There was a much-anticipated shift from Logistics Health Incorporated (LHI) to Managed-Care Associates (MCA) – a division of Sedgwick – which is a company recognized for processing workers’ compensation claims. Unfortunately, according to watchdog 9/11 Health Watch, MCA-Sedgwick is failing 9/11 victims. Some qualifying individuals who receive medical monitoring or treatment through the World Trade Center Health Program (WTCHP) must work with a third-party administrator to process claims, locate participating providers, and ensure they are receiving the care they are entitled to under federal law.
A Shaky Start for MCA-Sedgwick Following LHI Replacement
Thousands of 9/11 responders and survivors rely on MCA-Sedgwick to receive medical treatment for serious 9/11-related conditions, many of which are various types of cancer. These individuals were excited for the switch from LHI to MCA-Sedgwick, as reports uncovered evidence that LHI had failed to meet the needs of 9/11 victims for many years.
Unfortunately, MCA-Sedgwick has not received a positive review from 9/11 Health Watch, an independent watchdog that has received documentation of more than 100 complaints which relate to the same issues as experienced by responders who dealt with LHI. The watchdog has since expressed these concerns in a letter to MCA-Sedgwick. Additionally, the Centers for Disease Control and Prevention (CDC) was aware of similar reports in the fall of 2022 of how MCA-Sedgwick was failing to help those who are in desperate need of medical treatment.
The CDC decided to keep the contract with MCA-Sedgwick, and it is unclear if anything has improved since 9/11 Health Watch sent the letter to the third-party administrator earlier this year. Whether or not the CDC will maintain the contract going forward will undoubtedly depend on whether MCA-Sedgwick can cure the deficiencies in its handling of 9/11 WTCHP claims.
What Role Does MCA-Sedgwick Play?
MCA-Sedgwick is a nationwide provider network (NPN), that has been tasked with locating participating healthcare providers for WTCHP members throughout the country. While the CDC indicates that most members will not need to change doctors, some have had to switch, which has led to delays and gaps in treatment. For WTCHP members who live in the New York metropolitan area, or who can travel to New York for medical treatment to participating providers, the involvement of MCA-Sedgwick may not be an issue.
And what of the WTCHP members who either do not live in the New York metropolitan area or who cannot travel here for treatment? They must rely on MCA-Sedgwick to find doctors for them, facilitate scheduling, and handle the prompt processing of claims to ensure there are no wrongful denials of claims submitted by medical providers. Far too many WTCHP members have experienced problems for years that they thought would disappear upon the takeover from LHI in regard to very important resources which they rely upon.
Contact Pitta & Baione LLP For Your Free Consultation
At Pitta & Baione LLP, our 9/11 benefits lawyers are well aware of the shortcomings associated with MCA-Sedgwick’s takeover of LHI. Many of our clients have experienced significant hardship because of unprocessed claims, failure to locate a qualifying provider, and billing issues, among a host of other problems. Our team, which includes a former employee of one of the largest WTCHP clinics, will do whatever is needed to help our clients get through the red tape and fight to obtain their rights associated with the WTCHP.
If you have a health-related issue due to exposure to toxins at Ground Zero, our team of 9/11 lawyers can help you navigate the WTCHP claims process as well as assist in pursuing potential compensation through the Victim Compensation Fund (VCF). Schedule your free consultation today by calling (844) 982-2667 or by contacting us through our website.
