Sedgwick runs the largest Third-Party Administrator (TPA) of workers’ comp claims in the nation.

This behemoth payer’s frequent incompetence, non-compliance with state laws, and claim mismanagement make workers’ comp needlessly difficult for providers and have labor representatives referring to the so-called “predatory” company as a “menace” to injured workers.

The latest alleged victims of Sedgwick’s failures: 9/11 first responders and survivors.

9/11 Health Watch Executive Director Benjamin Chevat delivered a scathing letter to Sedgwick CEO David North, alleging that the TPA has impeded care for 9/11 first responders and survivors by:

• Denying payment to providers
• Delaying care for non-cancer conditions
• Losing important records
• Refusing to return calls from patients seeking care

Nothing in Mr. Chevat’s letter comes as a surprise to daisyNews, or to the providers and injured workers across the nation who report being failed, poorly served, or abused by Sedgwick.

In his letter, Mr. Chevat states that he is “not expecting a response” from Sedgwick or its CEO. Similarly, we do not expect Sedgwick to make any statement or take any corrective action. In our experience, Sedgwick shows little interest in changing its operations, which have generated billions in profit for its private equity backers.

Like 9/11 Health Watch and others with limited ability to influence the powerful, we can only watch, report, and call out injustice.

9/11 Health Watch: Sedgwick’s Failures “Inexcusable”

Chevat excoriates Sedgwick, stating that first responders and survivors under Sedgwick’s purview are “facing significant challenges to receive needed care due to [Sedgwick’s] poor performance.”

Chevat lists four specific complaints about Sedgwick’s performance that will ring familiar to our readers (all emphases ours):

“1. Sedgwick not paying network providers bills submitted for payment to your company in a timely way, not providing providers support when bills are rejected so that they can understand the rejections and resubmit them. This is happening so frequently that many providers are refusing to continue to participate.”

daisyNews has documented numerous examples of Sedgwick improperly denying or reducing reimbursement to providers, including through the use of inapplicable or unsubstantiated discount contracts.

We have filed formal Audit Complaints with state authorities regarding how Sedgwick handles bills that it improperly denies, including Sedgwick’s apparent practice of mislabeling formal appeals for correct payment as so-called “duplicates” of the original bills.

“2. A large backlog of over 8 months in non-cancer certification requests that 9/11 Health Watch reported to the program last fall. This backlog means NPN members are delayed getting access to care for their noncancer conditions.”

Delaying and denying access to care is a seeming selling point for Sedgwick, which openly boasted of delivering clients a “return on investment” by derailing 54% of treating physicians’ requests for injured worker treatment.

Sedgwick removed that statistic from its website following public shaming by daisyNews; however, its current website still promises massive “savings” from its “automatic” treatment decisions.

“3. 9/11 Health Watch reports cases to the World Trade Center Health Program where your company continues to lose records that are provided to it by program members.”

New York transit workers are no strangers to Sedgwick’s penchant for bungling the paperwork, as evidenced by their reaction when Sedgwick failed to issue thousands of indemnity payments. Reportedly, this followed the Transportation Workers’ Union voicing concerns that Sedgwick lacked the “capacity” to manage workers’ claims effectively.

“4. Every week 9/11 Health Watch is contacted by a program member who can't get Sedgwick staff to return their calls seeking care.”

daisyBill employees know firsthand what it’s like to try to figure out where to access care under Sedgwick, to say nothing of what happens when providers attempt to inquire after payment or treatment requests. To say the least, communication is not Sedgwick’s superpower.

Keep the Pressure on Sedgwick

9/11 Health Watch joins daisyNews, labor leaders, and others in publicly calling out Sedgwick. At a recent convention, labor representatives unanimously passed a formal resolution stating that injured workers (emphases ours):

“...have been abused, ignored, mistreated, disrespected, and caused pain by the unprofessional, uncourteous, and uncaring third-party claims/benefits administrator, Sedgwick.”

So far, state authorities have shown little inclination to rein in Sedgwick’s abuses. But that does not mean there’s no value in continuing to shine the brightest possible light on Sedgwick’s shortcomings. As Vaclav Havel said:

"I don't know whether I'll be able to change certain things for the better, or not at all...There is only one thing I will not concede: that it might be meaningless to strive in a good cause."

daisyBill tracks your bills and payments, and alerts your staff to take action when necessary. Click below to see how we make comp billing easier, faster, better:

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