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Sedgwick CMS


Obtain my personal medical records without my authorization and permission

Complaint Rating:  70 % with 20 votes
70% 20
Contact information:
Segwick CMS
PO Box 14455
Lexington, Kentucky
United States
Phone: 866-211-1487
Sedgwick CMS continues to contact my doctors to obtain my personal medical records without my authorization and permission.

This is a very serious matter. They need to let me know what they have done with my personal medical records since obtained and why. They also need to stop it.
Complaint comments Comments Complaint country United States Complaint category Other
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 3rd of Dec, 2008 by    0 Votes
You should check with your physician to see if Sedgwick CMS has submitted any false documents to obtain your medical information.
In my case forged releases were sent in order to retrieve protected health information unlawfully.
You might also consider filing a complaint with the Department of Health and Human Services. Although DOHHS doesn’t regulate insurance support organizations like Sedgwick CMS, the more complaints the better.

I would also file a complaint with the Department of Insurance in the state where you live as they regulate people like Sedgwick CMS.

Also, get the name of your claims examiner and post it on the web, on sites like /link removed/ It’s only fair that their friends and family know what they do to sick people.

Hope this helps!
 8th of Dec, 2008 by    0 Votes

I am a former Sedgwick CMS employee here and can tell you that Sedgwick CMS has what's called "STEP Processes" that case managers are required to follow depending on the program. If you filed an Short Term Disability claim or a Long Term Disability claim, you may have signed a "Release of Information" without realizing what it was. If you did, then unfortunately they have every right to obtain your medical records from your treatment provider for as long as you are on disability.

If you did not signed a release of information and Sedgwick CMS requested your records without your knowledge and your physician's office provided them the records, they both are violating your HIPPA rights and can be held accountable in a court of law.

If I were you, this is what I would do:

1. Forget about the Case Manager go right to the top. Contact Sedgwick via the 800 number you use for your claim and demand that you be provided the Operation Manager's name (not supervisor). Sedgwick email system is the first name.last name@sedgwickcms.com. Once you get that name, fax a signed letter to that individual advising them you believe that your HIPPA rights were violated and you are requesting a COMPLETE copy of your file, including JURIS notes, and a copy of the STEP process. The Juris notes will show you each date and time your case manager called your Physician's office requesting your medical records. If you don't request the computer notes you will not receive them. Sedgwick has to provide these records to you free of charge.

2. Once you get your records, go through them to see if there is ANYTHING you signed that stipulates Sedgwick has the right to obtain your medical records. If you signed something then unfortunately Sedgwick did not violate your HIPPA rights.

3. If you do not find any documents that allows Sedgwick to obtain your Medical Records, immediately contact your Physician's office, provide them the dates/times Sedgwick received your medical records from their office (hint-look on top of the faxed medical records. Sedgwick has an electronic medical records system and stamps everything) and DEMAND they provide you a signed Release of Information signed by you that allowed them to release your medical information.

4. If Sedgwick does not have a signed release of information on file nor does your Dr., then immediately go to an attorney with your complete file and request that a federal lawsuit be filed against both your physician and Sedgwick for violating your HIPPA rights.

Here is a link to HIPPA: http://www.hipaa.org/

Oh, by the way, judging from that Kentucky address, I suspect your either an ATT claimant, Eaton, GD, or CTA claimant and handled in the Chicago office. If so, the Op's Managers are Ratna Bagwe (ATT), Matt Wicklander (Eaton), Cheryl Morler (CTA), and unfortunately I don't know who the Op's manager is for GD.

Hope that helps.
 2nd of Aug, 2009 by    +1 Votes
discrete thanks for the info this could help alot. I am an ATT employee and union steward for CWA and I am working to protect worker rights to FMLA and disb so anyone ready this email esmith66@sbcglobal.net subject sedgwick
 12th of Jun, 2010 by    0 Votes
They will continue to get your records and are allowed to do so as long as you are requesting compensation from them. They have a right to know what you are treating for/claiming before they pay for it.
 30th of Sep, 2010 by    -1 Votes
I do agree they is a rep off my things was stolen and i got a deny claim and my understanding is if i have gave you all proff why i get deny so i do belive u is telling the truth if anyone could help me get the vice president info please do contact me brown 318-458-0566 or ducduc5042yahoo.com
 28th of Jul, 2011 by    0 Votes
If Sedgwick is paying the bills on your behave, then YOU have given them authorization to do so AND as a portion of that agreement you give them the right to EVERY document, prescription, Doctor's Bill, X-ray, office visit etc., that is accumulated on your behave, THAT IS THE LAW.
 6th of Nov, 2011 by    -1 Votes
For the comment posted on July 28 2011. That would be false. They do not need all your medical records. Only records pertaining to that claim. Be very specifec when you fill out any form. I write it in their form also as well as mine from my insurance. This company is seedy and they are out for their best interest not yours. They are liars and are constantly asking for more documents. You can not trust them. I went to see their IME and he didn't even have current medical records. Ask me if they could take copies of the information I brought with me. I said " NO...you can pay to receive this". I'm not doing anything for them. Its like handing the enemy sme bullets. I'm in this for the fight...I'm not giving up.
 14th of Dec, 2011 by    0 Votes
Thank you greatly for this (initial) post. 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.
 31st of Dec, 2011 by    +1 Votes
wa wa...every insurance company has the right to review and approve for treatment. And differenet medications require pre-approval.
 31st of Dec, 2011 by    +1 Votes
No insurance company is going to pay you or your bills without reviewing records. How else would they know what they're paying for. Nothing specifc to this company.
 15th of Feb, 2012 by    0 Votes
I am having a problem getting ahold of my agent. I havent received a check for workers comp in two weeks. I have called my agent several times per day for the last week and a half, and no answer and no return calls. I have bills to pay and children to feed. We ended up having to move and change address do to lack of funds, and do to our home being broken into, and death threats from the neighbors. It was a very unsafe environment for my family. All I want is a simple return phone call. How hard is that?
 20th of Jul, 2012 by    0 Votes
I never signed ANYTHING for release of my medical records. I am now 30 and they dug up and obtained medical records from when I was 16 and had knee surgery. (my claim is over a broken foot and ruptured discs). Because I was on pain medication for my knee surgery 14 years ago, they are claiming I'm a "narcotic addict with 'chronic pain'" even though that was 14 years ago! I have to go to court over all of this, I'm 12 weeks pregnant and absolutely furious!
 22nd of Jul, 2012 by    0 Votes
It seems to me that after devouring two other companies who were competitors in the past, someone needs to contact Congress to check out the Anti-Trust Laws. Sedgwick may very well be in violation of Anti-Trust Law. I have a complaint pending with Sedgwick at this moment, and from what I have been reading, I am not too optimistic about a fair and equitable settlement.
 1st of Feb, 2013 by    0 Votes
I need help If any one can help me I had a case settled for pennies and I was supposed to get 12000 dollars as part of the settlement and I never got this money for all I know this lady Sherry Moffitt, Sedgwick manager pocketed this money, my case no.is YMR 04877 settled last year and after countless calls and denials Sedwick CMS never explained what happened to this money, please help me my name is Ernesto Suarez and my number is 786 597 9370 my email is suarezernesto184@yahoo.comThank you
 7th of Feb, 2013 by    0 Votes
In most states you don't have to deal with Sedgwick directly. You can get a Workers Comp attorney for nearly free. They watch your back for you and only collect if they retrieve a settlement for you. Don't go it alone. These people know the law as their job and WILL take advantage of you. Also you are entitled to have a QRS (Quality Rehab Specialist) work with you. Mine goes to my DRs appointments with me at no charge and documents everything in legal protocol. He's neutral but helps guide me.
 12th of Aug, 2013 by    0 Votes
if this is a workers comp claim, then workers comp law TRUMPS HIPAA, i'm sorry to tell you. they have the right to your records unless you were VERY specific on your auth form
 16th of Mar, 2015 by    0 Votes
This is Leon Sebetich I work for Honda of Alabama, my associate # is 23217. I need a copy of all my pay stubs when I started getting Short Term Disability, I need them ASAP, I have to have them to give them to my lawyer . Thank you so much Can you email them ? Coorsman47@yahoo.com
 17th of Jul, 2015 by    0 Votes
If this is a Worker's Comp claim, as Sedgwick is paying for your medical treatment, they legally own your medical records. Sedgwick, or any other insurance company, will not pay for a medical appointment of yours unless they are able to review what occurred during that medical appointment. They need proof that the medical appointment was indeed related to your injury claim only.
Regarding the other comment about Sedgwick not paying for your medical bills and your medical bills are in turn going to collection: if you are indeed receiving collection notices and medical bills addressed to you, this means that the medical provider does not have your Sedgwick Claim information. Sedgwick has no way of knowing that these medical bills exist because they are being billed directly to you instead of being sent to them. Please call the collections company and provide them with your insurance information so you do not get sent to collections. Either that or fax a copy of your collections notices to your adjuster. This happens frequently because the medical provider is not provided with your proper insurance claim information when you attend an appointment.
Regarding your checks, if this is a Workers Compensation claim, depending on your state, there are waiting periods and retro periods that need to pass before your adjuster can issue you your benefits check. In most states, the initial payment is not considered "late" until 30 days after your initial date out of work.
If you are attorney represented, your adjuster is not legally able to speak with you directly and they will not be able to return your calls. If you call constantly and do not leave a message, they will not know that you called.
A lot of these accusations are due to lack of knowledge on the subject. Your insurance company is not out to get you. There are many rules and regulations that need to be taken by your insurance company prior to issuing you benefits, paying your medicals, etc. It is impossible for these steps to be completed on the first day that your claim is reported.

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