Is Your Virginia Worker’s Comp Claim Managed by Sedgwick?

If you were injured at work, you might receive a communication from a claims adjuster with Sedgwick Claims Management Services (“Sedgwick CMS” or “Sedgwick”). Sedgwick is a third-party administrator (“TPA”) that is often brought in to handle claims adjusting on behalf of insurers or employers that do not have their own in-house claims personnel.

Because Sedgwick is hired by employers and insurance companies, they have a vested interest in resolving claims in a manner that benefits these companies. Unfortunately, it often accomplishes this goal at the expense of injured workers.

If you were injured on the job and your employer retained Sedgwick CMS to manage your workers’ compensation claim, we encourage you to read through the following article to learn about Sedgwick and how to maximize the value of a settlement. We also invite you to call The Law Offices of Mark T. Hurt to schedule a free consultation with an experienced workers’ compensation lawyer.

We represent injured workers on a contingency-fee basis, meaning we are only entitled to a fee if we successfully secure benefits on a client’s behalf.

Is Sedgwick Claims Management Services Owned by an Insurance Company?

No. Sedgwick is a third-party administrator that manages workers’ compensation, work injury, disability, and FMLA claims for employers and small insurance companies.

Founded in 1969, Sedgwick is the largest TPA in the United States and a common fixture in many Virginia workers’ compensation cases.

What is Sedgwick CMS’s Role in Virginia Workers’ Compensation Claims?

As a TPA, Sedgwick plays a significant role in the outcome of Virginia workers’ compensation claims, including (but not limited to):

• Investigating claims;
• Determining whether a work injury is compensable;
• Selecting authorized treating physicians;
• Approving or denying healthcare treatment, doctors’ visits, surgical care, pain management, physical therapy, and prescription drugs;
• Assigning a Nurse Case Manager to evaluate injury and treatment progress;
• Deciding whether an individual qualifies for wage loss payments, such as temporary total disability or temporary partial disability;
• Determining whether claimants are entitled to payments for permanent impairment;
• Auditing medical bills;
• Determining whether an employer should offer a worker’s comp settlement;
• Working with insurance defense lawyers to defend companies from claims;
• Working with peer review services to find ways to delay or deny medical care;
• Asking injured individuals to attend Independent Medical Examinations (IME) in an attempt to reduce the claim values; and
• Deciding whether to pay for a functional capacity evaluation when maximum medical improvement (“MMI”) is reached.

Is Sedgwick CMS a Neutral Party in Virginia Workers’ Comp Claims?

No. Sedgwick is hired by an employer or its worker’s comp insurance carrier, meaning that it is not a neutral party.

Sedgwick represents the best interests of employers, touting that its clients “experience some of the best outcomes and lowest overall claims cost.” Unfortunately, lower claims costs can often equate to taking the rightful benefits and compensation out of the pockets of injured, hard-working employees.

Sedgwick CMS has grown into a billion-dollar company by handling workers’ compensation claims, and its adjusters are extremely experienced at obtaining favorable outcomes for companies. As such, if your employer hires Sedgwick, it is critical for you to seek representation from an experienced Virginia workers’ compensation attorney who can tenaciously fight to protect you and your family’s interests.

What Should I Do If I Am Hurt on The Job, And My Employer Hires Sedgwick?

Workplace injuries and illnesses can be stressful and challenging, even without the added pressure of having to deal with a savvy claims administrator, such as Sedgwick CMS. Even when a TPA is involved, however, it is still possible to maximize benefits, and we can help lessen your burden by providing strategic guidance through every step of the process.

If you are injured at work, we recommend taking the following steps:

• Report an injury. Under Virginia law, individuals must notify their employers about a workplace injury or illness within 30 days. We recommend reporting an injury (in writing) as soon as possible, as any delay can be used against a claim. For example, if an employee waits too long, the claims administrator could argue that the injury was caused by an event outside of work.

• Compile TPA information. When reporting an injury, it is vital to ask for pertinent details regarding Sedgwick, including the name of the claims adjuster, their contact phone number, and the claim number. Before reaching out to a Sedgwick claims adjuster, it is advisable to consult with an experienced Virginia workers’ comp lawyer to help avoid costly pitfalls.

• Do not discuss an injury on social media. While it may be tempting to post about an injury or claim on social media, this is not prudent, as this information could later be used against you by a workers’ compensation examiner.

• File with the Virginia Workers’ Compensation Commission Within Two Years. The statute of limitations for Virginia workers’ compensation claims is two years from the date of an injury. Failure to file a claim by the deadline could compromise benefit eligibility; thus, it is critical to make a timely filing.

• Schedule A Free Consultation with An Experienced Worker’s Compensation Lawyer. When a claimant is up against a TPA, an already challenging process can become even more difficult. As an experienced Virginia worker’s compensation attorney, Mark Hurt can be by your side to tenaciously advocate for the best possible outcome.

Does Sedgwick Settle Virginia Workers Compensation Claims?

One of Sedgwick’s primary goals is to settle workers’ compensation claims as quickly as possible. Unfortunately, in pursuit of this objective, its claims examiners attempt to meet these goals by pressuring physicians to release employees back to work before they are physically or mentally ready, denying valid requests for medical care, delaying payment of wage loss benefits, or offering unjustly low settlements.

As an experienced and aggressive workers’ compensation lawyer with over two decades of experience, firm-founding attorney Mark Hurt can help build a compelling case and advocate for a just and fair outcome.

Call The Law Offices of Mark T. Hurt to Schedule a Free Consultation with an Experienced Virginia Workers’ Comp Lawyer.