After many sleepless nights and 35 pounds of involuntary weight loss, our client was forced to admit his physical and mental health conditions had become unbearable. As a result, he left his job as a software programmer in Wilmington, Delaware and filed for short-term disability (STD) benefits through his group plan with JPMorgan Chase (administered by Sedgwick Claims Management Services, Inc.).
Despite his constellation of medical conditions, Sedgwick chose to deny our client’s claim with less than a half-page of halfhearted “explanation.” When our client came to Dabdoub Law Firm, it was obvious to us that Sedgwick had spent as little time as possible with our client’s claim with the goal of denying it from the onset. As such, we appealed the denial and provided the insurance company with ample evidence of our client’s disability.
H. pylori Infection, Back Pain, and Mental Health Conditions
Our client has been diagnosed with Helicobacter pylori (H pylori) infection, gastritis (stomach inflammation), dyspepsia (indigestion), radiculopathy of the lumbosacral region, thoracic back pain, post-traumatic stress disorder (PTSD), and adjustment disorder with anxiety and depressed mood. Although many people with H. pylori infection do not develop symptoms, our client suffers from severe abdominal pain, nausea and vomiting, constipation, bloating, weight loss, and chronic drowsiness.
The worse his physical symptoms get, the more our client’s mental health declines. As a software programmer, our client needs to be in top physical and mental shape at all times, especially within the toxic work environment he has experienced at JPMorgan.
While trying to manage his symptoms and work full-time, our client received his first bad performance review in 10 years with JPMorgan. This incident not only triggered our client’s mental health problems but also shows just how disabling his medical conditions are.
Sedgwick Fails to Read 4 Doctors’ Notes
To support his claim for STD benefits, our client provided 4 doctors’ notes and a letter of support from his wife. If Sedgwick had read any of these documents, it would have had no choice but to award our client STD benefits. Dabdoub Law Firm simply emphasized the facts of our client’s treatment history.
For approximately 5 years, our client sought treatment with his primary care physician (PCP), a doctor with more than 20 years of experience as a family medicine specialist. Our client’s PCP treated him from the onset of his abdominal and gastrointestinal conditions and affirmed his disability, explaining that our client’s symptoms would retrogress if he were to return to work. According to our client’s PCP, he will only be able to return to his occupation as a software programmer “after full recovery.”
Our client’s PCP also referred him to a specialist who is board-certified in internal medicine and gastroenterology and has over 20 years of experience in the field. At the request of JPMorgan/Sedgwick, this specialist completed an attending physician statement, where he indicated that our client was disabled and would be unable to work for a continuous period of time. As the gastroenterologist explained, abdominal pain and nausea make it impossible for our client to sit or stand for extended periods, and unpredictable flares of symptoms make our client’s ability to work full-time unreliable at best. The specialist also agreed with our client’s PCP that work-related stress and pressures would make our client’s conditions worse. Simply put, our client needs time to recover from H. pylori infection and get back to a healthy weight.
As if our client’s PCP and gastroenterology specialist were not enough, his chiropractor also spoke up about our client’s disability. Our client has compressed nerves and experiences radiating pain and discomfort throughout his lower back and hip, and his abdominal and gastrointestinal conditions exacerbate his back and neck pain.
All of these physical conditions make our client’s mental health conditions much worse. Our client has PTSD from unresolved childhood trauma and an adjustment disorder with anxiety and depressed mood. The work culture at JPMorgan has triggered memories of our client’s abusive father, and working under a “demeaning and demoralizing manager” and “an equally toxic team leader” have led to intrusive memories, flashbacks, upsetting dreams, dissociation, avoidance, and addictive, impulsive, and self-destructive behaviors. Our client has an extremely negative evaluation of himself and others and regularly suffers from panic and anxiety attacks, mood swings, depression, impaired attention, trouble sleeping, suicidal ideations, concentration issues, confusion, and impaired decision making.
No one has seen the way our client’s physical and mental health conditions influence one another quite like his wife. As part of his claim, our client’s wife wrote a letter of support detailing his misery. Our client and his wife have resorted to spending their life savings on his medical bills, and they can no longer enjoy the outdoor activities they used to do together due to our client’s failing help. After a year of watching her husband try to work through his disabilities, STD benefits and time to battle his medical conditions give our client’s wife hope for the future.
Our Client Needs an Honest and Fair Evaluation
Our client hopes to recover, but he cannot do so with the constant triggers of his occupation. He has STD benefits for exactly this kind of situation. Upon appeal, Dabdoub Law Firm simply reminded Sedgwick that it owed our client an honest and competent claim evaluation under the Employee Retirement Income Security Act of 1974 (ERISA).
We gave the insurance company another chance to consider the facts and abide by our client’s policy. Fortunately, Sedgwick complied.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
Our expertise in long-term disability claims means our clients have the backing of a law firm with attorneys who have:
- expertise in disability claims.
- fought all major disability insurance companies and know their tactics.
- a track record of success.
- won major disability lawsuits that improved the law for disability claimants.
- recovered millions of dollars in disability benefits.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.
Get in touch and get experienced disability lawyers on your side while you:
- Submit a disability insurance claim,
- Appeal a long-term disability denial,
- Negotiate a lump-sum settlement, or
- File a lawsuit against your disability insurance company.
Call us at (800) 969-0488 or contact us online for a free consultation with a disability attorney.