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:
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.
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.
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:
The Sedgwick claims person assigned to your case may:
To complete these tasks, Sedgwick may work with many vendor partners, such as:
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.
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:
Sedgwick has several wholly-owned subsidiary companies, including:
Sedgwick has handled workers comp claims for employers and insurers such as:
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.
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.
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:
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.
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.
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.
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.
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.
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.
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.