Sedgwick, as one of the leading global providers of technology-enabled risk, benefits, and integrated business solutions. Sedgwick plays an instrumental role in the realm of disability claims management for disability claims. Our aim in this guide is to furnish you with critical information and insights into Sedgwick disability claims, including the application process, common pitfalls to avoid, and effective strategies to maximize your chances of a successful claim.
Understanding Sedgwick Disability Claims
Sedgwick manages thousands of disability claims every year, acting as a third-party administrator on behalf of employers and insurance companies. Companies task Sedgwick with evaluating your disability claim and determining whether you’re eligible to receive benefits. Understanding the ins and outs of this process is paramount to secure the disability benefits you’re entitled to.
Types of Disability Claims
Sedgwick handles both short-term and long-term disability claims. Short-term claims are typically for periods of incapacity of less than 6 months, whereas long-term claims cover longer periods, often to age 65 and sometimes for life.
Filing a Sedgwick Disability Claim: The Steps
Claim submission might seem daunting, but following a clear process will make it less intimidating.
- Notifying Your Employer
The initial step in filing a disability claim is notifying your employer about your condition. Ensure all documentation is submitted within stipulated deadlines to avoid claim denial.
- Completing the Sedgwick Claims Kit
After notifying your employer, you will receive a Sedgwick Claims Kit. This contains essential documents and forms to be completed and returned promptly.
- Providing Medical Documentation
Support your claim with comprehensive medical documentation. This evidence plays a crucial role in Sedgwick’s decision-making process, making it indispensable for a successful claim. Your medical evidence needs to explain why your symptoms prevent you from working. Remember, diagnosis of a particular illness does not necessarily mean disability.
There are no conditions that automatically qualify you for disability benefits. The Social Security system is different and has a “Blue Book” list of conditions it will consider for review for people applying for disability benefits. Among them are:
- Musculoskeletal disorders (e.g., bone, joint injuries, skeletal spine injuries)
- Special senses and speech (e.g., visual disorders, blindness)
- Respiratory disorders (e.g., chronic bronchitis, emphysema, asthma)
- Cardiovascular system disorders (e.g., chronic heart failure)
- Digestive system disorders (e.g., inflammatory bowel disease, liver dysfunction)
- Genitourinary disorders (illnesses involving the urinary and genital organs)
- Hematological disorders (illnesses of the blood, blood-forming organs)
- Skin disorders (e.g., dermatitis, burns, chronic skin infections)
- Endocrine disorders (e.g., pituitary gland disorders, thyroid gland disorders)
- Congenital disorders that affect multiple body systems
- Neurological disorders (e.g., epilepsy, benign brain tumors)
- Mental disorders (e.g., bipolar disorder, anxiety, depression)
- Cancer (malignant neoplastic diseases)
- Immune system disorders (e.g., HIV infection, lupus, inflammatory arthritis)
- Regular Follow-up
Stay proactive throughout the process. Regularly follow up with Sedgwick about your claim’s status, ensuring you are always informed.
How to Strengthen Your Sedgwick Disability Claim
Understanding how to bolster your claim can bolster your chances of success.
Consistent and Comprehensive Medical Records: Ensure your medical records are consistent and comprehensive. This means every medical visit, treatment plan, and test result should be documented and included in your claim.
Detailed Physician Statements: Detailed physician statements highlighting how your disability impacts your ability to work are paramount. The more detailed the report, the better Sedgwick can understand your condition.
Understand the Plan’s Definition of Disability: Disability definitions are often similar, but not always. . Understanding your specific plan’s definition will help tailor your claim more effectively.
Common Pitfalls in Sedgwick Disability Claims
Awareness of common pitfalls can help prevent a claim denial.
Lack of Medical Evidence: Sedgwick requires extensive medical evidence to approve a disability claim. Insufficient medical documentation is a leading cause for claim denial.
Missing Deadlines: Timely submission of all required documentation is critical. Late submission can result in claim denial.
Failing to Appeal a Denied Claim: A denied claim can often be overturned on appeal. It’s essential not to lose hope and appeal with additional evidence if your initial claim gets denied.
Appealing a Denied Sedgwick Disability Claim
If your claim is denied, an appeal can be made within 180 days. In this stage, it’s beneficial to have an experienced disability attorney on your side to increase the odds of success.
Navigating through Sedgwick disability claims can be complex, but with an in-depth understanding of the process and potential pitfalls, you can successfully manage your claim. Remember, consistency, detailed medical evidence, and promptness are your best allies in this journey. Call Jonathan Feigenbaum today for more information and to see how he can help you fight to get what you deserve.