Complaint Review: Sedgwick Claims Management

I have dealt with Sedgwick on several occasions, mostly for surgeries I have had. It’s incredibly difficult to reach a particular person, and you or may not be able to speak to your "examiner”. They lose emails and faxes, claim they never got them when sent multiple times. They make your doctor fill out 11 pages for any sort of medical claim, then it’s never enough information so they want more.

More "clinical findings”, more details, an explanation of their diagnosis, you name it. Once they receive enough info to appease them, they have a nurse review the doctor’s findings and decide if the info supports your claim. I applied for three days time (after my company’s waiting period), and minimal accommodations upon return to work. Accommodations which wouldn’t even prevent me from working. All they would do is make it more comfortable to work with my situation. They declined me.

They said if I could get more "clinical findings” from my doctor they *might* be able to review it again. My doctor flat said no. He said he is my doctor, he diagnoses me, he determines treatment, and any special requirements I need to heal. He said no one at Sedgwick or my company’s HR department are qualified to determine any of those things, much less counter his information and say it’s not enough. He is absolutely right. He said he will talk to them on the phone if they like (and I’m sure he will tell them the same) but nothing else will be sent in.

I don’t even think he should have to take time from his day to do that. This process has now taken more than two weeks. I can’t return to work unless Sedgwick approves my accommodations, or until he sends a note saying I can return without accommodations. I don’t get paid for any of it. We are behind on our mortgage. And let me add that they requested my medical information before I gave them a release. Is it me or isn’t that an HIPAA violation? I wish my company would use someone else to manage claims, because this is not an isolated incident. It happens to everyone. Sedgwick are underhanded and evil, they don’t care about you or your recovery, they care about their own bottom line.