Opinion ID: 2821415
Heading Depth: 3
Heading Rank: 4

Heading: Shaw’s Denial of LTD Benefits

Text: On August 18, 2010, Sedgwick sent a letter to Shaw informing him that he did not qualify for LTD benefits based on a review of Dr. Reincke’s and Dr. Payne’s medical documentation. Shaw was told that “[c]linical information does not document a severity of your condition(s) that supports your inability to perform any occupation.” (Id. at 267.) Sedgwick No. 14-2224 Shaw v. AT&T Umbrella Plan Page 7 found that although Shaw’s condition “may warrant ongoing treatment, the information reviewed does not provide clinical evidence of total disability from August 8, 2010.” (Id.) Sedgwick concluded that Shaw’s doctors’ notes did “not provide specific objective physical examination findings to indicate functional impairment.” (Id.) Specifically, Sedgwick found “no specific measurements of range of motion,” “no new neurological testing and motor strength testing,” or “recent imaging studies or any other type of studies or findings to indicate functional impair[ment] from [his] sedentary job duties or any other type of job duties.” (Id.) Sedgwick informed Shaw that the job specialist identified three alternative occupations that he was qualified to perform based on his training, education, and experience. The denial letter from Sedgwick included an outline of the appeals procedure. The letter stated that Shaw or his provider had to submit “[a] clear outline of your level of functionality” and “[f]indings from physical examinations.” (Id. at 272.)