Articles Posted in Sedgwick

Fibromyalgia is a very complex chronic pain disorder that affects an estimated 10 million individuals in the United States and approximately three to six percent of the world population.  For those suffering from fibromyalgia, the disease causes widespread pain and tenderness to touch and can affect the entire body.  Fibromyalgia symptoms can include stiffness, pain, fatigue, tiredness, depression/anxiety, memory, sleep issues, concentration, and headaches including at times migraines.  Fibromyalgia symptoms can be very severe and debilitating affecting a persons’ work, social and daily life.

The criteria, established by the American College of Rheumatology in 1990, contains a history of widespread pain in all four quadrants of the body for the duration of three months or more and pain in at least 11 of the 18 designated tender points when pressure is applied.  In 2000, the American College of Rheumatology ceased using the criteria of tender points and instead focused on pain being widespread and accompanied by symptoms such as sleep problems, problems with thinking and fatigue.  Unfortunately, those who suffer with fibromyalgia typically have normal results with conventional testing. A physician knowledgeable about the disease, such as a rheumatologist, is necessary to make the diagnosis in part by ruling out other causes.

The National Fibromyalgia Institute (NFI) website states that fibromyalgia is marked by profound, chronic, and widespread pain that can migrate to all parts of the body in varying intensities.  The pain can be described as stabbing, shooting, muscle aching, throbbing and twitching.  Neurologists have noted that patients with this disease can experience numbness and tingling, aggravated by stress, weather and movements.

O’Ryan Law Firm, on behalf of Plaintiff Jo Ellen W., recently filed a lawsuit against Sedgwick Claims Management Services, Inc. (“Sedgwick”). The Plaintiff was employed as a Labor and Delivery Clinical Nurse with Franciscan Alliance which made her eligible for disability benefits under the Franciscan Alliance, Inc. Short-Term and Long-Term Disability Benefit Plans (the “Plan”).

In Jo Ellen W. v .Franciscan Alliance, Inc. Short-Term and Long-Term Disability Plans and Sedgwick Claims Management Services, the Plaintiff filed a lawsuit to gain the long term disability benefits she was entitled to under the terms of the Franciscan Alliance Plan.

Facts of the Case

At the O’Ryan Law Firm, we have represented several clients who have become disabled due to the severe symptoms of Scleroderma.

According to the American College of Rheumatology:

WHAT IS SCLERODERMA?

As one of the largest employers in Indiana, Eli Lilly covers thousands of employees under their Extended Disability Plan (“Lilly EDL Plan”). The Lilly EDL Plan is self-insured, a rarity in the long term disability world. Just a few years ago, Anthem was the claims administrator for the Lilly EDL Plan but in the spring of 2012, Lilly hired Sedgwick to administer extended disability claims under the EDL Plan. Shortly after this time, our office began receiving calls from Lilly employees whose EDL benefits had been terminated or were under investigation by Sedgwick.

One of the calls we received was from the former Executive Director of Human Resources at Lilly who had worked for Lilly for over 25 years. Unfortunately, her diagnosis of Fibromyalgia worsened over the years until she was forced to leave Lilly and apply for short and long term disability benefits in December 2007. Fibromyalgia is a disease the Seventh Circuit has characterized as “common, but elusive and mysterious.” Sarchet v. Charter, 78 F.3d 305, 306 (7th Cir. 1996). In evaluating fibromyalgia in the context of a disability claim, the court in Sarchet described the disease as:

Its cause or causes are unknown, there is no cure, and, of greatest importance to disability law, its symptoms are entirely subjective. There are no laboratory tests for the presence or severity of fibromyalgia. The principal symptoms are “pain all over,” fatigue, disturbed sleep, stiffness, and–the only symptom that discriminates between it and other diseases of a rheumatic character–multiple tender spots, more precisely 18 fixed locations on the body (and the rule of thumb is that the patient must have at least 11 of them to be diagnosed as having fibromyalgia) that when pressed firmly cause the patient to flinch.

Based on the severity of her fibromyalgia condition, our client was approved for EDL benefits in May 2009 and she received those benefits for over 3½ until Sedgwick abruptly terminated those benefits.
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