Sedgwick CMS

[bubbanut8]

My workers compensation claim was made in the State of:

I am new on here and have seen the posting on Liberty! I was wondering if anyone on here has had the honor of dealing with the SI management comapany called Sedgwick? From what I have read the have offices in many different states, but they seem to only manage the very large money makers.
Such as GE, Lincoln electric, AT&T, Target, Wal-Mart, sears Holdings and companies like these.

If you have any insite on how to deal with them please let me know because they are unbelievably horrid! Claims Adjuster never answer phone calls or return calls, take prescriptions to get filled and they have put a lock on so cant get them filled or get a hold of her to get the lock off, wont approve any treatments, constantly going to IME (2 every 3 months) then deny, deny, deny....

any help would be helpful

[queenbee]

I have been dealing with Sedgwick for 18 months it has been a nightmare,
I have experienced everything you have posted.
I have no advice , unfortunately
they stop checks whenever they feel like it so put whatever extra way for the time they do this and they also like to have you watched.
Good luck

[.SH]

you can get them to start paying atty fees by getting them repeatedly into work comp court.
but it only works well if you have a cooperative atty or represent yourself.

[bluebagger93]

Hi.
I am in Wisconsin, work for Kohl's Department Stores, was injured in March and have been dealing with Sedgwick ever since. They are a nightmare. From the very first day that I was taken off of work, they have challenged everything. They do start and stop checks at will. The Claims Adjuster will never respond to e-mails or phone calls. My employer is no better. They have a Risk Mgmt Team that handles all claims. They are a joke.
When an MRI was ordered for me, they had a company they use called First Med or something like that. They said I had to use one of their providers. They were all the Open Sided MRI kind. I went and had it done. It showed a possible tear in my knee, but nothing really stood out. After a few more weeks of excruciating pain, my Dr ordered a closed MRI and took me off of work until it was done. Sedgwick took 5 weeks to approve it. My Dr. said he has never dealt with a company like this before. All the phone calls to him were unbelievable. I have had 4 Nurse Case Managers in 3 months. Every time one of them agreed that I needed a closed MRI, I was given a new Nurse. I finally got smart and called the State and found out what I could and couldn't do. I was told that they should in no way impede my health care. Then, I sent an e-mail detailing what the state told me to my direct boss, two people in HR, the Risk Mgmt Manager and the Claims Adjuster. That's how it finally got approved. I had to point out "Impeding my health care" strongly. After the 2nd MRI, they found I had a 30% tear in my Lateral Meniscus and I just had surgery last week...they found a second tear in an Anterior something.
After the MRI and surgery were approved, my checks stopped. It's their way of playing with you. They definitely don't like someone who challenges them. I thought it was just me.
Right now, I am recuperating and doing PT and just waiting to see what they do next. I was told by the State that as long as I am following what my Dr said and keeping them updated that I don't need to work with a Nurse Case Mgr, they can be there at the appointments but neither I nor my Dr need to talk to them.

I had to be put on anti-depressants a month or so ago because of the stress, pain and the way my employer is treating me as well as this insurance company.
I posted on the Wisconsin board whether I would be eligible for PPD for both tears and what would happen if I didn't go back to work when I am healed as much as I can because I just can't stand the thought of going back there. They have made me feel like I inconvenienced them by falling in their parking lot ( black Ice). Not to ever get a response or be asked how I am doing after 10 years has really shot me down. I'm an Admin Assistant to 6 VP's and know them pretty well...not to hear a word from them? I just don't get it and it hurts.

I feel for you. The only advise I can give you is to get educated on your State Laws and stand firm. Sedgwick is a nightmare. Good luck with everything.

If anyone has an answer to my questions, I would really appreciate it.

[surfisher53]

do not trust Sedgwick...they are trained liars...I had a finger amputated at work ,that same week a claims adjuster from sedgwick called to say that my injury was minor and i was only entitled to one week off, after telling him to kindly screw himself ,i called my employer to straighten them out..even after that they jerked me around for six months with missing payments and and late checks,i got fed up and got an attorney,i found out that i should not have signed for any payments related to my finger loss,so he had to file 2 petition claims for more money...alot more money that they didnt tell me about,since my lawyer belongs to one of the biggest law firms in Pennsylvania and deals only with comp claims,the out come is most assured to be in my favor.

[timetraveler]

These people are real criminals in suits, I have been dealing with them for over 14 years, they have had wellness checks done on me, detective agency's follow me. checks lost in the mail so to recover I had to fill out an affidavit and have it notorized and sent certified mail to them to get it replaced. after 14 years they accused me of making money post injury, and have cut off my comp checks just before last christmas. they have a little pissy pants lawyer who keeps finding reasons to postpone the case, I have been in court twice, one trip to a doctor of their choosing with a five day notice to appear. You see I currently live 1000 miles from my state of comp.
when I asked the judge if I will be reimbursed for my travel back and forth if I win, I was told "no one told you to move out of state" the state is Michigan and after returning this past week from another wasted court date. I was told there is a new law in Michigan to return comp cases to work no matter the extent of the disability.
Sedgwicks lawyer offered me a redemption this last time, and after I accepted it, they changed their mind and offered to just resume payments with back pay, which I accepted and they reniged again, you cannot discuss any money offers in court in front of the judge, so they can screw with you all they want. and I caught my lawyer and their lawyer laughing it up when I was out of the room. so the only thing left to do is file an investigation with the attorney grievance commission and have my attorney sanctioned for misconduct. or take matters in my own hands, you know we are millions strong if you count the soldiers that are thrown away after serving their country with distinction and just thrown away with the rest of us when they(big Business) can't USE us anymore. I fear your horror has just begun my friend with Sedgwick....

[bubbanut8]

I have been dealing with them for quite a while. I have actually found a little enjoyment lately by getting my adjuster into trouble! When I call she never returns my calls so since I have been dealing with them for so long I have found out that speaking to the operator at Sedgwick as well as First script I can get information I didnt have like the floor supervisor's name and even her supervisor! Oh boy does she get pisse_ off when I talk to them!!!! I know it's trivial but it's a little payback.

I also enjoy going to hearing with my lawyer he isn't one of those who has the need to socialize and tell jokes at the hearings. He is there to do a job for me and believe me he does it!! It is great when he tells them how it is and has the case law to back him up! I am very surprised with the law firm sedgwick hired they are a big firm and highly respected but they never send anyone seemingly competent to the hearings only associates who don't seem to be familiar with the case! good for me bad for them!

[timetraveler]

I can relate to that payback stuff, but it's hard when your lawyer keeps sucking up to the big corporate lawyer, the corp is big but the lawyer is a chicken s___t and after once again flying 1000 miles for court, my lawyer didn't provide opposing council with the subpoena'd doctors reports, the corp lawyer accused him of malicious conduct and the corp lawyer and the judge went on for 15 minutes defining what constitutes malicous intent, while my lawyer sat chewing gum and looking like he slept in his clothes, the case was postponed until August. JUSTICE DELAYED IS JUSTICE DENIED! one day I'm going to have a serious talk with my family lawyer and find out what I did to piss him off, so he would recommend this idiot lawyer for me!

[bluntforcetrauma]

I thought the IC I was dealing with were crooks. This Sedgwick sounds much worse.

You cannot represent yourself in these claims, if so the IC lawyers will exploit everything they can to take advantage of you because you don't know what your rights are.

As far as I knew, they can't stop checks at their will, they have to have a Hearing and a judge makes the call. This may vary by state, but you have to be covered by some protection. They are directed to pay until WC deems it.

[timetraveler]

That course of action would make sense, that they must first prove they have a case, I received a letter on the 5th of December 2007 which was from the W/C Agency which stated the reason of dispute as..Terminating ongoing benefits due to post injury income...the check on the 7th did not arrive, and I have received nothing since. except delay after delay, and you know what really makes the whole thing so dirty is the Judge knows the tactics used by both attorneys because she also was an attorney at one time, and she allows these deliberate delays to go on and on. where in the court system do you get actual justice? they all belong to the same fraternity and we are the pawns in their sick little game.
you would think being a judge she would hold her position in a higher standard of the law, to be the balance of judgment, and not allow these delays, it's not like if they actually opened the case and argued for and against the evidence, that they would run out of work! I met a lady in the waiting area who has been fighting for two years with CBS because she was hurt on the job! judges were lawyers, lawyers do the monitoring of their own profession, it's a system plagued with reasons to fail the average person going before it looking for justice. on the 15th I will file a grievance against my attorney, does anyone know how to have a judge replaced? my attorney told me she sides more than not on the side of corporate America. so without a decent attorney willing to fight for me, I don't see an end to this in my favor no matter what evidence I have. and if I fire him he still gets paid the law allowed percentage of my settlement! wonder who wrote THAT into the law books? There is no reason for him to fight hard he gets paid either way!