Sedgwick (formerly Sedgwick CMS) is not an actual insurer. But it provides many services like an insurance company. They call themselves a “third-party administrator” (TPA) which basically means that they are insurance adjusters for self-insured companies and smaller insurance companies that have a small claims department (or have no clams department). This means Sedgwick handles the claims process for them.
Our lawyers have seen Sedgwick representing companies like Target, LabCorp, Home Depot, Walgreens, Sears, General Electric and Kroger. Sedgwick will handle the claims process for car crashes, workers’ comp, premises liability (including slip and falls), other injuries, disability, FMLA, and professional liability (including medical malpractice).Background
After about 40 years, the company has 10,000 employees and 190 offices in the United States and Canada. What they do is essentially take over the job of the insurer. field investigations at accident scenes, figuring out how much must be set aside in reserves for injury claims, coordinating with lawyers defending their clients’ claims, and trying to reach a settlement with the victim's lawyers. The main difference between TPAs like Sedgwick and dealing directly with the insurer is that Sedgwick competes for its clients’ business. How do they get the business? By helping the negligent party save money by paying out as little as possible. What does this mean to you? Typically, it means they are going to try to get the case settled on the cheap. Sure, all insurance companies do this. But Sedgwicks of the world just have more incentive to try to rip off the victim.
For liability claims like automobile accidents, the company notes on its website that it follows these “best practices”:
to make immediate contact with injured third party claimants to ascertain the facts and claimed damages. Statements are taken as appropriate from the claimant and witnesses; police reports are obtained when available and relevant; photographs may also be obtained.
As you might expect, we tell our clients that they refer all requests for dialogue from insurance companies or third-party administrators to us—there is typically no good reason for an automobile accident claimant to speak with the opposing side’s insurance representatives.Competition
Sedgwick is one of the largest third-party administrators. Business Insurance, ranked these companies by by revenue:
- Sedgwick: $808,152,678
- Gallagher Bassett: $401,900,000
- UMR, Inc.: $393,949,776
- Broadspire: $236,467,690
- ESIS: $195,400,000
- Meritain Health: $193,000,000
- CoreSource, Inc.: $ 86,619,141
- York Risk Services: $ 86,000,000
- Wells Fargo: $ 74,512,426
- Canon Cochran Management Services: $ 67,500,000
Sedgwick was also the largest third-party administrator for workers’ compensation claims (calculated by revenue paid for claims), with Gallagher Bassett just underneath it.Technology
Sedgwick uses a software program known as Juris as a central repository for all of its client information. Juris maintains data on medical bills (“including information such as payment details, service descriptions, procedure codes, methods for calculating fees, provider and vendor contacts, and reasons for review”), and time tracking (for workers’ compensation and disability cases, “to monitor the work statuses of individual claimants while off work or on restricted duty. This function helps users track a claimant’s progress and get the claimant back to work quickly”).Trying to Reach a Settlement with Sedgwick Without a Lawsuit
Sedgwick is a bit harder to predict because they are following their clients instructions. Some clients ask Sedgwick to take a tough position and give them little authority to evaluate and settle claims for fair value. Other Sedgwick clients are looking to get cases resolved and take a very different view. In car accident and slip and fall cases, which is where we generally see Sedgwick, it is difficult to resolve cases before filing suit just because a lawsuit seems to get Sedgwick's clients to focus on the case.
But Sedgwick appears to be a little more realistic in valuing cases than its main competitor in third part adjusting, Gallagher Bassett. It seems -- just based on the online reviews we get from victims complaining about their dealings with Sedgwick -- is that this is a tough company to deal with if you are not represented by an attorney.Dealing with Sedgwick on Injury Settlement Claims After a Lawsuit is Filed
Like almost all insurance companies and third party administrators, Sedgwick gets more reasonable after a personal injury lawsuit is filed. Companies using Sedgwick generally have to hire outside attorneys to defend claims. The cost and expenses in defending a case - mostly attorneys' fees -- becomes an issue when a lawsuit is filed. As a result, Sedgwick's clients get more serious about evaluating the claim before it goes to the next level.Hiring a Lawyer to Take on Sedgwick
If you have been hurt in an accident in Maryland where the at-fault company is self-insured and uses Sedgwick or another third party administrator, call us at 800-553-8082 or click here for a free no obligation consultation.More Information on Dealing with Sedgwick in Injury Cases
- Valuing Injury Cases (how much is your case worth?)
- Slip and Fall Claims (an overview)
- Sample Settlement Packages (letter to insurance company for compensation by settlement)
- Handling Injury Claims Without a Lawyer (tips for personal injury victims)
- Getting Your Property Damage Fixed (tips for auto accident property damage claims)
- Frequently Asked Questions (handling injury claims against Sedgwick and other insurance companies/third party administrators)
- Help Center (if you want to know how to go after a company like this one, we give you all the tools you need to do it)