Sedgwick Claims Management Services, Inc. continues to violate a critical California payment requirement with apparent impunity.

The Third-Party Administrator (TPA) routinely fails to send electronic Explanations of Review (e-EORs) in response to providers’ electronic bills (e-bills), as state regulations require.

This week, daisyBill reported 83,925 new violations to the California Division of Workers’ Compensation (CA DWC), bringing the grand total to 298,034 since June 2022. This means that 298,034 times:

• Sedgwick violated a clear billing requirement.
• Sedgwick imposed an unnecessary administrative burden on practices, forcing staff to enter payment data from paper EORs manually.
• Sedgwick demonstrated that state regulations designed to protect providers are effectively optional for payers.

Every insurer or employer for which Sedgwick is the TPA should be aware that when an injured worker seeks treatment, Sedgwick often turns obtaining reimbursement for that care into an administrative nightmare.

Furthermore, workers are complaining about Sedgwick’s care management, as demonstrated by the TPA’s current battles with New York transport workers. Labor representatives have declared Sedgwick a “menace” to injured workers.

Sedgwick’s non-compliance is a choice. daisyBill’s EDI Grades (shown below) demonstrate that other TPAs voluntarily honor their legal payment obligations.

The CA DWC has responded with barely more than a shrug, imposing zero consequences or monetary penalties on the nation’s largest workers’ comp TPA. Since our last formal complaint to the agency, Sedgwick’s violations have continued to pile up as the CA DWC repeatedly lets the TPA off the hook.

Below, see Sedgwick’s non-compliance data and our latest formal Audit Complaint to CA DWC Administrative Director George Parisotto.

Sedgwick Non-Compliance Climbs in 2025

The most recent formal Audit Complaints daisyBill submitted to the CA DWC regarding this issue included data on e-bills providers sent to Sedgwick from April 1, 2024, through September 30, 2025.

The data (below) demonstrate that over that period, Sedgwick failed to send e-EORs for 83,925 (14%) of e-bills. Worse, Sedgwick’s rate of e-EOR non-compliance rose through 2025 so far, peaking at 19% in February before dipping and rising again to 18% in September 2025.

Verifiable EDI Data

dasiyBill publishes Electronic Data Interchange (EDI) “Grades” for every claims administrator (also known as payers or carriers) to which daisyBill clients submit e-bills.

This EDI grade reflects the claims administrator’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 top ten claims administrators in our system, as measured by the volume of bills our providers send.

Sedgwick’s EDI grade is a solid D. Clearly, Sedgwick flounders compared to other major TPAs, including:

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

If Sedgwick treats providers this abysmally, how does it treat injured workers? As Transport Union Workers Local 100 put it in their recent update, “...this predatory company [Sedgwick] is a menace to workers…”

Audit Complaint: 83,925 New Sedgwick Violations

Below is the formal Audit Complaint daisyBill submitted to CA DWC Director Parisotto, the CA DWC Legal Unit, and Sedgwick:

To: [Redacted]@dir.ca.gov
CC: [Redacted]@dir.ca.gov, [Redacted]@sedgwick.com
Subject: Sedgwick EDI Non-compliance: X12 835 Missing - Apr 2024 through Sep 2025 Count 83,925

Hello George and [Redacted],

I am submitting an Audit Complaint that documents verified data regarding workers’ compensation e-bills submitted to Sedgwick Claims Management Services, Inc. by daisyBill providers between April 1, 2024, and September 30, 2025.

• During this period, daisyBill providers sent Sedgwick 616,155 e-bills.
• Sedgwick failed to respond to 83,925 (14%) e-bills compliantly. In each instance, Sedgwick did not electronically send the provider an EOR (X12 835) as mandated by California EDI regulations.

A provider's electronic receipt of an EOR (X12 835) is a critical component of electronic billing because when a claims administrator sends EORs electronically, the data contained in the 835 file automatically: 

1. Closes the payment loop for a workers’ comp e-bill and
2. Posts to the respective e-bill significantly reducing a provider's administrative burden of manually recording payment information to the e-bill.

Since June 22, 2022, daisyBill has now filed 298,034 Audit Complaints with the DWC to report Sedgwick for failing to adhere to California EDI regulations.  As evidenced by Sedgwick’s continued lack of EDI compliance, the DWC is failing to enforce California workers’ compensation laws and regulations, which harms the providers who treat injured workers.

The table below lists the e-bill and electronic EORs (X12 835) data gathered for Sedgwick, showing Sedgwick’s consistent electronic EOR non-compliance throughout 2024 and 2025.

I’ve attached a zip file containing a CSV list containing 83,925 e-bills providers submitted where Sedgwick failed to return a mandated electronic EOR to the provider. The attached CSV list includes the following columns:

• Column L: [Bill] Transmission Date
• Column W: EOR (835) Compliance Due Date
• Column X: 835 EOR: Receipt Date - This column is BLANK because Sedgwick failed to send the provider an electronic EOR (835).
• Column AO: Patient Name
• Column AP: Claim Number

daisyBill takes the hassle out of workers’ comp billing, so your practice can say “yes” to injured workers. Click below for a closer look:

EASY COMP BILLING: DAISYBILL