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
The Plaintiff was employed by Franciscan Alliance for over 18 years until she became disabled in 2012 due to the disabling effects of fibromyalgia, chronic neck pain, and complex partial seizure disorder.
The Plaintiff filed an application for long term disability benefits and was paid disability benefits by the Franciscan Alliance Short-Term and Long-Term Disability Plan from October 2012 to October 2014.
Sedgwick Terminates Long-Term Disability Benefits
On October 10, 2014, Sedgwick terminated the Plaintiff’s long term disability benefits claiming that although the Plaintiff could no longer do her own occupation as a nurse (a very physical job) the Plaintiff was able to do more sedentary jobs. In reaching this conclusion, Sedgwick hired record reviewing physicians to review the Plaintiff’s medical records and conclude that she was able to work. These doctors never examined or even spoke to the Plaintiff while reaching their conclusion that the Plaintiff could miraculously return to work after having been off for several years.
After Sedgwick’s termination of her disability benefits, the Plaintiff filed an appeal with Sedgwick challenging Sedgwick’s conclusion that she could now return to work. With this appeal, Plaintiff included significant medical evidence to prove her disability. Despite substantial medical support for her ongoing disability, including her doctor’s certification that she was totally disabled, Sedgwick denied Plaintiff’s appeal.
Plaintiff Seeks Substantial Relief From the Lawsuit
In order to continue to pursue the benefits claim, the O’Ryan Law Firm on behalf of the Plaintiff filed a lawsuit in the St. Joseph County Courthouse seeking reinstatement of her disability claim and payment of the back benefits owed by Franciscan Alliance. The Plaintiff alleged in the lawsuit that the Franciscan Alliance breached the long term disability plan by prematurely terminating the long term disability benefits. The Plaintiff also alleged that Sedgwick violated their fiduciary duties owed to the Plaintiff, as the claims administrator for the Franciscan Alliance disability plan, by processing the claim in a manner that led to the premature termination of the Plaintiff’s benefits.
Sedgwick’s wrongful actions have caused the Plaintiff to seek the following relief from the Court:
- A judgment that requires Sedgwick to pay all long-term disability benefits that are due, along with all accrued interest
- A judgment that the Plaintiff’s eligibility for future long-term disability payments be reinstated
- A judgment that the Plaintiff will continue to receive future long-term disability payments for as long as Plaintiff remains eligible under the terms of the Plan
- A judgment that Sedgwick will pay for all reasonable attorney fees
- A judgment that Sedgwick will pay for all associated court costs
- A judgment that Sedgwick will pay for all damages related to their breach of their fiduciary duties
If you are a former employee of Franciscan Alliance whose disability benefits have been denied or prematurely terminated by Sedgwick, please contact the O’Ryan Law Firm for a free consultation on your rights.