Sedgwick Claims Management Services, Inc. is routinely non-compliant with California workers' comp payment laws and regulations. Among its violations: repeatedly failing to send providers the required electronic Explanations of Review (e-EORs) in response to electronic bills (e-bills).

Sedgwick's persistent, widespread violations cost providers time and administrative resources, forcing practices to input payment information that e-EORs would otherwise post automatically.

Moreover, as e-EORs document and timestamp payment, failure to send e-EORs leaves providers having to chase down confirmation that Sedgwick processed the e-bill.

From October 1, 2025, through March 31, 2026, Sedgwick failed to send e-EORs in response to 49,960 e-bills, 22% of the e-bills daisyBill providers submitted to Sedgwick in that time frame.

daisyBill tracks multiple compliance metrics for Sedgwick. On Electronic Data Interchange (EDI) compliance broadly, Sedgwick earns a “Grade” of D. Specifically for e-EOR compliance, Sedgwick earns an F grade. Over the past 365 days, only 40% of Sedgwick's e-EOR responses were timely and error-free.

Sedgwick is the largest Third-Party Administrator (TPA) in the country. Its sheer size and market impact make its non-compliance a system-wide problem. Thousands of California providers treating injured workers covered by Sedgwick-administered plans face this e-EOR failure. The burden isn't limited to one insurer or one region; it's baked into how Sedgwick operates at scale across the state.

Every insurer or employer using Sedgwick as its TPA should know that when an injured worker seeks treatment, Sedgwick (dubbed a "menace" by labor representatives) often turns the process of obtaining reimbursement for that care into an administrative nightmare.

This week, daisyBill will submit a formal Audit Complaint to the California Division of Workers' Compensation (CA DWC) reporting new e-EOR violations, bringing the total number of Sedgwick violations daisyBill has reported since 2022 to 359,626.

The CA DWC has the authority to act. Given Sedgwick's dominance in the market, it has every reason to do so. Further, the DWC should be asking: if Sedgwick fails this badly at responding compliantly to providers’ e-bills, how can they possibly be trusted to serve injured workers compliantly?

While, historically, the CA DWC has taken no punitive action against Sedgwick of which we are aware, we hope that new CA DWC leadership will recognize that past inaction is not a precedent worth continuing. The agency has allowed Sedgwick's non-compliance to compound for years. New leadership has the opportunity, and the obligation, to finally exercise the agency's authority to protect providers.

Sedgwick Keeps the Non-Compliance Coming Into 2026

For years, Sedgwick has violated the e-EOR requirement with apparent impunity.

The pattern has continued since our last Audit Complaint, which covered e-bills daisyBill providers sent from April 2024 through September 2025. During that time frame, Sedgwick's monthly non-compliance rate ranged from 10% to 19%.

Since then, Sedgwick has hit monthly non-compliance rates as high as 41% (in January 2026), for a cumulative non-compliance rate of 22% over the most recent six-month period for which we have complete data.

Those 49,960 missing e-EORs represent 49,960 instances in which a California provider treating an employer’s injured worker had to stop and manually chase down payment information that Sedgwick was legally required to send.

Multiply that across the full range of employers and insurers that use Sedgwick as their TPA, and Sedgwick’s failures function as an industry-wide tax on providers, paid in wasted time and administrative labor, imposed by one company's refusal to meet a basic legal obligation.

The Poorest Performance in the Game

On our Claims Administrator and Network Directory, daisyBill publishes EDI Grades for every payer to which daisyBill clients submit e-bills.

This grade reflects the payer's performance in properly accepting, processing, and responding to e-bills. More precisely, it reflects whether the claims administrator imposes unnecessary administrative burdens on providers by failing to adhere to EDI payment protocols.

The EDI Grade reflects data collected from the previous 365 days and is updated daily. Below is the list of the top ten claims administrators in our system, ranked by the volume of bills our providers send.

Sedgwick's EDI grade is a solid D, well below its peers'. Other major TPAs in our systems may have their shortcomings, but do not even approach Sedgwick's level of failure:

• Gallagher Bassett (EDI Grade B)
• CorVel (EDI Grade A-)
• AmTrust North America, Inc. (EDI Grade B)
• Athens Administrators (EDI Grade B+)

Sedgwick handles more claims than any of the TPAs above, and performs worse than all of them. The company with the largest footprint in California workers' comp is delivering the worst EDI compliance in the industry.

Then there’s the e-EOR problem.

e-EORs are not optional niceties. They're how providers confirm that an e-bill was adjudicated, what was paid, and why payment for any services was denied or reduced. When they're missing, late, or malformed, providers are left in the dark.

Over the past 365 days, daisyBill's data shows that only 40% of Sedgwick's e-EOR responses earned full credit (meaning they were received electronically, posted successfully, and arrived on time). The other 60% broke down as follows:

• 23% had payment balance errors,
• 16% arrived after the regulatory payment timeframe had elapsed,
• 18% were missing entirely, and
• 2% were so malformed they couldn't be posted at all.

The result: Sedgwick earns an F on e-EOR performance.

Together, an F grade for e-EOR compliance and an overall EDI grade of D paint a complete picture of a company that has made a sustained, institutional choice to treat provider-facing compliance obligations as optional.

If this is Sedgwick's level of concern for healthcare providers, how well can it serve injured workers?

daisyBill tracks the response to every one of your bills, so you know which payers are breaking the rules. Click below to learn more:

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