Although the disability claims process is intended to be administered in a fair and objective way, it rarely is. This is true particularly when it comes to “national accounts” (greater than 2,000 lives) self-insuring its own STD/LTD.
These large corporations exercise far too much control over the claims process dictating medical review outcomes, contacting treating physicians for added medical review write-ups, and enforcing so-called rules that may or may not be applied to all employees. As self-insurers, they never seem to know their place as employers, but rather attempt to dictate the terms of the claim the way they want.
In some states where large HMOs are located, such as Kaiser in CA, large employers often hook themselves up with medical outcomes related to their companies. While this is an easily recognizable unfair claims practice, unfortunately larger national employers HAVE THE CLOUT to manage the claims process as they see fit. The interests of employees under the law is secondary to the conflict of interest that exists by companies who profit from their own denials.
While it is surprising to me that most employees who are dealt a stacked deck during the claims process continue to support their own employers as “caring, and sympathetic, and willing to help them,” it is not true that all employers manage claims fairly. Although I am not on the Board of any large corporations, I did sit in on many of Unum’s “National Account” meetings where employers were present. Their attitudes toward their own employees would surprise you.
Enter in: Sedgwick. I have managed claims involving Sedgwick for two decades and I can tell you the company remains as hard-necked as it ever was. Sedgwick is used as a third-party administrator by large-scale self-insured companies. It follows a strict definition of a large set of rules that administers disability claims “strictly by the book”, never allowing claimants to miss a deadline, due date, or phone calls. The company is also known for calling treating physicians, sometimes more than once a day.
The company is relentless. At times it refused to recognize legally appointed ERISA representatives, requiring a complaint to the US Department of Labor. It is no accident that “National Account” employers use Sedgwick as a third-party administrator. So much for sympathetic, caring employers.
In the end, large employers only have one primary objective and that is to replace the disabled worker with someone who can work the required number of hours and do the job tasks as they are intended to be done. That’s it. The truth is, some large employers have such a convoluted disability program that they themselves often do not understand. What is essential, though, is that employees understand their employers’ disability process so they can obtain the benefits owed to them.
A large employer in the state of Michigan sets of a 100%/50% payout of some sort of salary continuation until all of the sick time, PTO and vacation pay is redeemed. Then, they offer a RAC (rehab program) of finding an alternative job for a minimum of 9 hours, or, two years of unpaid medical sick time. If this is impossible, the employer refers the claim to Sedgwick who in their terms, “adjudicates an LTD Plan that is total disability only. Are you kidding me? What about this disability plan is actually favorable to the employee?
It’s important to realize that not all employers are there to help you. They definitely are not.
