Sedgwick CMS
Commits Fraud Against Employees

I was on medical leave starting 1-24-11. Christina M. Was the case worker on the claim & denied paying benefits for the last 2 weeks I was off of work due to "not being medically necessary". I filed an appeal with Sedgwick, & Stephanie Fontanez was the appeals officer. She denied my claim using information that didn't even pertain to me. When I call this to her attention, she wrote a "corrected" letter.

I have made several requests for the medical records with the information they used to deny the 1st appeal & the "corrected" letter, which also contains medical errors. I filed another appeal, and found out that Christina M. Is the Appeals officer for the 2nd level appeal. She denied the 1st claim so I know I'm not going to get a fair review for my appeal. Denying a claim based on false information is illegal in all 50 states, and refusing to send the medical records as requested, which is also indicated in their letter that they would send upon request. The request has been made twice with no response. Companies should not be able to get away with treating people like dirt just because they can, and then being allowed to lie about the medical information so they can deny a claim. I want my money that is owed to me interest at 10% per diam, along with the medical records they used to deny the ciaim, esp. The ones for the dr visit on 2-26-11.

Company: Sedgwick CMS
Country: USA

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