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Sedgwick Cms / Vpa Ltd / Ltdh Benefitsbreach of contract/ fiduciary duties

I began a workers compensation leave 7/18/08 to have a number of orthopedic procedures that would allow me to regain the use of my mobile parts injured over the years as I also have a number of multiple chronic illnesses, the 2 issues clashed. Sedgwick CMS approved my first 2 years of LTD benefits, although not paying money as my workers comp ttd benefits exceeded the ltd, I remained eligible. As the workers comp injuries and my personal illnesses clashed I went into delayed recovery. In June 22/10 I was informed they would be beginning their review for ltd under the social security guidelines that would begin 1/18/11 if approved. I had actually physically worsened in 10/10. I discovered my examiner had never requested records needed for the review to continue my benefits LTD/LTDH and they would rush it. I offered to help, alll they really requested was ortho, not my personal medical records with multiple diagnosis' covered under social security with the ortho injuries included. The local government I work for CEO's high risk management section oversees the 3rd party administrator and got extremely inappropriate with me today when she said the IME's decision was not favorable and asked about my medical treatment for one of my medical conditions while demeaning another, but they would send me to an orth IME regardless that I saw the workers comp AME yesterday. My doctors give 51% current TTD to ortho and 49% current TTD to my personal medical they are treating the 2 as if they are in 2 diffferent bodies. Without th egregious distress their refusal to request current medical records and take the report of their IME whose physical exam of me consisted of poking me in numerous pressure points on my body and talked about having an illness not in my diagnosis and questioning my knowledge of what my doctor reports I have. I am not a doctor. I have multiple issues and am being treated like a bothersome autopsied "red-tape traumatized" by a maze of loopholes used to destroy our health instead of enhance it to return to a meaningful, honored career.

Responses

  • Ma
    MAUIJAMES Aug 06, 2012

    Regarding Sedwick Vpa Calabasas Cal. I have had mental illness for some time. I can not keep a job. Sedgwick is the short term DI company who has helped for 7 months. Now they are tightening the screws and stressing me out. Even though the approx 100 pages including there own IME report supports my illness, they continue to suspend my claim, and say there are waiting on further records. I have seen 6 psycologist/psyciatrists all with the same and consistant information. Funny thing, you pay into a policy for years, and when it your time in need, they give you a hard time. I want to make a complaint the the disabilty board. Do you know how this works?

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