Sedgwick CMS / wrongly denied claim

United States Review updated:

I found there are a lot of complains and even lawsuits against Sedgwick CMS. Just wanted to express and share my own experience with Sedgwick. They seem not responsive during the claim period, not able to contact the case owner directly via phone or email and I have to call 800 # to go through the options everytime just to talk to someone. After about two weeks, got an email the case is being denied. They seem not sensitive or really care about people too.

When we already have health issues to face with, the last thing we need to deal with company like Sedgwick. May I ask if anyone has the similar experience with Sedgwick that is not very responsive, don’t really seem know what they are doing and denied legitimate claims? Or, if they have better “performance” for their own benefits if to deny more claims?

If Sedgwock denied claims and we have to go back to work. If health situation gets worse or something happens to us, if we have the right to sue Sedgwick? Or if is it worth it to fight with Sedgwick when health is the priority. But, we need to stand up against unethical company to protect others too.

Jun 28, 2014
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  • Ml
      Aug 25, 2014

    I have been taken out of work since 7/11/14. Sedgwick has denied my claim due to "not enough medical evidence". I am going to see my PCP as well as 2 specialists. All have submitted detailed medical records for me. This is not the first time I have been denied. I am a single mother with 2 small children. I have no income. My cell phone has been turned off, car repossessed and I have been served a demand letter for rent. I am to avoid all stress. HA HA How can I do that when I can't provide for my family and face homelessness?? As of today, my doctors are not sure when I can return to work. I was also advised today that my FMLA is exhausted and we need to find an "accommodation" so I can keep my position.

    0 Votes
  • Lo
      Nov 14, 2014

    I was injured on the job while employed as a CDL driver. My lower back and neck, twisted my spine. I have been dealing with Sedgwick, or i should say my Attorney has, since 2007 when they stopped all medical treatment then back billed all the doctors i had seen. after appearing in front of Washington State workmans comp judges a few time and winning each one, they, Sedgwick appealed each time and got it over turned on technicalities. My Attorney appealed the last time in which it went in front of Superior Court in Snohomish County Washington and we yet again won which finally re-opened my claim and Sedgwick paid the "back billed" doctor payments but not after it killed my credit :-( Now, here in November 2014, they are flying me up to Seattle yet again for another IME which I already know will not be for me. Because they did this in 07, ive been getting care through VA since and they got free care for me, until now. VA will be billing them for 7 years of treatment, pain meds and Doc Visits. Maybe had they treated me in the beginning, i wouldn't have a herniated disk and several bulging disks. What started as 4 disks (2 in lumbar and 2 in cervical) has turned into somewhere around 9 or 10 with problems. Thankfully, i have SSDI but that doesnt cover what im loosing each month and wont replace my Stock i had to sell to make ends meet. Im 50 yr old now and my livelyhood is gone. Its sad that they just dont work to fix you from the start and play deep pockets. The Stress, depression and anxiety ive obtained since then is driving me nuts. Until 2 years ago, my wife was pulling my 230 lb @ 6' 4" (her at 5 ft and 100 lb) butt out of bed and chairs when VA gave me a trapeze to enable me to get out of bed. How degrading is it when you have to roll out of bed to use the bathroom so as to not wake your wife every few hours... and the lack of sleep due to pain... oh boy. VA has had me on Methadone, Morphine and now im on a Fyntanal patch along with a few other pain meds. All i can say to anyone that has to deal with this company is, Lawyer Up!

    0 Votes
  • Gr
      Jan 02, 2015

    I worked for Lowe's who uses Sedgewick to handle there work comp claims as they are self insured. After asking for all kinds of information that had nothing to do with my injury or claim, they refused to pay for the medication the doctor ordered. About two weeks after the injury I received an email from the claims examiner who had cut and pasted a section of my MRI report into the email saying my claim was denied. She stated this was because I had a pre existing condition / injury according to the MRI. This was completely untrue as the part of the MRI she was quoting had nothing to due with what and where my injury was. She had no idea how to read an MRI report yet she denied my claim. Also there is no pre existing in work comp if you injure or re injure something while working for a new employer. I tried contacting the claims person by email and phone but she would not respond to me nor would she respond to my request for an appeal or review by a medical doctor. I then tried contacting her supervisor who also refused to respond to me. They cut off treatment I was having and refused to cover refills on meds ordered by my doctor. My doctor went so far as to write a letter to Sedgewick and tell them they were not reading the MRI results correctly and that there denial was incorrect. She also got no response. I found a law firm who specializes in this area of insurance company bad faith claims. They took my case immediately on retainer so it cost me nothing up front. They have sued Sedgwick and the parent insurance company along with Lowe's several times for the same type of case and won. My advise to anyone fighting with Sedgwick is to Google Doyle & Raizner law firm. Sedgwick is like the company in the movie the Rainmaker, they never pay out. Just deny, deny, deny. I agreee with the comment above Lawyer up.

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