Two Plaintiffs, due to being denied long-term disability benefits sued Sedgwick Claims Management Services, Inc. (Sedgwick) in two cases in the District Courts of Pennsylvania and North Carolina. In both cases filed through the respective plaintiffs’ disability attorneys, Sedgwick is accused of wrongfully denying long-term disability (LTD) benefits, as defined under the respective Plans, to the Plaintiffs.
The Pennsylvania Case
In Roxanne L. v. The PNC Financial Services Group, Inc. (PNC) and Sedgwick Claims Management Services, Inc., the Plaintiff filed a lawsuit against PNC and Sedgwick for the denial of long-term benefits as provided by ERISA. Plaintiff was employed by PNC Bank, which contracted with Sedgwick to provide long-term disability and health benefits to its employees. Due to her employment, Plaintiff was eligible for benefits as defined by the Plan.
Plaintiff received long-term benefits from PNC and Sedgwick until Defendants issued a letter to Plaintiff on December 28, 2010 that insufficient medical information as of November 14, 2010 would prevent them from providing the Plaintiff with ongoing disability payments.
Plaintiff was notified of the right to appeal this decision, which she did, but to no avail. Plaintiff has suffered damages and has exhausted all administrative remedies, leading to this lawsuit filing.
The North Carolina Case
In Rebecca M. v. The PNC Financial Services Group, Inc., The PNC Financial Services Inc. And Affiliates Long Term Disability Plan, and Sedgwick Claims Management Services, Inc., the Plaintiff was eligible under the terms of the Plan provided by PNC and funded by Sedgwick due to the fact that the Plaintiff was employed by PNC as a Functional Training Manager III.
On or about November 3, 2003, Plaintiff became totally disabled under the terms of the Plan and continues to be totally disabled under those terms to the present time. Plaintiff filed for long-term disability benefits according to the terms of the Plan.
On or about February 23, 2004, Plan’s former claim administrator, PNC Financial Services, approved Plaintiff’s claim for long-term disability benefits beginning on January 31, 2004. Sedgwick took over as claim administrator in March 2004 and continued approving Plaintiff’s claim for long-term disability (LTD) benefits.
However, via letter dated March 11, 2008, Sedgwick ended LTD benefits for the Plaintiff beginning on October 31, 2007, claiming that the Plaintiff is not totally disabled, despite knowing that Plaintiff’s condition had not changed since the time she ended working at PNC.
Plaintiff requested an appeal review, but Sedgwick upheld its decision to terminate LTD benefit payments via letter on October 1, 2008, despite violating ERISA regulations due to the unreasonable and unfair withholding of Plaintiff’s LTD benefits. Plaintiff has exhausted all review procedure and administrative remedies, leading to the filing of this lawsuit.
Benefits Sought By The Plaintiffs
In the two cases mentioned above, the Plaintiffs seek the following relief from the Court against PNC and Sedgwick:
- A judgment that a de novo review be conducted on the records and claims files belonging to PNC and Sedgwick
- A judgment that the Plaintiffs are eligible to receive the long-term disability benefits that are due to them, along with accrued interest
- A judgment that the Plaintiffs receive compensation for all damages that have been incurred due to the termination of their LTD benefits
- Complete reimbursement of all attorney fees and court costs
- All other relief that the Court rules to be just and proper