Rude and Incompetent
This has got to be one of the worst insurance companies I've ever dealt with. I deliver heavy cases and I have repetitive motions that take place while working, so I have been injured a few times. Each time dealing with this company has been a horrific experience. I had surgery and these people act like I got hurt on purpose to make the chump change they send me when ever they feel like sending it. Sometimes you may not get a check for 3 weeks. I am use to getting paid every week. I get paid to do my job, how in world does the lady who cuts my checks get paid for not doing her job. How does she even still have a job. I would rather be back to work working with a bad knee, than to keep dealing with these people. I've talked to this lady's boss and he said he wanted me to call this woman every Wednesday to remind her to send out my check. Why do I have to remind someone to do their job, I just don't get it. This woman calls my PT center while I'm there on a Monday, I get a letter authorizing work conditioning, still no check for over a week now. I literally hate dealing with these people. My nurse case manager is the brightest point, now she is on top of her game.
Posted on 10/26/2012
I amongst numerous injured worker's comp stemming from multiple of companies have found our MEDICAL CLAIMS/CLAIMS denied.
My attorney, Michael Ainbinder chimes that Kroger is PROTECTED by their "UNION" status, PARDON ME - WORKER'S COMP IS DEDUCTED FROM EVERY AMERICAN'S PAYCHECK.
AT&T offers disability coverage for their employees administered by Sedgwick CMS. Their plan exploits many loopholes in the Federal Law regulating these plans. They will and have terminated benifits for reasons not related at all to the recipients disability or ability to be gainfully employed....
Sedgwick CMS is a third party administrator of Disability Claims for many large and small organizations across the country. They are liars and cheats! They will deny claims for virtually any reason, true or not. Their compensation schedules are such that the more claims they deny the more money they make.
They will harass you, lie to you, change their requirements, and do everything possible to deny a claim regardless of if it is a legitimate claim or not.
They will deny you rights provide you in State Laws and in case law in Federal Courts and say these 'rights' are 'not authorized under the plan'. Ratna Bagwe and Rick Hernandez in their Chicago office are among the best of their liars.
Did you know that Sedgwick CMS uses local police agencies to intimidate claimants by filing false police reports and "crank calls" to law enforcement agencies and EMS Services. The two stories below reveal the terror and humiliation of ATT Employees at the hands of Sedgwick CMS.
Sedgwick has been fined BILLIONS OF DOLLARS, but it's interesting that NO ONE HOLDS THEM ACCOUNTABLE TO PAY ONE PENNY. You can find RICCO throughout the internet against Sedgwick.
Synopsis of my Experience:
Date: November 26, 2008
Location: Ralph's in Laguna Hills
My first letter from them - my claim was denied, because Sedgwick/Ralph's/Kroger stated that I fabricated the incident.
To counter Sedgwick/Kroger, are the following:
(1) Police report;
(2) Police investigating the incident using the car plates that I had jotted down (Jacob Chakroun) refused to give me his information. Officer obtained Jacob Chakroun's information.
(3) Video footage, to which the officer investigating the incident watched the footage.
(4) I had disclosed to Robert Gonzales that I was just hit - he called me a liar. Despite his remark, I left to have myself check out at the local hospital emergency room.
(5) Operations Manager kept two feeds of the footage.
April 12, 2010 Sedgwick states they accept my claim (let's pretend we accept the claim), because I was NOT GIVEN ACCESS TO ANY DOCTOR. Yes, nice that they gave my a RX card for medication, but without authorization to see a doctor, it's good as a DENIED CLAIM. MORE IMPORTANTLY, I called Andrew Gemmer on January 26, 2011 asking where my reimbursements were for both mileage and out of pocket expenses. Andrew Gemmer matter of factly stated that my CLAM HAD BEEN DENIED FROM THE BEGINNING AND REMAINS DENIED.
My doctors had attempted to get authorization for two total knee replacements, as Jacob Chakroun macerated both my knees.
This past summer of 2010, Sedgwick/Kroger demanded that I see their doctor, to which he had confirmed my two knees needed total replacement. In addition, he stated that I had sustained a T1/T2 Spinal Injury, to which lists me as a PARAPLEGIC.
My attorney states my CLAIM HAS NOT BEEN DENIED, but I have no authorization for any of my surgeries, and I also believe that I have sustained internal injuries.
I need a chair lift and a electric wheel chair - DENIED.
We have an registered nurse who was injured while attending to a patient - her medical claim was denied.
We have a quadraplegic who was injured with a HOT WIRE and falling.
The list is endless, and if WORKER'S COMP IS NOT GOING TO PAY OUT, then GIVE US EVERY PENNY WE PUT INTO THIS FREAKING SCAM.
Posted on 4/20/2011