Sedgwick Claims Management

Who is Sedgwick?

Sedgwick CMS is a Third Party Administrator (TPA) that handles workers compensation, short & long term disability and Family Medical Leave Act (FMLA) claims for employers. As a TPA, Sedgwick manages workers compensation and disability claims, similar to an insurance adjuster, but is hired by your employer.

NEW, Summer 2013:  If you are dealing with Sedgwick and do not have an attorney, please get one.  This is the kind of company you’re dealing with: Attorneys ask for criminal charges in Camarillo man’s death.

What does Sedgwick do?

Sedgwick is not a neutral third party, but instead contracts with employers as the administrator for claims.  Sedgwick’s clients include employers like AT&T, General Electric, Greyhound, United Healthcare, Delta Airlines, Xerox and many more.  With 130 offices and a staff of 6,300, Sedgwick offers additional services to employers like investigation of claims, cost management assessment, litigation management, time-off tracking, and identification of high-risk groups.

Sedgwick CMS handles all types of claims from on-site injuries or resulting chronic pain issues to maternity leave. Sedgwick claims managers approve or deny authorization for doctor visits, surgeries, physical therapy or prescription coverage and administers disability payments.  (This is why you need a MD workers’ compensation lawyer.)  Depending on your injury, you might be assigned a Nurse Case Manager to attend doctor visits with you or you could be required to use one of their contracted physicians.

(Note: many workers’ compensation lawyers will seek to prevent the nurse case manager being in the room with you.  That is their job, as your advocate.  If you have asked yourself, is thnurse case manager allowed to be in the room while I meet with my doctor, the answer might be no.  Talk to your workers’ comp lawyer.)

 

What do I do if I’ve been injured and my employer uses Sedgwick?

In order to contact your claims adjuster, you must first go through your employer to receive a contact phone number and claim number.  Sedgwick does have a general phone line for their Maryland office, (800) 285-3258, but you will need your employer and/or claim number to direct you to the specific phone number for your employer.   It’s best to speak with your lawyer before contacting.

If not dealing with an attorney:

General correspondences can be mailed to PO Box 808, Hunt Valley, MD 21030 or faxed to (410) 773-4221.  Remember to keep a written copy of all correspondences for your records as well.  Sedgwick reports that they will respond to voicemail messages within 24 hours.

 

What if Sedgwick denied my claim?

LAWYER!  If your claim is denied, you will usually receive a written notice.  Typically, an appeal must be filed within 180 days of the denial.  The claims administrator will then have 45 to 90 days to decide the appeal or will notify you if they decide to extend the timeline.  Your employer’s health benefits information might have a Summary Plan Description, which could contain specific details in regard to their procedures and timelines for workers compensation or disability claims.  Most employer provided disability plans are regulated by the federal law for minimum standards, the Employee Retirement Income Security Act (ERISA).  More information is located at www.dol.gov/dol/topic/health-plans/erisa.htm.  If your appeal has been denied, or you feel you are not getting the maximum coverage for your injury, you need to seek a Maryland Workers’ Compensation lawyer.  You can get one via the workers’ comp calculator.

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