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My husband was diagnosed with epilepsy 2 years ago. He recently began having seizures through the medication so his doctor suggested going on short term disability to undergo testing to get to the root of the problem. STD began July 5, 2016. The doctor ordered a lot of testing and ultimately referred us to an epilepsy lab in Houston, TX (4 hours from home). He was admitted inpatient from 9/6/16-9/9/16. The adjuster told me yesterday that if they did not have the full records from the inpatient stay by close of business, 9/13/16, they would further deny the claim and close the case. How am I supposed to get hundreds of pages of medical records that fast? We signed a medical authorization but was told that only allows them to speak to the doctors, not obtain records. We left Friday at noon from Houston and they are demanding the records by the following Tuesday! 2 BUSINESS DAYS! The customer service rep yelled at me that I should travel the 4 hours and go pick them up or the claim will be closed by the end of the day. THIS HAS TO BE ILLEGAL! I spoke to the hospital and received an email advising that it takes up to 15 days to fill the request. I sent that to the adjuster and I promise I will appeal even if I have to hire a lawyer to do so. This is ridiculous.
I completely undesrtand what you are going through. I was in car accident injured my left shoulder, neck, and lower back and sedgwick denied my claim because they didnt undertsand why I could not work oh dont mention constant migraines from car accident... my doctor instructed me to stay off from work for a month due to therapy, testing etc.. I guess sedgwick is more medically trained than my doctor. I wish I could join in a class action suit because its horrible how they treat people that are dealing with unexpected life situations. when you pay for a benefit you should be able to use it. fyi the whole state of ca sued sedgwick for denying claims that had medical reason.
That does not make sense since the poster stated the short term disability began July 5th. I took that to mean his symptoms/flareup began that day, which would give 60 days for the paperwork to be gathered and submitted. I have used Segwick, and they are very prompt as long as you get your paperwork in to them. They will also give you an extension if you need it. If the initial complaint began September 6, then the poster would have had 15 business days (not weekends) to get their paperwork submitted. That is why I am inclined to believe, by the poster's statement of July 5th, that Segwick closed the case after the July date's paperwork was not complete. Which would cause the poster to be required to start over, which restarts the clock on STD, which most policies require one to be out of commission for 15 days straight for the financial benefit to kick in. Like I said, I have already done this.
If you go back and read he wasn't admitted until September 6th and released on September 9th yet they wanted records by COB September 13th.
Sedgwick is a joke!
You have had until July 5th. This is September.