For providers, Sedgwick Claims Management Services, Inc.’s routine violations of state law and regulations make it increasingly difficult to treat injured workers.

For employers and insurers, Sedgwick’s violations (300,000+ and counting) should raise very large, very red flags regarding how the TPA:

• Handles injured employees’ claims
• Hurts access to care for employees
• Reflects on their businesses

One of Sedgwick’s most egregious, consistent violations is the way it denies Second Review appeals that providers send to dispute payment denials and reductions. Rather than processing these appeals, Sedgwick denies them by incorrectly labeling them as “duplicate bills.”

While providers carefully adhere to California law to compliantly and timely appeal incorrect payments, Sedgwick flouts the law with these improper denials.

daisyData show that in the first three quarters of 2025, Sedgwick denied 17,454 appeals that providers submitted to secure lawful payment. Of those, Sedgwick denied 42% (7,343) as “duplicate bills.” This week, daisyBill submitted formal Audit Complaints reporting these latest violations.

Since 2022, daisyBill has submitted formal Audit Complaints to the California Division of Workers’ Compensation (CA DWC) documenting 36,226 instances of Sedgwick denying appeals as “duplicates.”

Of course, the CA DWC has taken no substantive action to deter Sedgwick’s persistent violations.

All payers commit errors, including occasionally misidentifying appeals as duplicate bills. However, only Sedgwick makes this “error” with such implausible regularity, year after year.

Coupled with Sedgwick’s past touting of high treatment denial rates, employers and insurers should carefully consider the implications of putting Sedgwick in charge of their injured employees’ recovery.

Sedgwick: Leading the Industry in Violations

According to our data (below), Sedgwick’s non-compliance appears significantly more flagrant than that of any other claims administrator.

This is particularly concerning given Sedgwick’s position as the largest claims administrator in our system and the nation’s largest workers’ comp TPA.

daisyData for California bills submitted from January 1, 2025, to September 30, 2025 show that for all Second Review appeals each claims administrator denied:

• Sedgwick denied 42% as “duplicate bills.”
• CorVel, the second-worst offender, denied just 6% as “duplicate bills.”
• Gallagher Bassett, the second-largest payer in our system, and most other claims administrators denied 0% of Second Review appeals as “duplicate bills.”

To be absolutely clear, daisyBill submits every Second Review appeal compliantly:

• The designated SBR-1 form is used for every appeal.
• “BGW3” is reported on the billing form as required by billing rules.
• The CMS-1500 billing form is unmistakably labeled as a bill for “RECONSIDERATION.”

Regardless, Sedgwick has continued to effectively dodge providers’ appeals by labeling them as “duplicates.”

Sedgwick’s Abuse: Not Confined to Doctors

Including the “duplicate bill” violations outlined above, daisyBill has reported over 300,000 violations of various payment requirements by Sedgwick to the state. If Sedgwick so brazenly and consistently violates the legal rights of doctors, what are the odds the TPA treats injured workers any differently?

It wasn’t very long ago that Sedgwick advertised how its Utilization Review services (UR) derailed 54% of the care doctors requested for injured workers, promising a “5:1 return on investment” for employers and insurers.

Now, the redesigned Sedgwick site boasts of systems that “allow utilization review decisions to be applied automatically” and promises even grander “gross savings” and “return on investment” resulting from its bill review and UR.

When a TPA seemingly prides itself on saving clients money by decimating medical care and provider reimbursement for that care, employers have to wonder about the long-term implications.

Below is a table featuring Second Review appeal data for the 25 largest claims administrators (as measured by the volume of bills for California injuries our provider clients submit to each).

For each claims administrator, we list:

• 2025 CA Original Bill Count: The number of original California bills our providers submitted in 2025
• Second Review Appeal Count: The number of Second Review appeals our providers submitted
• Second Review Deny Count: The number of Second Review appeals that the claims administrator denied
• Second Review Deny "Duplicate" Bill Count: The number of Second Review appeals the claims administrator incorrectly denied as “duplicates”
• Second Review Deny “Duplicate” Bill Percent: The percentage of Second Review appeals the claims administrator (incorrectly) claimed were “duplicates” of the original bill in question

Workers’ comp has a Sedgwick problem.

If state authorities don’t take meaningful action, the system will continue to degrade, to the detriment of injured workers and the providers who treat them.

daisyBill makes billing for injured workers’ treatment faster, easier, and more accurate. Click below for a closer look:

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