Q: After denial, Sedgwick isn’t responding to written reqs for Copies of Claim Files OR the STD Policy, what can I do?
Fortune 100 employer, ERISA policy. Sent written requests to Sedgwick 3x, 1st was 11/22. Will not return my calls. Employer states Sedgwick provides copy of policy/Summary Plan. Sedgwick advised STD policy exhausted from previous unrelated LOA; apply for LTD via Lincoln. Without policy & files, unclear if/how to appeal. 1) Can Employer provide copy of Policy? 2) Any law pertaining to response time from administrator/Sedgwick?
A: Under ERISA, the plan administrator (usually your employer) is required to provide plan documents to you within 30 days of your request. With both your employer and the insurance company refusing to provide you anything, you may need to get an attorney involved. Feel free to contact my office and we'll talk to you for free. We handle short-term and long-term disability cases across the country and we recently helped someone with a very similar issue where the insurance company refused to provide a copy of the insurance policy. Hope this helps!
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