FAQ Page

   
FAQ Type:  
 

 
    
1. What do I have to do during my disability?
2. How does the Short Term Disability claim process work?
3. How does Sedgwick get the physician's information for my STD claim?
4. What should I do if my doctor determines that I will not be able to return to work on the date provided on the first certification provided by the doctor's office?
5. Can Sedgwick contact my doctor to get the necessary information to process my claim?
6. How long will it take to process my extension on my Short Term Disability Claim?
7. What happens if Sedgwick cannot get information from my doctor?
8. Why didn't Sedgwick approve my claim to the date my doctor requested?
9. Why would Sedgwick need to request a copy of my medical records?
10. How do I see the status of my claim?
11. How long will it take to process my STD claim?
12. How much can I expect to receive for my Short Term Disability benefits?
13. When will I actually receive my STD payments?
14. Why could my STD payment be late?
15. Why haven't I been paid from the first date of disability?
16. When will my STD benefits end?
17. Will deductions be taken from my STD payment?
18. I'm Going From Short-Term Disability (STD) To Long-Term Disability (LTD). What Happens Now?
19. Why Do I Have To Fill Out All These Forms for my LTD claim?
20. What Kind Of Work Information Do You Need for my LTD claim and Why?
21. How Does The LTD Process Work?
22. What Are My Responsibilities During the LTD Process?
23. What Are Sedgwick's Responsibilities during the LTD process?
24. How Long Does The LTD Decision Process Take?
25. The website indicates that my claim is approved to 2014, what does that mean?


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Question : What do I have to do during my disability?
 
Answer :
You have a very important role in the STD process. To ensure you receive all of the STD benefits to which you are entitled, you must:
  • Sign and return all forms to Sedgwick as soon as possible
  • See your doctor on a regular basis and follow the treatment plan
  • Stay in touch with Sedgwick and your Supervisor; provide information as requested
  • Return to work when your disability ends
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Question : How does the Short Term Disability claim process work?
 
Answer :

You should first file your claim with Sedgwick. How Do do I file my claim?

Once you have filed your claim, Sedgwick will contact your employer and obtain the employment information (your date of hire, salary, employee status, etc.) that we'll need to begin processing your claim.

Your claim will be assigned to a Disability Representative for review. If you have a short-term disability claim, a determination resulting in an approval, denial, or request for additional information will be made within 4 business days. If your claim is approved, you will receive your payment from either Sedgwick or your employer, depending on the payment schedule your employer has established with Sedgwick. If your claim is denied, you will be notified in writing. If Sedgwick needs additional information, you will be contacted by telephone or letter (depending on the information needed.

If you have not recovered or you are not able to return to work on your scheduled return to work date, your doctor may call Sedgwick to report the extension, or you can download the Supplemental Certification Form for Extension of Disability form for your doctor to complete. If you download this form, fill out the top portion and have your physician complete the bottom section of the form, and either fax or mail to Sedgwick. Once Sedgwick has received your extension, we will review the extension and a determination resulting in an approval, denial, or request for additional information will be made within 4 business days.

If you miss a payment and your claim is subsequently approved or extended, your current Short Term Disability benefit amount will be combined with any benefits you were due from the prior period, and paid to you in your next payment. Sedgwick makes every effort to approve and pay claims in a timely manner to avoid any disruption to the claimant. However, there are times when we are unable to approve and pay a claim on the scheduled payment period as determined by your employer. This could be caused by a delay in filing the claim, receipt of medical documentation or other required information. If this should happen any amount owed will be paid on the next scheduled payment date.

If you have any questions, you can contact us at the following numbers: Sedgwick Contacts

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Question : How does Sedgwick get the physician's information for my STD claim?
 
Answer :
If you are filing a new claim and we have not received information from your physician for this claim, tell your doctor to call Sedgwick immediately. Your physician will need to supply Sedgwick with medical information regarding your disability. If your physician is unable to call, you can download the Certification Form for Initial Certification of Disability for your physician to fill out. Fill out the top portion of the form and instruct your physician to fill in the bottom portion of this form and fax it to Sedgwick as soon as possible, to complete the filing process of the medical portion of your claim.

If you have not recovered or you are not able to return to work on your scheduled return to work date, download the Supplemental Certification Form for Extension of Disability Benefits and fill out the top portion. Have your physician complete the form and either fax or mail it to Sedgwick in order to continue your disability benefit payments.

PLEASE NOTE: Filing does not guarantee you will receive benefits. You must first meet the medical criteria and provisions of your company's plan. For a copy of the plan document, please contact your benefits department.

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Question : What should I do if my doctor determines that I will not be able to return to work on the date provided on the first certification provided by the doctor's office?
 
Answer :
Please do the following if your doctor determines you are unable to return to work on the date they provided on the original certification: Ask your doctor's office if they will call Sedgwick as soon as possible, to report the new return to work date and provide verification of your diagnosis or have your doctor complete the Request for Extension of Self-Insured Disability Benefits (PDF) form. This extension form must be completed in its entirety and signed by your doctor's office and may be faxed to Sedgwick. After your doctor's office has provided Sedgwick with this information, Sedgwick will review the extension and advise you if the additional time is approved. (After Sedgwick receives the completed extension, our goal is to make a determination or request additional information within 4 business days.)

Please Note: Your doctor may be extending your disability but may not have an exact Return to Work Date available at this time. Sedgwick requires a specific date to process the extension. The doctor's office may use the date of your next appointment if they are unsure of your return to work date. If you are unable to return to work at that time, they would need to provide us with another extension. Multiple extensions can be requested. Sedgwick cannot process incomplete extensions.

To avoid a delay in payment of your benefits we suggest you request an extension as soon as you are aware one will be needed.
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Question : Can Sedgwick contact my doctor to get the necessary information to process my claim?
 
Answer :

If you are experiencing difficulty having your physician provide disability information to Sedgwick, please contact us with your physician's fax number and we can fax a form to your physician's office in an attempt to obtain the required objective medical information.

If your employer has established procedures with Sedgwick to call your physician upon initial filing, we will phone your physician for you.

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Question : How long will it take to process my extension on my Short Term Disability Claim?
 
Answer :
It is Sedgwick's goal to process an extension of a short-term disability claim within 4 business days from the time the completed extension is received. You can check the status of your existing claim by accessing the Check Claim Status page. Occasionally there is a need for additional medical records. If additional medical records are required to make a decision regarding your request for extension, your doctor's office will be contacted within 4 business days.
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Question : What happens if Sedgwick cannot get information from my doctor?
 
Answer :
If you have requested assistance in obtaining medical information from your physician, Sedgwick will assist you. However, if we are unable to obtain the necessary medical information from your physician, it is ultimately your responsibility. If Sedgwick does not receive objective medical information to support your disability, your STD claim cannot be approved.
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Question : Why didn't Sedgwick approve my claim to the date my doctor requested?
 
Answer :
Sedgwick reviews the information provided by your doctor and determines if there is medical evidence to support your inability to perform your job duties. If your doctor has indicated you will be disabled beyond normal guidelines for your condition, Sedgwick will approve your claim to a certain date, and re-review your claim when that date arrives (to see if the additional time is supported).
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Question : Why would Sedgwick need to request a copy of my medical records?
 
Answer :
If the information presented by your doctor does not completely support your disability, Sedgwick may request a copy of your medical records in an attempt to obtain objective medical information.
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Question : How do I see the status of my claim?
 
Answer :
Click here to see the status of your claim.
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Question : How long will it take to process my STD claim?
 
Answer :
It is Sedgwick's goal to process a short-term disability claim within 4 business days from the date all required information is received. You can help speed up the process by doing the following:
  • Sign and return to Sedgwick all forms as quickly as possible
  • Ensure your doctor immediately provides Sedgwick with the medical information requested
  • Stay in touch with Sedgwick throughout your disability leave

PLEASE NOTE: You can also check the status of your existing claim by accessing the Check Claim Status page.

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Question : How much can I expect to receive for my Short Term Disability benefits?
 
Answer :
The actual amount of your Short Term Disability payment is determined by several factors:
  • The percentage of replacement income your plan specifies (this may be less than 100% of your usual wages; may be based on length of service, or other requirements in the plan)
  • Income received from other sources could be deducted from your gross benefit amount
  • Your employer may have made arrangements for Sedgwick to pay your health insurance, 401K, etc. while you are disabled, (and would be deducted from your payment)
  • Taxes could be withheld if you are covered under a taxable plan.
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Question : When will I actually receive my STD payments?
 
Answer :
Sedgwick wants you to receive the STD benefits for which you may be eligible as quickly as possible. In fact, Sedgwick's goal is to process your claim within 4 business days from the time we receive all the necessary information. Sedgwick will make every effort to obtain the required objective medical information from your doctor. You can help speed up the process by doing the following:
  • Sign and return to Sedgwick all forms as quickly as possible.
  • Ensure your doctor immediately provides Sedgwick with the medical information requested
  • Stay in touch with Sedgwick throughout your disability leave.

If your claim is approved, you will receive your payment from either Sedgwick or your employer, depending on the payment schedule your employer has established with Sedgwick.
PLEASE NOTE: You can also check the status of your existing claim by accessing the Check Claim Status page.

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Question : Why could my STD payment be late?
 
Answer :
Below is a list of possible reasons your STD payment could be late.
  • Sedgwick has not yet received information supporting your disability
  • Information received by Sedgwick is incomplete and/or Sedgwick needs additional information on your claim.
  • The necessary information was received after the normal payroll cycle had run
  • A waiting period may apply to your disability

PLEASE NOTE: If you miss a payment and your STD claim is subsequently approved, your current STD benefit amount will be combined with any benefits you were due from the prior pay period and paid to you in your next payment.

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Question : Why haven't I been paid from the first date of disability?
 
Answer :
Some plans have a waiting period that must be satisfied before benefits are payable. In order to find out if your plan has a waiting period and what that waiting period consists of, please refer to your benefits booklet or summary plan description.
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Question : When will my STD benefits end?
 
Answer :
Your disability payments could end due to any of the following situations:
  • You are no longer considered disabled under the Plan
  • You have reached the maximum benefit amount or time allowed under the Plan (see your Benefits Booklet or Summary Plan Description to find out the applicable provision)
  • You return to work

PLEASE NOTE: Your actual benefit plan could contain additional reasons for your benefits to end. You should consult your Benefits Booklet or Summary Plan Description for more information.

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Question : Will deductions be taken from my STD payment?
 
Answer :
Depending on the plan under which you are covered, some of the deductions that could be taken from each of your STD payments include:
  • Taxes
  • Health Insurance
  • Other Income/Benefits
  • 401K
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Question : I'm Going From Short-Term Disability (STD) To Long-Term Disability (LTD). What Happens Now?
 
Answer :
When an STD claim appears it will exceed the maximum period allowed on a STD claim, the STD claim will be 'flagged' for review and referred to the LTD examiner. When additional information is needed in processing an LTD claim, Sedgwick will send specific forms to be completed.

If Sedgwick is not handling your STD claim, but is administering your employer's LTD plan, contact your employer for instructions on filing your LTD claim.
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Question : Why Do I Have To Fill Out All These Forms for my LTD claim?
 
Answer :
When determining if an employee is disabled, the examiner must request information related to job duties, the claimant's functional capacity and more. Some of the typical forms or requests during the LTD process are as follows:

Daily Activities Questionnaire (DAQ): This form may be sent to the claimant at various times during the LTD process. This form asks a multitude of questions regarding the claimant's daily activities. The DAQ elicits such things as the claimant's diet, daily activities, and physical demands, so we may better assess the claimant's capabilities and life style related to their disability.

Job History Questionnaire: A Job History Questionnaire may be sent at various times during the LTD process, when the examiner needs to determine if a claimant has the ability to function in another occupation.

Physical Capacity Evaluation (PCE): This is an assessment of the impact of the impairment on the claimant's physical capacity to do work related activities. It considers any related limitations from symptoms.

Mental Residual Functional Capacity Assessments (MRFCA): This form helps in assessing the impact of the claimant's mental capacity to do work. It considers any related limitations from symptoms. There are four criteria concerning the basic mental demands of an occupation: Understanding, carrying out, and remembering simple instructions, use of judgment, responding appropriately to usual work situations (co-workers, supervisors etc.), and dealing with changes in a routine work setting.

Attending Physician Statement (APS): This form is similar to the Physician Certificate (PC) that is required for STD claims. This form requests medical information necessary to review and adjudicate a claim.
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Question : What Kind Of Work Information Do You Need for my LTD claim and Why?
 
Answer :
The employer provides a statement about the claimant's occupation, and a job or position description, which contains detailed information about the employee's job. The job or position description is a critical factor in disability evaluation. The job description is used to determine the physical components of a particular job, and whether that position is sedentary, light, medium, or heavy work. The job description is significant in evaluating disability duration and severity and, in some circumstances, determining whether modified duty options should be explored (e.g., some conditions which would result in disability for an individual performing heavy work will have little or no impact on an individual performing a sedentary job).
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Question : How Does The LTD Process Work?
 
Answer :
When the first portion of the LTD application is received, a claim file must be established. In order to be eligible, your employer's LTD plan must be in effect and you must be covered under the terms of the plan on the date you became disabled.

A complete review and evaluation of all medical evidence must be done in order to make a disability determination. Disability may only be established on the basis of objective medical evidence, including clinical findings. Physicians do not determine disability. Medical sources provide evidence; the claim professional determines disability.

In order to determine whether a claimant is disabled from performing his/her occupation, the examiner must determine the functional requirements of the claimant's occupation. To make this determination, the examiner must request various employment related documents.

Each portion of the LTD application must be reviewed and missing information may be requested. Any inconsistencies, omissions, and errors must be documented and resolved before Sedgwick can approve a claim.
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Question : What Are My Responsibilities During the LTD Process?
 
Answer :
The claimant plays an important role in the LTD process. It is the responsibility of the claimant to bring to Sedgwick's attention, everything that supports their disability. They may do so by furnishing medical and other evidence that allows Sedgwick to reach a conclusion about the disability and the effects on inability to work. They should provide comprehensive information about:
  • The treating physicians,
  • The recommended treatment,
  • Their job responsibilities,
  • Their educational level and past work experience, and
  • Other sources of income applicable to the LTD plan.
Claimants further assist in the process by actively participating in the gathering of information, completing authorizations and other required forms, following the recommended treatment plan, attending all assessments, and returning to work as soon as possible.
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Question : What Are Sedgwick's Responsibilities during the LTD process?
 
Answer :
It is Sedgwick's responsibility to gather supporting information necessary for accurate case decisions, to communicate clearly with the claimant, and to provide timely assessments. It is also our responsibility to identify early intervention candidates, and to return the claimant to work whenever possible.
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Question : How Long Does The LTD Decision Process Take?
 
Answer :
This depends on several factors, including the amount of additional information Sedgwick may need to make an accurate decision. Once Sedgwick has all the information required to thoroughly assess the claim, the claim determination will be reached as timely as possible.
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Question : The website indicates that my claim is approved to 2014, what does that mean?
 
Answer :
You are approved until 2014 and will stay approved provided that you remain disabled and continue to meet your Plan's provisions.
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