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Sedgwick Claims Management Services Complaints 394

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5:02 pm EDT
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Sedgwick Claims Management Services false information

I also agree that Sedgwick doesn't care about anyone but themselves. I've been dealing with them since Feb of this year and it's the same run around like everyone else has complained about. They feed you false information to cover their own butt. It takes forever to get an approval from them. I was told by an employee of their that to get workman's comp paid you have to be gone 3 days...which is a lie...you have to be gone 4 for them to pay out. So they denied my workman's comp claim and screwed me out of money I could have used while off work two weeks. They do play dumb and act like their are totally trying to help you out, but it's like a warranty from a company. The warranty protects them not the consumer. They do stab you in the back every chance they can get. And when I did get hurt on the job in Feb, she told me that I had to file a workman's comp claim with the company insurance where the incident took place. That is the biggest BS I've ever heard. You can't file a workman's comp claim with a company that you don't work for. She should have known that as an employee of Sedgwick, but yet...she's trying to place the blame on someone else and not take responsibility. So if you deal with Sedgwick in Texas and you get claim representitive by the name of Devon McLeod...DON'T trust her. False truth and lies come from her lips. I just hope these people understand on what they are doing to those in need of help. I can sleep at night...can they?

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1:01 am EDT
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Sedgwick Claims Management Services do you have to die to get you money or what?

Omg i work for United Health Care and my job title is customer service. I lost my voice and was diagnosed with laryngitis which lasted almost 2 months and during the process i had to get my tonsils taken out well they denied my claim stating that it wasn't enough medical information to cover the claim which i don't understand i talk to customers and set up deliveries for pt's now how can I do my job if i can't speak to the patient it's not like i can just go to work and file papers and the thing that hit me the most was that they approved it and denied it all in the same day smdh wth i lost my home my car and i have 4 children this company is a crock of bull and my company needs to invest into another company.

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Johnny310
US
Sep 12, 2015 10:21 am EDT
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Ive been dealing with these inhumane people for 2 years, they have stopped payment on me stating i missed a Doctors appointment when in fact i did not. I had micro lamenectomy surgery not only did it take them 8 yes 8 months to authorize phyiscal theropy but as well tried to say i did not need it. They were over ruled but by then im right back where i started with back and leg pain, Doctor says now i have nerve damage. They skipped a check on me recently 7 weeks to get it by that time im in disarray i mean im getting max 230.00 a week on perm disability which is nothing close to what i was making where i was employed for 12 years 6months into injury i get laid off i mean if i had to do all over again i would have never even said i was injured at work and took care of ut on my own. My milage check takes minimum of 8 weeks to recive after i fax in. I finally said screw it and got a lawyer. Nothing is going to give me that peace of mind these people have so rudly took from me. Worst company by far i have ever dealt with in my life. I hope the come round kicks them square in the pants.not metion to get authorization for xray or mri takes bout a month to 2 months.

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JJJJLL
San Antonio, US
Aug 13, 2013 5:40 pm EDT
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I too work for UHC and they are jacking with me... They have 40 pages of medical records just from July 20 and the medical records indicate that I was inpt for 12 days and now doing outpaitent rehab. But yet they tell me they don't have enough info to make a dec.
Give me a break, any normal everyday person, who read my records could see I couldn't go to work if I was hospitalized for 12 days.

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double distaught
US
May 31, 2013 12:25 am EDT

I also work for uhc. I have severe pain from nerve damage. I can't sit for more than 30 mins without feeling chronic pain in my back, buttock and leg. I can't stand for more than 15 mins. There is no way I can sit for 7 hours without getting up. And they do not allow you to just get up. You have to put your computer in personal just to go pee. The back and leg pain is unbearable. And sitting only puts more pressure on the nerve
I am on nerve damage pain meds. I've had tons of injections. My dr. Has sent sedgewick all the information they requested. The dr. has given me clearance to be off due to my condition. He has sent them a detailed letter on behalf of my first denial. My adjuster told me since the first claim was denied, to submit a new one and she would review it and try to get it approved while I appeal the first one. I have not heard from her. I waited for the call saying it was approved but instead. I heard nothing when I called to check. The rep said someone tried to call you to tell you it was denied. I never recieved any call, no message was left, and no missed call. I still have not recieved the letter. So now I have to appeal again. I have the letter only becaused someone from the ltd another company emailed it to me.I showed it to the dr. He was so angry. He said they are impossible to deal with. They want you to keep sending the same info over and over they ack like they don't understand even though its clear as day in writing. They want people to just give up and just go back to work. I requested a email of my denial letter from them 3days ago. I still haven't recieved it. I spoke with an attorney. She said the same thing. It's sedgewick, they are well known for dening claims. They make it a practice. She advised me to fax her both my letter and my request for them to fax her all my info the dr sent them. I have not gotten paid in two months. I am close to getting put out and loosing two cars. I can't pay my bills with no money. I pray with the attorneys help and i will get justice. They should be put out of business for treating people this way. Just heartless.I hate them and pray, I never ever have to deal with them again

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Sickandscared
Huntington, US
Apr 23, 2013 10:11 am EDT

I am sorry to hear of everyone's trouble's but have to admit I was glad to see that I am not the only one struggling with Sedgwick. They denied my Short term disability claim and I did put in for an appeal, this too was denied. They state they send the appeal to an outside (independent) physician, which is crap! Sedgwick pays these doctors to review your claim. There is no way I can work, never mind work the outrageous 70+ hours a week working for Optum Health. The stress of having severe/chronic medical conditions is overwhelming all on it's own, and then add on the stress Sedgwick is putting on me and my spouse is despicable.

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tired of Sedgewick
La Jolla, US
Dec 13, 2012 3:55 pm EST

The reps at Sedgewick dont care, are rude, insensitive, and so are some supervisors...its the most horrible company I have ever had to deal with !

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tired of Sedgewick
La Jolla, US
Dec 13, 2012 3:48 pm EST

I too work for UHC and I'm having major problems with Sedgewick. Not returning my calls, denying my claim, I have lost my apt, had to sell second car, borrowed loans on car that is paid off. They took their time with my appeal from 5 months ago it's still being investigated and the claims rep called me from his home informing me my appeal was denied

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Californa Now MN
Buena Park, US
Sep 14, 2012 5:43 am EDT

report them to the DOI (department of insurance

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FrustratedandANGERY
Beverly Hills, US
May 18, 2012 4:45 pm EDT
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I too work for the same company and have an injury that leaves me in bed and pending a possible surgery. Sedgwick has approved one claim and today i found out has denied my last claim. They are rude and insensitive telling me I should try to go back and do my job. Now I might loose my job even though I have proof of my disability. Have you obtained a Lawyer?

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6:23 am EDT
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Sedgwick Claims Management Services benefits to kill your employees with

My wife had a short-term disability with Sedgwick CMS that continues to be ongoing, to this day, despite her having returned to work weeks ago. Constantly changing stories about the status of the claim, poor communication, poor training, and an overall attitude that you are a criminal and that nothing provided is going to be sufficient for them to pay your claim. Charles Schwab and Company claims to care about their employees financial health, but don't mind if one of their employees doesn't get paid for five to six weeks because of negligence and a bottom-line is our only concern attitude. Shame on any company that uses Sedgwick CMS in any capacity, you didn't do your homework.

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2:12 am EDT
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Sedgwick Claims Management Services can't get loss time pay

This is a horrible company. I got hurt at work back in October last year and have had nothing but a horrble time with these people. Your calls always go to voice mail and then they never call you back. I was suppose to have some of my lost time pay by the 13th of april but that never happened and now i Keep calling and no one will get back to me! I cannot live off of no cash! this company should be looked into for their practices. Time to get rid of them!

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crazypamie
Hilliard, US
Aug 17, 2013 7:31 pm EDT

I have the same problem with Sedgwick doctors even trying to contact Sedgwick and the person covering my case review was on vac. So I had to go see my own doctor for treatment. But I have gotten an attorney because I had to use my vac. time so I could get a pay check while I was out of work with a back injury. This is the second time that I have filed a claim with Sedgwick and they have never paid for my lost time .I guess maybe that is why company's hire them so they won't have to pay for job injury's. I will post what the outcome of my case ends up being win or loose . My claim was filed in Georgia .

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barbaraj247
US
Jan 28, 2013 8:46 pm EST
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I totally agree with you! We are having the same problems. If we don't get results soon, I'm considering filing a Class Action Lawsuit. I anyone is interested, please email me at barbaraj247@yahoo.com and type "CAL" in the subject line.

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1:20 pm EDT
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Sedgwick Claims Management Services 23 years of lousy medical treatment

SInce the accident date of February 10, 1989 this insuarance company has given me the run around. They have sent me to sub-standard chiropractors and a neurologist who said my back pain was because I drank one (1) Smirnoff Ice Malt Liquor a night. That due to the slip and fall accident I sustained in the bottom of AT&T's parking lot, injuring my left knee, left thumb, lower back and neck and back and spinel cord is the reason I am in horrible pain. I can't walk right and am off balance and my back goes in horrible spasams. My attorney has done little or nothing. I am scheduled for a deposition over 100 miles away on Monday March 26, 2012. The pain is so bad, I walk on glass every day and I am not a diabetic. This insurance company has failed to provide proper health care according to the Florida State Statutes and stalled so that I can't go before a Judge.

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5:02 pm EST
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Sedgwick Claims Management Services law breaking heartless scammers

I've been dealing with sedgwick for approximately 2 1/2 months. They did not begin my payments within their legally allotted timeframe, and continue to "oops, we don't know what happened, so sorry, it won't happen again"; in the past couple of months... "forget" to send my checks. There was a 3 week unpaid span the 1st time, and currently i'm into the 2nd week of the same "oops" on their part. My adjuster won't return my calls, aside from the taped interview at the beginning (Well, 18 days into this, anyway) and last week after like 7 vm from me. I'll get to that. Last month, I fought until I was able to speak with the adjuster's supervisor, whom promised me it wouldn't happen again... It did, and he isn't returning my calls this time either. 2 supervisors, my adjuster, and some type of "higher" supervisor, none will respond to my voice or email.in fact, this time around with the missing checks, adjuster promised me last week that i'd have my checks sent immediately that day via fedex. Liar. It didn't happen. And still, no one will return my calls. Ah, and they calculated my payments incorrectly as well, shorted me quite a bit. I'll bet that was an accident, same as the adjuster entering fictional back to work dates that never existed which continue to stop my checks. They're crooks, I believe, because no one can be that stupid and qualify for hiring at an insurance company. Gonna start calling attorneys today. Did I mention they keep putting off paying my med bills and prescriptions? It's been coming out of my own pocket prescription wise, and stacked bills going into collection. Adjuster said there'd be a separate adjuster for the medical, which is apparently non-existent as well. This is unbelievable. And illegal... I'm going for the guts on this at this point. I've got a family to support on this 2/3rds of my income.

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SICK-AND-TIRED
Tampa, US
Apr 02, 2012 6:26 pm EDT

My husband was injured in August 2011 and he is having the same issues with him not receiving checks. When we call the adjuster he blames the error on the machine that sends out checks (OK, sure). This has been happening since August, I just sent a not so nice email to the adjuster asking him if he has to chase around his boss for his paycheck (IT THING NOT!). He had the nerve to tell my husband the last time to call him to remind him to send the check! Since when do you have to call and remind someone to do their job?! This company is ridiculous!

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elu
San Luis Obispo, US
Feb 09, 2012 10:18 pm EST

exactly what they did with me...it, s time to really get an attorney...but be aware they will became really aggresive after that, I am so sorry I was so naive at the beginning ..this is their game, playing naive...read everything you can find about workers comp and get a good lawyer...

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8:40 pm EST
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Sedgwick Claims Management Services liability

I fell in a hole in the parking lot (not lit very well considering right at doors) at Walgreens on September 02, 2011, while an employee on a smoke break was watching. That employee got a manager and they took pictures, and my info. Sedgwick contacted me later that day, all happy to help me. I have submitted all bills and called numerous times. I leave a message and write down the date and time, but no one returns my calls. It maybe only a serve ankle sprain/strain, but I was off work and lost all my holiday pay. I only ask for my medial bills, lost wages, fuel costs, and for the hole to be fixed before someone gets hurt really bad. Total came up to a little over $5, 000.00. I am now getting bills, It wasn't my fault I fell in the hole that still (to my knowledge) has not been fixed.

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Brobledo
US
Jun 29, 2016 1:59 pm EDT

Can i ask you how long did it take for this company to help you out, and Did they pay you for your loss wages, med bills and pain and suffering and can you tell me was the pay out good

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SonOfDad
Joliet, US
Sep 28, 2012 5:06 pm EDT

yes they did

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jfktheone
Utica, US
Sep 28, 2012 5:02 pm EDT

did they ever finnally reinburst you?

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2:38 am EST
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Sedgwick Claims Management Services us veteran gets screwed

Brought all new bathroom... Shower, sink, toilet, vanity, faucet, etc... At home depot... After a few weeks my contractor noticed that the faucet had a manufactures defect. Returned it to home depot along with the vanity & took pictures of the damage to my new bath room... This was aug. 2011, this is the end of nov. 2011 & i'm still dealing with sedgwick cms as a claim svc for home depot. Bunch of liars, cheats, and everything above. Their tactic is to delay, delay, delay!... I havent had a bathroom in my house since aug. 2011 & i'm a returning veteran.
Home depot takes no responsibility for their vendors. I will not shop at home depot ever again in my life, neither will my children, their children.

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kfox2011
US
Dec 28, 2012 4:26 pm EST

I'm going through the same situation right now! Some of the most unprofessional people I have EVER worked with! Every time I call the women handling my claim, she's out of the office! When I finally got a hold of her, she said she was waiting for the installation company to contact me! Its been 2 months since my claim was made!

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Oregoninjury
klamath falls, US
Mar 08, 2012 7:24 am EST
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http://sedgwickcms.blogspot.com/2009/02/sedgwick-cms-blog_06.html

Check this site out its a big log on Sedgwick

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HomeDepot_Care
Atlanta, US
Nov 22, 2011 3:56 pm EST
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Hi, my name is Sheronda and I'm with Home Depot customer care. I'd like to look into this for you. Please email me at sheronda_care@homedepot.com. Thank you!

Sheronda
Social Media
The Home Depot
Atlanta, GA 30339
sheronda_care@homedepot.com

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10:01 pm EST
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Featured review
This review was chosen algorithmically as the most valued customer feedback.

I recently had back surgery (Lumbar fusion), recovery was extremely painful and long. After my doctor provided valid info that due to the trauma I would need approx 2 more months to recover fully, as well as physical therapy, sedgewick cms denied my extention of my claim. My employer att then uses the time I was off from work to build a case for...

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10:47 pm EST
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Sedgwick Claims Management Services [censor] for brains

I had a workers comp claim with sedgwick cms. They and the company chose to play dumb and ask like the claim wasn't really happening. "they were all confused about the situtation". Go figure... That's management. Asked me to use my short term disability in the mean time. We all know what that's about... Keep the claim off workers comp. Gave me grief from the beginning. Don't have this form... Got to send that form. They seem to think everyone has an office with fax, e - mail, built in their home. Most of us just average blue collar people and want it taken care of thru a phone call. Not with this company better be signed with your blood. Keep every fax conformation and every letter in a folder. Sedgwick pays you when they feel like it or calls leaves a message but doesn't tell you what they need... Just to call them back. So calling in is hell in its self. We all know the automated game... But when they answer you have to say all the claim numbers again anyway. I found... I just yell the numbers back to them and they seem to want to get you to "the adjuster". What a real piece of work they are. They fumble thru papers on their desk... Not yours of course. They bluh... Bluh... Bluh. Pretty much about nothing and you wonder why you just called the "devil" himself. The whole sedgwick cms should be shut down but these companies like crooked insurance companies cause it doesn't fall on their books. [ not now anyway ] someday those of us that have been thru the fraud, greed, lothing, #, heartless, # they are... We will be wactching one of those news programs and say "yep they did it to me". Keep fighting and never cave to the cowards they are.

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Oregoninjury
klamath falls, US
Mar 08, 2012 6:57 am EST
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also, you can file a complaint at Oregon insurance Division
http://insurance.oregon.gov/consumer/tomake.html
If you live in Oregon, I got this from the US Senator Jeff Merkley's Office they called me back when I called the and a wonder woman and her name is: Whitney Navarro Castillo she said that our Senator is for Federal issues but, his office called me and I was very impressed and made me feel that you can go to our state and federal offices and get help. The website above is part of the State of Oregon division for us if we are having a problem with insurance companies and they investigate and can proceed with fines. My first complaint my attorney filed and they acted immediate and we won. So use your states resources, they do work. I feel for you with Sedgwick CMS, I say the CMS stands for "Complete Messed up System"! Don't let them get you because you only have 2-years after your injury, Get a attorney there is only certain limits on there fees they can collect for workmans comp. There is an excellent attorney in Portland Shullman Dubois LLC, You can appeal denials! email me at donnaleanorris@aol.com if you have questions, I have read on these laws and have a good attorney.

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Oregoninjury
klamath falls, US
Mar 04, 2012 9:57 am EST
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Betty Sears with Sedgwick is your worst nightmare, she loses your paperwork, then you check doesnt come, she did this on purpose during christmas time and I had no money to buy presents. I almost had my house forclosed because of non
ayment issues that she doesnt recieve her faxes

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elu
San Luis Obispo, US
Feb 09, 2012 10:31 pm EST

they know everything about us, they are following me after my cellphone gps, they even call home pretending to be someone else..
they are sending threataning looking people to intimidate me ...but stupid people don, t realize that this will make me fight back harder and realize they have something to loose...

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Sedgwick Claims Management Services stay away

I feel, SELF-insured says it all... Sears Holdings, AT&T, Coke, Pepsi and quite a few other large companies use Sedgwick Claims Mgmt Services. And that is exactly what they do...insure the company they work for (self-insured). They are supposed to follow state L&I laws, but with all the loopholes available to their legal team, the laws are pointless to enforce. And the saddest part of all is that these companies have loyal customers who are blind to the fraud committed by the shareholders everyday with the money spent by the consumer on their products. I will never be a consumer of any product from any company that pays Sedgwick enormous sums of money to destroy the lives of the faithful employees who keep the cash flow going. Google it...Nationwide abuse of our laws, our money, our trust.

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12:52 pm EDT

Sedgwick Claims Management Services horrifying experience

Never work for a company that is "self insured" as you will have Sedgwick to deal with if you get hurt. They will pretend to be so helpful and then will stab you in the back. They will do anything legal or not to win the case for the employer. It is just a very bad experience.

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wlblish
Phoenix, US
Dec 02, 2012 9:20 am EST

I DON'T KNOW HOW SEDGEWICK EMPLOYEES CAN SLEEP AT NIGHT KNOWING THERE DEALING WITH PEOPLES LIVES
AND WELL BEING.THIS IS SECOUND TIME DEALING WITH THEM.MY CLAIM IS IN APPEALS .THEY TOLD ME THEY DID'T GET DOCTORS NOTES IN TIME.MY DOCTORS ASSURED ME THAT THEY WOULD HAVE THEM IN ON TIME.I EVEN WENT TO DOCTOR OFFICE TWICE TO MAKE SURE IT WOULD GET DONE.COME TO FIND OUT THE GIRL THAT DOES THIS WAS ON VACATION.SO I WAS DENIED BENEFITS.I REALLY DON'T KNOW WHAT ELSE I COULD OF DONE.I'V BEEN DISABLE SINCE AUGUST NO PAY SINCE OCTOBER I'M ABOUT TO BECOME HOMELESS.THIS IS WHAT YOU GET AFTER TWENTY FIVE YEARS HARD WORK.

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elu
San Luis Obispo, US
Feb 09, 2012 10:15 pm EST

that's exactly what they do

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Sedgwick Claims Management Services disability fraud

I went on FMLA on 1-24-11 through 3-14-11. Sedgwick CMS's claims agent, Christima Muchow, denied the claim from [protected], stating it was not medically necessary for me to be off of work for knee pain caused by a blood clot. My medical doctor is the one who kept me off of work all this time, thereby making it medically necessary as he felt I should not return until 3-14-11. I filed an appeal, the appeal's officer being Stephanie Fontanez. She denied the appeal stating that on 2-26-11 I was seen by a dr for a bladder infection, not a sinus infection. That date was a SATURDAY & I've never had a bladder infection. This information was used to help with the denial. I called this to her attention & she wrote a corrected letter, this time stating that their doctors, one a gastrointerologist, the other an opthalmologist, reviewed my claim & tried to get in touch with my eye dr, who didn't respond. Yet in the corrected letter, she stated that there was nothing wrong with my eye to begin with. Then why did I have to see my eye dr every Monday until an abscess cleared up. She stated that there were not signs of reddness or tenderness. Any time an abscess is present, there is always reddness & tenderness. I appealed her denial, and received a letter from Christina Muchow stating that she had received my appeals letter. Why is she reviewing my case on the 2nd level appeal when she is the one who denied it in the 1st place? All she's going to do is let it collect dust until 7-27-11 & then write the denial letter. Furthermore, I have requested the medical records which they stated I'm entitled to but refuse to send them. Why is they can get away with this stuff? And when I complained to the Director of Insurance, they said they couldn't handle the complaint, the BBB couldn't handle the complaint & referred me back to the Director of Insurance for TN. The company sending the letters is in KY. My complaint was also sent to the Department of Labor, again they wouldn't touch it. Who is over a company that is this bad & who puts fraudulent information in their claim letters, thinking a corrected letter with more fraudulant information will fix the problem? I want to know who to turn to so I can go after them full force for stuff like this. It is legally & morally wrong.

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Injured in USA
Injured in USA
Best Place, US
Mar 10, 2022 8:41 pm EST
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One day they will be crushed! These people couldn't possibly say I have the best job in the world Mr Johnson lost both legs now him and his 5 kids and his wife lost their home. DAMN I AM A CHAMPION

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CKurt
US
Aug 05, 2016 1:11 pm EDT

I feel terrible for anybody that has to deal with this company. I've been home recovering from scoliosis surgery (one of the biggest surgeries any person could have). I have 8 broken ribs, 22 screws and rods along my spine, and these people are still asking me for more medical information. My surgeon is also going crazy with their stupidity.
Instead of helping people heal at home, they are only complicating the recovery process. I have called 4 times with the same issues, and all agents give you a different answer. One tells me I have to appeal because I ran out of time, the second one tells me not to appeal until they receive documents, the 3rd one says it's in process and I should wait to be contacted... yeah, contacted! when? Dealing with his company is worse than having a difficult delivery. I really do feel bad for anybody like me; who need time to rest and recover, and being extremely stressed with Sedgwick's foolishness.

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Amanda Hansen
US
Jul 22, 2016 6:46 pm EDT

Just so you all know, denying claims for medical/disability purposes takes more time and requires much more work than approving procedures and/or benefits. It doesn't sound like this Sedgwick administrator is at fault. It sounds like you all should be discussing your coverage and medical/disability plan with your employer. That is where the problem lies.

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sickofusrnms
Peoria, US
May 23, 2015 12:52 pm EDT
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This company is hell to deal with. Thanks to them, I became even more disabled than I was to start with thanks to them putting me through hell to prove I was disabled in spite of nearly dropping dead of a heart attack, 3 surgeries, sudden deafness and my boss filling out all the paperwork insisting I need to be on long term disability.

Meanwhile, I met a young woman at the pharmacy who also is on disability through Sedgwick CMS and she is in such good health that she travels regularly, flying everywhere, walking all over cities, dining out, going to movies. She's even posted photos of her trips on her Facebook page. I don't know how this can happen, where someone like me who is truly disabled has such a hard time getting disability I have nearly died more than once and been hospitalized numerous times while other people who are approved are traveling the world! I couldn't even ride in a cab to the airport without pain and becoming more disabled. Yet this woman is a jet-setter.

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cas229
Flagstaff, US
Nov 27, 2012 5:54 pm EST

I was online today searching for a disability attorney to represent me against Sedgwick CMS when I came across this job posting BY Sedgwck for an Appeals Specialist position with their ranks. Notice the items that are handled by this specialist - including reviewing surveillance reports on clients. This company is unethical and ruthless. All they are concerned about is their bottom line.

Appeals Specialist (Work-at-Home Option)at Sedgwick CMS in Maine
Appeals Specialist
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."

PRIMARY PURPOSE:
To facilitate the denied disability (short-term, long-term and accident) claim appeal review process by observing all aspects of the ERISA law; and to serve as the liaison between the review unit and the claims operation.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Gathers and reviews denied disability claim appeal documentation including, but not limited to, appeal request letters, medical documentation, medical consultant reviews, surveillance reports, independent medical evaluation reports and functional capacity evaluation reports.
Reviews medical documentation and provides clinical and claim expertise on appealed claims.
Prepares written response to appeal request letters within the legislative timeframes.
Prepares appropriate communication to client and claim operation summarizing the appeal review determination.
Monitors and tracks the number of appealed claims.
Provides training to the claim operation regarding the claim appeal process.
Ensures integrity of the claim appeal process and ensures compliance with ERISA legislation.
Adheres to the highest quality and ethical standards when reviewing appealed claims and making determinations.
Supports the organization's quality program(s).

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cas229
Flagstaff, US
Nov 27, 2012 5:02 pm EST

Do you have any tips on finding a good disability attorney who can fight Sedgwick? I have presented my case to half a dozen in the past week but no one has been willing to take my case! It is an obvious case of abuse of the system that they denied continued benefits, misconstruing information and even lying in the denial letter. I live in Arizona and so far finding an attorney is very very difficult. ANY IDEAS or EXPERIENCE YOU CAN SHARE IS MOST APPRECIATED!

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do unto others as you want done to you
Chesterfield, US
May 31, 2012 3:31 am EDT

what you have to remember is that one day when her knee hurts 10 times worse than yours, trust me...she will remember the saying "what goes around comes around"

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funny how that works
US
Sep 20, 2011 3:39 am EDT
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Is there any Lawyers that can help an injured employee in Texas that is not afraid of Sedgwick CMS?

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in california
Boulder Creek, US
Jun 29, 2011 9:23 pm EDT
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I have dealt with sedgwick cms for seven years. They are by far the most unethical and dishonest company i have ever had to have known. My advise is 1) when you see there doctors, record the converstion and bring a witness. Do not expect these Doctors to have any ethics what so ever.
2) try to find the best lawyer you can.(they are hard to find) At least they cannot contact you directly anymore
3) they will lie and try to intimidate, film you, and try to discredit your integrity. Do not take it personal and keep going. Always take them to court.They are counting on you to give up. They will spend one third of the profits on itimidation.
I find comfort in the thought that there is awarm spot down below for my insurance adjuster and Sedgwickg cms Doctors

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beentheredunthat
Laie, US
May 17, 2011 4:51 am EDT

Don't even get me started on this company. They are one of the dirtiest. More ppl should speak up.

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11:58 pm EDT
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Sedgwick Claims Management Services rude and unprofessional

Sedgewick is the worst company to have to deal with. I have been attempting to apply for short term disability and have been turned down both on the initial application and the appeal, even though my physician has informed them that in my current condition I can not return to work. No one at Sedgewick bothered to inform me that they did not receive what they consider adequate information from my physician even though they themselves informed me that they spoke directly with him. Now since they have denied my appeal they tell me there is nothing more I can do and I am out of luck. Well I will continue to fight this until I can fight no longer. Sedgwick is wrong !

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Sedgwick Claims Management Services breach of contract/ fiduciary duties

I began a workers compensation leave 7/18/08 to have a number of orthopedic procedures that would allow me to regain the use of my mobile parts injured over the years as I also have a number of multiple chronic illnesses, the 2 issues clashed. Sedgwick CMS approved my first 2 years of LTD benefits, although not paying money as my workers comp ttd benefits exceeded the ltd, I remained eligible. As the workers comp injuries and my personal illnesses clashed I went into delayed recovery. In June 22/10 I was informed they would be beginning their review for ltd under the social security guidelines that would begin 1/18/11 if approved. I had actually physically worsened in 10/10. I discovered my examiner had never requested records needed for the review to continue my benefits LTD/LTDH and they would rush it. I offered to help, alll they really requested was ortho, not my personal medical records with multiple diagnosis' covered under social security with the ortho injuries included. The local government I work for CEO's high risk management section oversees the 3rd party administrator and got extremely inappropriate with me today when she said the IME's decision was not favorable and asked about my medical treatment for one of my medical conditions while demeaning another, but they would send me to an orth IME regardless that I saw the workers comp AME yesterday. My doctors give 51% current TTD to ortho and 49% current TTD to my personal medical they are treating the 2 as if they are in 2 diffferent bodies. Without th egregious distress their refusal to request current medical records and take the report of their IME whose physical exam of me consisted of poking me in numerous pressure points on my body and talked about having an illness not in my diagnosis and questioning my knowledge of what my doctor reports I have. I am not a doctor. I have multiple issues and am being treated like a bothersome autopsied "red-tape traumatized" by a maze of loopholes used to destroy our health instead of enhance it to return to a meaningful, honored career.

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MAUIJAMES
US
Aug 06, 2012 9:32 am EDT

Regarding Sedwick Vpa Calabasas Cal. I have had mental illness for some time. I can not keep a job. Sedgwick is the short term DI company who has helped for 7 months. Now they are tightening the screws and stressing me out. Even though the approx 100 pages including there own IME report supports my illness, they continue to suspend my claim, and say there are waiting on further records. I have seen 6 psycologist/psyciatrists all with the same and consistant information. Funny thing, you pay into a policy for years, and when it your time in need, they give you a hard time. I want to make a complaint the the disabilty board. Do you know how this works?

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Sedgwick Claims Management Services benefits

They play games, lie, and the benefits are sporatic. They don't take care of business in a professional manner, takes a llooonnngggg time for them to approve mri's, therapy, doctor appts., etc... They just don't care about anyone, but themselves. They suck and are the ins. company out there!

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Chanon
Jackson, US
Aug 01, 2013 9:58 am EDT

Sedgwick is nothing but a joke. They lie and tell you anything not to approve your claim. I had surgery on July 1st, this happens to be the same day sedgwick took over our claims, and i didnt return to work until July 23rd. I went for a follow up to my doctor on JUly 16th.So sedgwick only approved my claim up to the 16th .. my case worker, Peggy Reiter, states i have no medical paper work to back up the 17th-22nd but I have a dr excuse that clearly states he is not releasing me until July 22nd. So when i told her that she then states she got word that i went back before the 22nd . HA what a joke why would i be asking for compensation for 6 days if i went back to work.. they are a waste of any companies money and when I was under LIberty mutual i never never had this many issues .. I never had to resend the same information so many times. and i never spoke with so many rude people. not to mention i am changing my benefits at work no std or ltd for me i refuse to pay for because i refuse to every deal with them again !

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sahshah
Inglewood, US
Apr 27, 2011 6:05 am EDT

Im in california and Sedgwick has been in breach of contract and their fiduciary duties since 1/17/11 Im getting the run around, and need to know if anyone has any luck or help agency is it a HIPPA action United Health care is my PPO, 100 % premium paid under LTDH coverage, workers comp action involved, docs say personal medical is 49% and workers comp 51% at the current time but I'm receiving no benefits. I was denied under my personal medical thru an IME exam with minimal personal med records now they are sending me to an ortho IME--I received the first 2 years of LTD benefits and the guidelines for disability are used to determine disablity which my medical records do. I'm so lost. I work for local government and the high risk mgmt branch of the CEO is attempting to put their 10 month long lack of review and obtaining of records blame on me by consistently stopping my benefits, when workers comp stopped erroeneously paying ttd in 07/10. I am awaiting the AME report of the ttd benefit allowance period is applicable to the old rules, not 104 months. Too many insurance places involved when medical problems clash. I dont know what else to do.

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Sedgwick Claims Management Services liars

I had a roof installed by Home Depot, and it soon began to leak causing damages in my home.
Home Depot took responsibility at the time, and said the leaks were due to faulty flashing around my sky lights, and they gave me their claim Dept to contact, Sedgwick Claims Management.
It has been 6 months of hell dealing with Sedgwick, and I received nothing but stall tactics, and listen to lies.
At first Sedgwick offered us a fraction of their own insurance adjusters estimate. After we declined weeks later they decided to not pay anything, ignore our calls. After hiring a lawyer, they finally replied saying they are sending an engineer to make a determination. That phone call took them a month to make.
After numerous calls following up with Sedgwick to solve this issue, they said they did not like their engineers report, and were sending out yet another engineer. That was pretty obvious as to why.
Clearly the first engineers report was not what they hoped for.
Engineer number two comes out, and his report is an absolute joke and complete nonsense. In this report it reads the damages to my floors is due to the rotting doors. Meanwhile the doors did not rot until the water was coming through the flashing from above! This fact I know because I sat and watched this with my own eyes, and so did Home Depot when putting water hoses all over my roof to find the leaks.
With this bogus report, now Sedgwick claims zero responsibility. It is crystal clear the faulty flashing by Home Depot casued the leaks and damages.
This company intentionally stalls, are grossly unprofessional, and clearly unscrupulous.
All that is written about them online is true. How does the attorney general and INsurance board allow this criminal behavior?!
I am pursuing exposing Sedgwick, and I will fight for my thousands of dollars of damages.
Their hoping I will get exhausted will not work, I am actually looking forward to getting justice for myself, and so many others. online, in court, and in the media.
Shame on Home Depot for allowing them to represent them when they pride themselves on customer service!
And shame on you for knowing the truth, and not having the integrity to stand behind your product!

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withavoice
Waterford, US
Jan 12, 2012 10:09 pm EST

I have personally found out that Sedgwick CMS will do everything in their power to NOT look out for the customer. Rather, they like to make up lies so that their party does not have to pay. It is complete injustice and they are a joke! As mentioned above, they won't return phone calls and they stall until they can come up with a ridiculous excuse as to why they or their clients shouldn't be held responsible. Their unmoral practices are simply disgusting.

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flecia
Las Vegas, US
Oct 21, 2011 8:47 pm EDT

i have been dealing with sedgwick cms sense 9/2011, all i get is voice mail, i fax, call etc. they are giving me he run around, i guess i have to hire a lawyer also, more time but i'm sure it will be more money also...the question become is it with the time and paper work for the companys to do this...i guest they have the money to put out...

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unknownuser4527
fredrick, US
Mar 06, 2011 2:06 am EST

i have been hurt during work unloading a truck i waited forever to get mri done through sedgwick insurance and the only reason why i was approved for a mri was that i hired a lawyer and when the results came back they said it was a muscle strain well i was in terrible pain so i had a second opinion and found that to be a lie i had 3 herniated disk of the neck and one right before the tail bone i am persuing future compensation for my pain and their lies but morely for the principal of exposing them for the fruads that they are. Togeather we will win in exposing these fruads.

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Sedgwick Claims Management Services rude and unprofessional

My car was hit in the front right passenger corner on January 4th of this year, by a gentleman that drove a 7-11 company car. My car was undriveable. A police report was filed and the gentleman resumed full liability for the accident. Unfortunately, the car was insured by Sedgwick CMS. On January 4th, approximately 10am I filed the claim to my insurance company, Progressive. I was informed by my agent that since I only have liability on my car, that I was unable to obtain a rental car until Sedgwick was contacted and a claim was filed. I am 24 years old and in the state of New Jersey, most rental companies will not rent a car to you unless you are 25 or older. This was a huge problem seeing as I had no transportation. Anyway, both my insurance agent and I tried time and time again to contact this company and for reasons unknown, they were elusive. I could not get through to a person, all I could get were machines. After a week of trying, I finally had enough. I mailed and faxed a letter to their main office stating: if they were not going to give me the time of day, I was simply going to contact an attorney. I suppose that sparked some interest and I received a call the very next day. The call was from a man named Nabeel Nasir and he was extremely rude. I was treated like the accident was my fault and I was being bothersome. When in reality, they were assuming responsibility. The only up-side was that Nabeel was able to get me a rental car within a day of speaking to him. I obtained the rental from Enterprise on January 19th. I was told I needed insurance on my rental, again since I only have liability insurance. The gentleman at Enterprise was very accomodating and assured me that Sedgwick should be able to cover the insurance fee. He then tried to contact Nabeel... to no avail. I had no choice but to take his advice and take their rental insurance. I was not directed otherwise by Sedgwick, so I did not see it as a problem. About 2 days go by and I am contacted by Nabeel stating that my car was totaled and that he will contact me the next day with further instructions. No call and no answer when I tried to call until the following week on the 25th. I was told on the 25th by Enterprise that Sedgwick called them and told them they will only pay for one more day on my rental. I was beyond livid at this point. I received no information on my totaled car until I called Nabeel about 6 times in a row that same day. I asked to speak to his supervisor and I was not put on hold, I was hung up on. I never got a call back and could not get a hold of Nabeel for the rest of that day. The next day I took my car back to Enterprise, not wanting to use any money out of pocket. The gentleman at Enterprise explained that he was unable to contact Nabeel or anyone from Sedgwick and unless he could I was going to be charged the $160 for rental insurance. After waiting an hour in Enterprise calling Sedgwick, we finally got him on the line and asked for the reimbursement. He informed us that Sedgwick does not pay for rental insurance and would not explain further. We finally spoke to his supervisor to which she explained they will not pay for insurance, however they will lend me the rental until I had received my payout for the totaled car... but they still WOULD NOT pay the rental insurance. Thankfully, the gentleman at Enterprise had a heart and told me I did not have to pay for the insurance.

Overall, I felt I was ignored and treated very poorly by Sedgwick CMS, even though the accident WAS NOT MY FAULT. I hope no one ever has to deal with them again.

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Mannequin
US
Mar 08, 2012 10:24 am EST

Dear Sedgwick victim in TX
I wish I had read these stories when I was first injured on Feb 08, 2012. I received a letter this week stating they were denying my claim due to lack of medical proof. What?
I told my daddy who is 80 yo that I am in battle with Satan.
This company has lied, avoided, accused, been condescending, rude and unprofessional, to say the least.
i pray you are doing well after your horrific hassles from cealing with Sedgwick ( Sedgwitches!)
Best regards - from another victim.

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Sedgwick Claims Management Services disability claim

Although I have two notes from physicians releasing me from work due to knee pain after having hospital tests and cortisone shots, Sedgewick denied my disability claim . I pay monthly for short term disability which I will cancel soon as it apparently is a waste of money. I had an excellent work record until they refused to acknowledge my medical release notes for this physical pain experience.

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Kate Singer
Astoria, US
May 13, 2009 2:07 pm EDT

After breaking my foot I was forced to take a leave of absence from my position at Abercrombie and Fitch as a floor manager. After over six weeks, Sedgewick (the company handling my claim) has "lost" paperwork, failed to return calls and refuses to make a decision about my claim or provide information about when a decision will be made. I have not been paid since the beginning of my leave and can no longer afford food, doctors office copays, and will not be allowed to return to work until the claim is approved. The company has been an absolute nightmare to deal with and clearly is simply determined to deny any claim possible. I am destitute and at risk of losing my job all together when the simple fact that I have a fracture in my left foot has been confirmed by my doctor on all Sedgewick's forms. It is a simple claim, fully supported by a credible physician and still they will not give me any information. Sedgewick is ruthless and absolutely unprofessional and unethical. I cannot believe that they are utilized by so many large companies and that no government department has addressed the issue. It is truly a crime against the people who are most in need.

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angryinarizona
Phoeni, US
May 04, 2012 4:30 am EDT
Verified customer This complaint was posted by a verified customer. Learn more

This is the same experience my wife is currently having with Sedgwick. We've spent hundreds of dollars in uncompensated doctors visits and there have been six faxes sent to them, one containing 11 pages of case notes, and they still haven't approved the claim. Terrible customer service and an accusatory manner from the start of the claim filing process.

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larriet
Buffalo, US
Jul 07, 2009 6:34 pm EDT

Sedgewick CMS Has a employees contest to see how many people they can cut off Workers Compensation cases. In recent grand jury testimony A Sedgewick Cms employee told the grand jury. "I received a $5, 000.00 Bonus for falsifying documents to stop payments on workman's comp cases in New York and New Jersey. Other employees received up to $1, 00.00 for multiple denials weekly." A workman's comp attorney told me New York and New Jersey feel it's a waste of time to enforce the rules. because Sedgewick just stone walls there request or sends them to out of state offices.

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FAMILY RIGHTS
Birmingham, US
Jun 17, 2009 10:31 pm EDT

First of all, you have the right to appeal and to seek counsel. Get an attorney.

If this is a worker's comp claim, you need to contact your state workers comp office to tell them exactly what has happened. Try to be as detailed as you can about dates, times and employees you've talked to with this company.

Contact your state's insurance regulatory commission. Also, contact an attorney who handled Americans With Disabilities complaints and employment law.

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8:42 pm EST
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Sedgwick Claims Management Services failure to pay claims/unreasonable delays of treatment

This company has given us nothing but grief with it's constant delays, lies, and failure to pay claims. My previous doctor dropped me because they could not get payment for services / medications. The claims worker claimed for 4 years that she could not find my file everytime I called. I finally had to go to previous doctors and track down all the records myself and give her the information in order to get medical treatment for a back and neck injury that left me at risk for quadriplegia.

Once I got the OK, I could not find a doctor to take my case and they finally supplied me with a list to search for a doctor. I have had 5 surgeries on my back and neck and anticipate more in the near future. EVERY TIME I go to the designated pharmacy for my prescriptions, I am told that Sedgwick has denied payment and I have to call the worker to get a response from the company. Some medications require continued use or weaning, or the patient can suffer serious consequences. I have suffered nerve damage, loss of feeling, limited use of limbs, and as I said earlier am in severe pain and at risk for quadriplegia. They don't care. I am lied to constantly and my communication is ignored until the point of frustration and feelings of hopelessness.

My claim was settled to provide me with lifetime medical in leiu of a cash settlement, yet I was deprived of treatment from them for 4 years and had to pay myself at Urgent treatment centers and county med clinics and county hospital. It's unfortunate that I must file this complaint and pay from my limited income and taxpayers paid for the treatment that Sedgwick is responsible for.

I have been lied to so many times. They say after all this time that I need a prescription card. They said they had sent it to me at my parents address. (A lie) I have received other correspondence from them at my current address where I have lived for over 5 years.

I have confirmed my correct address over and over again. I waited for these cards and what happened? They sent a letter to my parents address asking if I wanted my scrips sent to me by mail 3 months at a time; no prescription cards like they said they were sending. More lies and tactics to thwart my treatment. Why did I not receive any prescription card? Why did the pharmacist say that they have problems with Sedgwick all the time? The pharmacy had never asked or required a card from me in the past.

Now I try to reach my claim worker and of course she is out of the office until the end of the month. I sent e-mails, and was advised of this. I then sent it to her supervisor and she too was out of the office. Their lies and efforts to delay and thwart my treatment is very stressful, which increases pain and impedes my recovery. (My last cervical spine surgery being only 2 months ago).

I looked online to find a number where I could reach someone to OK my medication. I found page after page of complaints against this company.

I also discovered that my brother in law has this same company and he has been suffering greatly for years trying to get approval for treatment and surgery. Because of his disability and the poverty that follows, he lives in a travel trailer at a campground, and in winter rents a room, needing help from family to survive while he waits and hopes to be able to work again someday.

Something must be done about these greedy insurance companies that fail to have any compassion towards people who are sick or injured and need help. Instead their tactics cause needless stress and additional pain and suffering to those who depend on them for help.

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WHOCARESATALL
Elgin, US
Feb 04, 2012 9:05 pm EST

THEY ARE THE WORST

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WHOCARESATALL
Elgin, US
Feb 04, 2012 9:04 pm EST

THEY ARE THE WORST !

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Iris Virella
Lawrenceville, US
Dec 17, 2011 11:05 pm EST
Verified customer This complaint was posted by a verified customer. Learn more

I understand your frustration very well. My husband still fighting for his rights after almost 7 years. Sedgwick denied and delay treatments and medication without compassion. This is a criminal organization.

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About Sedgwick Claims Management Services

Sedgwick Claims Management Services, Inc., is a leading global provider of technology-enabled risk and benefits solutions. At Sedgwick, caring counts; the company takes care of people and organizations by delivering cost-effective claims, productivity, managed care, risk consulting and other services through the dedication and expertise of more than 14,000 colleagues in some 275 offices located in the U.S., Canada, U.K., and Ireland.

Overview of Sedgwick Claims Management Services complaint handling

Sedgwick Claims Management Services reviews first appeared on Complaints Board on Nov 24, 2008. The latest review Claim was posted on Sep 6, 2024. The latest complaint LOA Filing was resolved on Feb 25, 2022. Sedgwick Claims Management Services has an average consumer rating of 1 stars from 396 reviews. Sedgwick Claims Management Services has resolved 41 complaints.
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    West Hills, CA
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  3. Sedgwick Claims Management Services emails
  4. Sedgwick Claims Management Services address
    P.O. Box 171816, Memphis, Tennessee, 38187-1865, United States
  5. Sedgwick Claims Management Services social media
  6. Janet
    Checked and verified by Janet This contact information is personally checked and verified by the ComplaintsBoard representative. Learn more
    Sep 06, 2024
Sedgwick Claims Management Services Category
Sedgwick Claims Management Services is ranked 748 among 791 companies in the Internet and Software category

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