Sedgwick Claims Management Services (Sedgwick CMS) is a third party administrator for the AT&T Integrated Disability Service Center (IDSC). Sedgwick CMS and its various team members administer claims for short-term disability (STD) and long-term disability (LTD) benefits under AT&T’s disability benefits plans.
Disability Benefits Determinations Duration and Amount
Your disability benefits plan is designed to provide STD benefits due to an illness or injury (if you qualify for such short-term disability benefits as defined by the STD benefits plan or program in which you participate). Your case manager considers your medical diagnoses and the duties you are able to perform to determine the length of a disability period.
The duration of your disability benefits is specifically based on the medical information your physicians and other treatment providers give to your case manager. Your case manager may try to discuss the recommended length of absence for the disability with your treatment provider.
The length of time you are eligible to receive either full- or partial-pay disability benefits under your disability benefits plan is based on your Term of Employment (formerly Net Credited Service (NCS) or Seniority) and the terms of your disability benefits plan. In general, the longer your Term of Employment, the longer you will receive full-pay benefits instead of partial-pay benefits. Be sure to review your disability benefits plan Summary Plan Description for detailed information.
Information Needed for Approval
Either you or your treatment providers will need to submit adequate medical information to support your disability benefits claim. Your treating provider might believe that an extended absence as a result of your disability is warranted. In order to support such opinion, your treatment provider must provide objective medical information to your case manager that includes, but is not limited to, the severity of your condition and functionality in order to support the diagnosis.
To facilitate the approval process of your disability benefits claim, your medical records and medical reports should include the following information in addition to the other information necessary to establish your disability claim:
- Your current symptoms;
- Other medical conditions that might affect or lengthen your recovery period;
- Existing abnormalities or deficiencies;
- Results from physical examinations;
- Observations made by your treatment provider during office visits/therapy sessions;
- Findings from a formal mental-status examination, including clinical presentation and interaction;
- Diagnostic tests and their results (for example, lab results, EMGs, CT-Scans, X-rays and MRIs);
- A treatment plan;
- Any prescribed medications and your response to those medications;
- Complications, if any;
- Level of functionality (restrictions and limitations);
- Documentation that supports the rationale that your treatment provider used when determining your level of functionality ; and
- A description of the impact that your level of functionality has on your ability to perform your job and other daily activities.
The IDSC will review this evidence and has “discretion” to determine whether you have a disability that qualifies you for benefits under your company’s disability benefits plan.
Continuation of Disability Benefits
The IDSC monitors your condition in order to verify whether you may return to work at the end of an approved period of absence. If you have not returned to work, either you or your treatment provider must provide your case manager with additional objective medical information to support your need for continued disability benefits.
The case manager will review the additional medical information provided to determine whether you qualify for an extension of disability benefits payments and will either approve or deny those extended benefits. You and your supervisor will be notified once the IDSC makes a determination of your benefits.
Denial of Disability Benefits
If your case manager exercise his or her discretion and determines that the medical information submitted by your treatment provider does not support the approval of short-term disability benefits under the terms of your plan, your disability benefits may be denied or terminated (discontinued).
Note: If you do not meet the Term of Employment specified in your plan, you may not even be eligible for short-term disability benefits. Your benefits may also be denied if you do not file your claim within 60 days of your injury or illness.
You should consider all of your options in case your request for disability benefits is not approved, which may include one or more of the following:
- Contact your supervisor to discuss your intent to return to work.
- Contact the IDSC to appeal the denial of your claim.
- If you are eligible and have time available under the Family Medical Leave Act (FMLA), discuss applying for FMLA with your supervisor to protect your time away from work.
- Contact an attorney to discuss your appeal rights.
What Happens If Your Claim Is Denied
If the IDSC determines that your medical information does not support disability benefits under the terms of your plan, your claim will be denied or terminated. You will receive a letter in the mail that outlines the reasons for the denial and should provide information about the appeal process.
Appeal of an AT&T IDSC Disability Denial Letter
If you have an individual policy or are a government employee and your long term disability claim has been denied or cut-off, you may not have to file an administrative appeal with the insurance company to enforce your rights. You should consult with an experienced disability attorney to determine your legal rights.
If you have a group plan AT&T Integrated Disability Service Center policy, your policy is likely governed by ERISA. ERISA does have strict appeal procedures and deadlines. ERISA requires an internal or administrative appeal if your benefits are terminated or denied. The time limit to file an appeal is very limited, usually only 180 days. Under some policies, you may have a second, voluntary appeal.
AT&T Integrated Disability Service Center Long Term Disability Attorney
Disability attorney Nick A. Ortiz offers the following legal services for disability claimants that have a short-term or long-term disability insurance policy issued by the AT&T Integrated Disability Service Center:
- Appeal of an ISDC denial of short-term disability or long-term disability insurance benefits;
- ERISA appeal of an AT&T Integrated Disability Service Center denial of group STD or LTD insurance benefits;
- Appeal of an IDSC wrongful termination of short-term or long-term disability insurance benefits;
- Lawsuit against AT&T IDSC after final denial of a short term disability or long term disability insurance claim;
- Lump-sum buyout or settlement of an AT&T IDSC short-term or long-term disability insurance policy.
Call AT&T IDSC disability attorney Nick A. Ortiz at 850-308-7833 for a free case evaluation.