help you in navigate the complex claims process and get you the benefits you deserve.

Here are some of the ways an attorney can help:

1. Evaluate Your Claim: An attorney can evaluate your claim and determine whether you have a strong case for disability benefits. They can review your medical records and other evidence to determine whether Sedgwick’s decision to deny your claim was justified.
2. Appeal a Denied Claim: If your claim has been denied, an attorney can help you appeal the decision. They can help you prepare a strong appeal that addresses why your claim was denied and provides additional evidence to support your case.
3. Communicating with Sedgwick: An attorney can communicate with Sedgwick on your behalf. They can help you understand the claims process and ensure that all necessary documentation is submitted on time. They can also help you negotiate with Sedgwick to achieve the best possible outcome for your case.
4. Represent You in Court: If necessary, an attorney can represent you in federal or state court. They can file a lawsuit if Sedgwick is unwilling to provide you with the disability benefits you deserve. An experienced attorney can help you build a strong case and fight for your rights in court.

Get Help with Your Sedgwick Disability Benefits Claim

Navigating a Sedgwick disability claim can be challenging—especially when you are already dealing with a serious medical condition. An experienced disability attorney can help you understand the process, avoid costly mistakes, and fight for the benefits you deserve.

If you are having trouble getting disability benefits from Sedgwick, it may be time to seek legal help. Disability attorneys typically work on a contingency fee basis, which means there are no upfront costs and no attorney’s fees unless benefits are recovered. This allows you to pursue your claim without adding financial strain during an already difficult time.

Choosing the right attorney matters. Look for a lawyer with experience handling disability claims, a strong track record, and a clear understanding of how companies like Sedgwick evaluate and deny claims. Nick Ortiz is a national disability attorney who has been representing long-term disability claimants since 2005.

If you are struggling to get the disability benefits you need from Sedgwick, call the Ortiz Law Firm at (888) 321-8131 to schedule a free case evaluation. With the right legal guidance, you can improve your chances of securing the benefits you need to support yourself and your family.