Articles Posted in Virginia Disability Lawsuit

United Health Group employee suffering with Fibromyalgia is denied short term disability benefits and loses her battle with Sedgwick Claims in a Virginia court.

In the case of Day v. United Health Group, Inc. Short Term Disability Plan, the plaintiff sought disability benefits against the defendant, a self-funded plan that was administered by Sedgwick, due to complaints of abdominal pain and body pain resulting from fibromyalgia. This case is a prime example of why it is imperative to ensure that a claimant’s medical records provide actual “objective” medical evidence of their inability to perform the material and substantial duties of their occupation. It may seem logical that the opinion of one’s treating physician should take precedent over a third party reviewer hired by Sedgwick.

However, according to many disability policies, it is not sufficient for a claimant’s physician to conclude that they are unable to perform the material and substantial duties of his or her occupation, or even document symptompatolgy that explains such an inability. Without “objective” medical evidence of such a condition, some courts are concluding that the denial of benefits based on the lack of such evidence is reasonable.
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The main objective of having disability insurance is to act as a bulwark for unforeseen circumstances. However, even the best of intentions can be foiled when the disability insurance companies that you have a contract with doesn’t play fair, as can be seen by the magnitude of lawsuits filed against them. For example, the CIGNA Group Insurance (CIGNA) was recently sued by several disgruntled Employee Benefits Plans’ participants for violations of the Employee Retirement Income Security Act (ERISA) in several states across the country due to the way CIGNA handled their claims for disability benefits. Let us take a closer look at the lawsuits that was filed at the courts.
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