What to Know About Sedgwick and Insurance Claims

Sedgwick is not an insurance company. It is a third-party administrator, often called a TPA. That means it handles insurance claims for businesses or insurers who don’t have their own claims departments.

When you hear the name Sedgwick, think of a company that acts as the middleman. They investigate claims, gather evidence, work with lawyers, and negotiate settlements. Their clients are usually large corporations or insurance companies that want someone else to handle the claims process.

This setup makes Sedgwick one of the largest players in the claims management industry. They process millions of claims each year for well-known companies, including major retailers, pharmacies, and manufacturers.

Who Exactly Is Sedgwick?

Sedgwick started as Sedgwick CMS but is now one of the most recognized third-party administrators worldwide. A third-party administrator does not provide the insurance money directly.

Instead, they manage claims on behalf of their clients, such as employers who self-insure or smaller insurance companies without their own claims staff.

This means that Sedgwick often acts like the insurance adjuster you would normally expect from a standard insurance company.

They interview injured people, review medical records, and determine the value of each claim. Their goal is to save money for their clients.

Sedgwick handles different types of claims, including:

• Workers’ compensation claims for people hurt on the job.
• Premises liability claims, such as slip-and-fall injuries in stores.
• Car accident claims involving company drivers.
• Disability and leave of absence claims for employees.
• Professional liability claims.

What Does Sedgwick Do in a Personal Injury Claim?

Sedgwick’s job is to step into the shoes of an insurer. That means they:

• Investigate the accident or injury.
• Interview witnesses and claimants.
• Collect police reports, photos, and other records.
• Audit medical bills to see what they believe is “reasonable.”
• Negotiate settlements.

Sedgwick often uses a computer program called Juris to track bills and medical information. This system lets them compare your medical costs with industry standards. If your doctor charges more than what Sedgwick thinks is fair, they may offer a lower settlement.

This process can be frustrating because it may feel like they are minimizing your injuries. But remember, Sedgwick’s main goal is to save money for its clients, not to maximize its payout.

Challenges of Working With Sedgwick

If you are making a claim, you might expect the process to be fair and straightforward. But with Sedgwick, you will likely face some challenges. Their adjusters are trained to protect their clients’ money. That means:

• They may offer you a settlement that is much lower than your actual expenses.
• They may delay processing your claim.
• They may use your own recorded statements against you.
• They may deny claims or close them without much explanation.

Even if the representative seems friendly, remember their job is not to help you. Their job is to protect their client. This is why many lawyers recommend that injured people not speak directly to Sedgwick without legal advice.

Can You Settle With Sedgwick Without Filing a Lawsuit?

Sometimes, yes. Sedgwick may settle claims before a lawsuit. But the settlement depends on how their client wants to handle it. Some clients allow Sedgwick to be flexible. Others tell them to be strict and fight claims.

In many cases, filing a lawsuit forces Sedgwick to take the claim more seriously. When a case goes to court, defending it costs money. This pressure can lead to higher settlement offers.

Without legal help, though, it can be hard to get Sedgwick to offer a fair amount. Their adjusters know how to use evidence and statements against claimants.

Can You Sue Sedgwick Directly?

In most cases, no. Sedgwick is not the insurer or the negligent party. They are just the administrator. However, if you can prove they acted in bad faith, such as handling your claim unfairly or arbitrarily, there may be legal options.

But typically, any lawsuit will be against the employer, the insurance company, or the person responsible for the accident.

Key Takeaways

• Sedgwick is a third-party administrator, not an insurance company.
• They manage claims for employers, insurers, and self-insured businesses.
• Their job is to save their clients’ money, which can make it hard for claimants.
• They use systems like Juris to audit medical bills and track claims.
• Settlements are possible, but lawsuits often push them to be more reasonable.
• You usually cannot sue Sedgwick directly, since they are not the insurer.