Lawyer Helping Injured Employees with Sedgwick Work Accident Claims and Settlements

 

Is Sedgwick Managing Your Work Accident Claim on Behalf of Your Employer? I Can Help You Negotiate a Workers Compensation Settlement with Sedgwick.

 

If you were injured on the job, you may receive a telephone call, letter, or e-mail from a claims adjuster with Sedgwick Claims Management Services.

 

Sedgwick is not an insurance company.

 

Founded in 1969 and headquartered in Memphis, Tennessee, Sedgwick is a third party administrator (TPA) that manages workers compensation, car crash, property damage, employment, Family and Medical Leave Act (FMLA), short term disability, and long term disability insurance claims for employers and small insurance companies with no or few adjusters.

 

The purpose of this article is to explain what you can expect if your employer has retained Sedgwick to manage your workers compensation claim. And how to maximize the value of your workers comp settlement with Sedgwick. It answers:

 

• Is Sedgwick a public company?

 

• What does Sedgwick do and why do companies and insurers hire it?

 

• How many employees work for Sedgwick?

 

• What companies hire Sedgwick to manage their bodily injury and workers comp claims?

 

• Who pays Sedgwick to handle a workers comp claim?

 

• Who are Sedgwick’s competitors?

 

• What do I do if Sedgwick handles workers comp claims for my employer or its insurance company?

 

• How do I get in touch with Sedgwick after an accident?

 

• Does Sedgwick deny every workers comp claim?

 

• Will Sedgwick try to settle my claim?

 

• Should I hire a lawyer to handle my Sedgwick work accident claim?

 

If you have questions about your workers comp claim with Sedgwick, or are looking for a workers compensation lawyer recognized as one of the best in America by his peers, call me for a free consultation: (804) 251-1620 or (757) 810-5614. I can help you resolve your Sedgwick workers compensation claim.

 

Who Owns Sedgwick?

 

Sedgwick is a private company. It is not affiliated with any insurance company or insurance broker.

 

The Carlyle Group, a private equity and alternative asset management firm based in Washington D.C., is the majority owner of Sedgwick. It paid approximately $6.7 billion for its ownership stake in Sedgwick at the end of 2018.

 

What Does Sedgwick Do When Handling a Workers Comp Claim?

 

Sedgwick is hired by your employer or your employer’s workers’ comp insurance carrier. It is not a neutral third party trying to determine what is fair for you and the employer.

 

Rather, Sedgwick and its employees pride themselves on helping employers and insurance companies “experience some of the best outcomes and lowest overall claims costs.” As stated in its Response to Request for Proposal from the North Carolina Department of Public Instruction in January 2015, Sedgwick knows that its clients are “looking for even more cost savings …”

 

Lower claims costs often means less money in your pocket.

 

Sedgwick may assign a number of people to your claim:

 

• A claims associate if your claim starts as a medical only claim, which means you require medical treatment but have not yet missed time from work. On average a medical only claims associate will manage 300 to 350 cases at a time.

 

• A claims examiner if you lose time from work because of your job-related injury or occupational disease. On average a lost time claims adjuster will manage 150 cases at a time.

 

• A claims assistant that helps the associate or examiner.

 

• A claims team lead who oversees the associate, examiner, and assistant assigned to your case.

 

The Sedgwick claims person assigned to your case may:

 

• Review the information available to determine if any red flags exist that suggest workers comp fraud. Sedgwick has a special investigations unit (SIU) that looks for potential fraud. As part of its examination, Sedgwick’s SIU unit may search your social media profiles.

 

• Put together a list of doctors from which to choose your authorized treating physician. I have reviewed Sedgwick documents available online that indicate Sedgwick believes in the aggressive administration and medical management of claims. To that end, Sedgwick is careful about the doctors it puts on the panel from which you can choose. As stated in one of its proposals to a potential employer client, “When injured workers visit top-performing providers identified through our benchmarking program at the onset of their injury, clients have 40 percent shorter claim duration, 68 percent less incurred cost, 73 percent faster RTW and 46 percent lower litigation rates.” Sedgwick also looks at the recidivism rate (how often an injured employee is re-injured after treatment) and the frequency of litigation when ranking doctors.

 

• Decide whether to approve or deny authorization for doctor visits, surgeries, pain management, physical therapy, or prescription medication.

 

• Decide whether to send you wage loss payments, such as temporary total disability or temporary partial disability, when your claim is under review and the Workers Compensation Commission has not entered an Award Order.

 

• Decide whether to accept your claim as compensable or deny it.

 

• Send your file to an insurance defense attorney who will try to determine if any valid workers compensation defenses exist.

 

• Make sure your wage loss payments are mailed on time if you are under an open award for income replacement benefits.

 

• Decide whether to assign a nurse case manager who will track your medical appointments and who may try to find a way to get you back to work before you are ready through constant pressure on you and your health care providers.

 

• Decide whether to use peer review services to find a way to delay or deny medical care, which means you will need to fight the medical treatment denial.

 

• Ask you to attend an Independent Medical Examination (IME) to try to reduce your claim’s value.

 

• Audit medical bills to try to save their client money. As the injured employee, you will not be involved in this process, though it could affect your ability to get the medical care you need if your doctor refuses to treat you until he or she is paid more.

 

• Decide whether to start return to work services, such as vocational rehabilitation, to try to get you back to work and reduce the employer’s financial exposure.

 

• Decide whether to pay for a functional capacity evaluation (FCE) when you reach maximum medical improvement (MMI).

 

• Decide whether to pay for a permanent impairment rating when you reach MMI.

 

• Decide whether to agree to pay a specific amount of permanent partial disability (PPD) benefits.

 

• Identify potential subrogation rights. For example, if you suffer a whiplash injury, back injury, shoulder injury, ankle injury, post-concussion syndrome, or knee injury in a car accident while on the job, you may have both a workers comp and third-party claim under negligence and tort law. If you recover money through the third-party case, either through a personal injury settlement or jury verdict, the employer and its insurer may be entitled to repayment of their workers comp lien.

 

• Along with your employer, decide whether to make a workers compensation settlement offer. Usually settlement offers above a certain amount require Sedgwick to get approval from their client. The amount of autonomy and control the Sedgwick claims adjuster has in making decisions for your employer and insurer depends on the contractual agreement between Sedgwick and your employer or its insurance company.

 

• Help the employer comply with OSHA reporting requirements after the work accident.

 

To complete these tasks, Sedgwick may work with many vendor partners, such as:

 

• Genex for field case management, catastrophic case management, and vocational rehabilitation services.

 

• Helios for pharmacy benefits management.

 

• MedRisk for its physical medicine and rehabilitation network.

 

• One Call Care Management for diagnostic and other medical services

 

• MES Solutions, Network Medical Review, and Dane Street, for medical record reviews, peer reviews, and IMEs.

 

Because Sedgwick is hired by your employer or its insurance carrier to handle its workers compensation matters, I recommend that you hire an attorney that handles Sedgwick workers comp claims before making important decisions. Sedgwick is not paid to look out for your interests.

 

How Big is Sedgwick?

 

Sedgwick is one of the largest third party claims administrators in the United States, if not the biggest. It generates more than a billion dollars in revenue per year.

 

And it is growing. Earlier this year Sedgwick announced the purchase of York Risk Services Group, another company that provided insurance claims management and loss prevention services.

 

On its website Sedgwick reports that it:

 

• Has more than 8,000 clients

 

• More than 21,000 employees in the United States

 

• Is used by 76% of the Fortune 100

 

• Is used by 50% of the Fortune 500

 

• Has a 99% annual retention rate. In other words, employers that hire Sedgwick are happy with its services. This likely means that the employers are saving money on accident claims, which means less money to injured workers and accident victims.

 

Sedgwick has several wholly-owned subsidiary companies, including:

 

• CompManagement

 

• CompManagement Health Systems

 

• EFI Global

 

• Sedgwick Institute

 

• Vale Training

 

• WeatherNet

 

Sedgwick has handled workers comp claims for employers and insurers such as:

 

• Amazon.com

 

• American Airlines

 

• AT&T

 

• CVS

 

• Delta Airlines

 

• General Electric

 

• Greyhound

 

• Home Depot

 

• Indemnity Insurance Company of North America

 

• Kroger

 

• LabCorp

 

• New Hampshire Insurance Company

 

• Safety National Casualty Corporation

 

• Sears

 

• Target

 

• United Airlines (United Continental Holdings)

 

• United Healthcare

 

• Westrock Services Inc.

 

• Xerox

 

• Several public entities, such as public schools, cities, counties, states, university systems, and transportation divisions

 

• And many more

 

According to a proposal from a few years ago, Sedgwick handles more than 2 million claims annually and is responsible for billions of dollars in claim payments on behalf of its clients.

 

How Does Sedgwick Make Money in Workers Comp Claims Administration?

 

The employers and insurers that hire Sedgwick pay Sedgwick’s fees.

 

My understanding is that Sedgwick charges its clients (1) an annual fee, (2) administrative fees on a per case basis that vary depending on whether the claim is medical only, indemnity, recordable only, or reportable only, and (3) fees for bill review, utlization review, and other services.

 

Who are Sedgwick’s Main Competitors in the Areas of Workers Compensation and Liability Claims?

 

Sedgwick has many competitors.

 

In addition to insurance companies that hire their own insurance claims adjusters to manage accident claims, these third party claims administrators compete with Sedgwick for business:

 

• Broadspire, a Crawford Company

 

• CorVel Corp.

 

• Creative Risk Solutions

 

• ESIS, Inc.

 

• Gallagher Bassett

 

• HealthSmart Holdings

 

• Helmsman Management Services

 

• Meritain Health, An Aetna Company

 

• Next Level Administrators

 

• OneCall Care Management, Inc.

 

• PMA Companies (Part of Old Republic Insurance Group)

 

• UMR Inc.

 

Though the employer or insurance company responsible for paying your workers compensation benefits will not change, the third party claims administrator might. This happens when the employe or insurer decide to change TPAs while your claim remains open. You should not experience any interruption in benefits during this period.

 

What Do I Do if I Was Hurt on the Job and My Employer Uses Sedgwick?

You must report your work accident and all injuries you suffered in the accident to your employer as soon as possible. This is true no matter who your employer is and who manages their workers comp claims. In Virginia, you have thirty days from the date of accident to file a written accident report. Wait too long and you may have to prove the employer had actual notice of the accident to get workers compensation benefits.

 

I recommend not only telling your supervisor about the accident and injuries but also sending a written report to your supervisor and safety manager and keep a copy for yourself. If you are not sure what put in your work accident notice, you can use my sample accident report letter as a starting point.

 

When you report the accident, ask your employer for the name of the claims administrator, a claim number, and a contact phone number. Your employer should have a specific phone number for Sedgwick.

 

Once you get the contact information for Sedgwick, hire an attorney who handles Sedgwick accident claims. Do not give a recorded statement to the claims adjuster without discussing your case with a workers compensation attorney who has dealt with Sedgwick before. And do not allow nurses hired by Sedgwick to convince you to use self-care recommendations rather than seeking in-person medical attention.

 

How Do I Contact Sedgwick About My Work Accident Claim?

 

Sedgwick’s corporate headquarters is located at:

 

1100 Ridgeway Loop Road

Memphis, TN 38120

Phone: (901) 415-7400

 

Sedgwick has a claims office in Richmond, Virginia. It is located at:

 

1800 Bayberry Court, Suite 200

Henrico, VA 23226.

Phone: (800) 368-8002.

 

Sedgwick has another office listed in Henrico, with a phone number of 804-673-5900.

 

In Maryland you can contact Sedgwick at:

 

11350 McCormick Rd #800

Hunt Valley, MD

Phone: (410) 773-4200

I recommend speaking with an attorney before contacting Sedgwick on your own after a work injury or the diagnosis of an occupational illness.

 

Does Sedgwick Approve Workers Compensation Claims?

 

Because so many employers and insurers hire Sedgwick, I receive many calls and e-mails from injured employees whose claims are handled by Sedgwick.

 

Sometimes Sedgwick approves the claim with little to no complication. Other times extensive litigation, including a workers compensation hearing, is needed to get the cash and lifetime medical benefits you deserve.

 

Does Sedgwick Settle Workers Compensation Claims?

 

Yes.

 

One of its document states, “Sedgwick underscores the need to our examiners to aggressively manage the claims to effectuate settlement or closure as soon as appropriate.”

 

I recommend hiring an attorney who has settled claims with Sedgwick before to get the best outcome in your case.

 

Should I Hire a Workers Compensation Lawyer to Deal with Sedgwick?

 

In my opinion, yes.

 

Two of Sedgwick’s goals are (1) to get you back to work faster and (2) to lower their clients’ costs.

 

While these goals can be good in theory, in practice they can hurt you. Especially if Sedgwick tries to meet these goals by pressuring your doctor to release you to return to work before you are ready physically and mentally, denying valid requests for medical treatment, delaying the payment of wage loss benefits, or making a low ball settlement offer.

 

Sedgwick has the resources to fight your workers’ compensation claim. It may use nurse case managers, adjusters, contracted physicians, defense attorneys, and private investigators to try to prove that you’re not disabled. But you do not have to take on Sedgwick alone.

 

An experienced attorney can help you build your case and get everything you are owed under the Workers Compensation Act.

 

Share Your Thoughts About Sedgwick and Call Me If You Need an Attorney for a Sedgwick Workers Compensation Claim

 

I understand how stressful the days, weeks, and months following a work injury can be. And I want to help.

 

If you or a loved one is dealing with a Sedgwick after a job injury, call me for help with the workers compensation claims process: 804-251-1620 or 757-810-5614. You are not alone. I can help.

 

I also encourage you to post your thoughts or share your experience about dealing with Sedgwick on this site. Even if I do not represent you in a Sedgwick workers compensation claim, my goal is to educate claimants across the state about what they can expect when starting a Sedgwick workers compensation claim.

 

Whether you are dealing with a Sedgwick workers compensation denial, or trying to negotiate a fair settlement with the Sedgwick claims adjuster or defense counsel, I can help. I have handled numerous Sedgwick workers compensation claims and appeals throughout Virginia. Dealing with Sedgwick can be unpredictable, since they are sometimes following their client’s directions.

 

But no matter the obstacles, I am ready to help you: 804-251-1620 or 757-810-5614. Call me if you live or work n Richmond, Petersburg, Fredericksburg, Roanoke, Prince William County, Fairfax, Newport News, Hampton, Williamsburg, Norfolk, Virginia Beach, Bristol, Harrisonburg, Lynchburg, Charlottesville, or Chesapeake and have a Sedgwick workers comp claim.