Denied STD work claim
Location: NM
I have been going through a lot of added stress this year and decided to start seeing a therapist through Spring Health. They specifically contract with my employer to provide some free therapy sessions. The therapist I am seeing is im the same state, and recommended I take leave for mental health reasons. I was going to take a leave of approximately 5 weeks, but after added stress when filling out the paperwork, my therapist filled out the paperwork for the full 60 days allowed by my employer without higher evaluation... or so I thought.
It turns out this therapist, that is working for a company contracted by my employer, is only a social worker and can only qualify me for 30 days, and to qualify for 60 days I have to see a PMHNP, MD, D.O., or licensed psychiatrist. OR the paperwork from my therapist need to be co-signed by one of said qualifies professionals. They gave me an additional week to get this done.
I scheduled and met with a PMHNP who agreed to sign off, but had to donher own evaluation. She did so. I submitted the paperwork to the claims provider and they reach out and say the claim is missing the office visit notes with objective information to support the extension. I explain I was told all I needed was a sign of from a PMHNP and if the PMHNP had submitted the initial paperwork, it would have just been approved with no issues for the full 60 days, but they continued to stated I needed to provide office visit notes.
It takes me a few days but I get the visit notes and provide them, and I get a call this morning that the extension is denied because the notes lack objective evidence to support it. Again, it's not really an extension. A PMHNP from Spring Health agreed with the assessment of a social worker from Spring Health that I not return to work before 60 days.
They have sent me an appeals form, and want new medical information, but i feel like they are giving me the run around and at this point they have me retroactively denied for STD which will more than likely result in me losing my job, and I can't help but feel all of this is on purpose. I don't know if I should call Sedgwick , the claims company, to talk to someone else or even a supervisor, if I should just talk to my therapists and do the appeals form, or just talk to an attorney now.
Many of my colleagues, including supervisors, have spoken openly about the benefits and how they have taken mental health leaves in the past, but they made it sound pretty pain free. This has been a miserable experience and kind of defeating the entire purpose. Thanks in advance!
Tldr: feels like I'm getting yanked around on a mental health leave, and I cant help but feel targeted because of my tenture and pay in position. I don't know if I should try to keep going through the process or just consult an attorney now. TIA
Posted Sep 1, 2026, 4:44 PM UTC