Sedgwick’s Shell Game? 139 CA Employers Exposed

Sedgwick’s Shell Game? 139 CA Employers Exposed

A California workers’ comp physician recently received eight checks totaling $110,858 from Careworks, a vendor affiliated with Third-Party Administrator (TPA) Sedgwick.

Those checks didn’t pay for a single employer’s injury claims—or even a single claims administrator. Instead, they covered 566 medical bills for 311 injured workers across 139 different employers.

Careworks even mixed in bills for injured employees covered by entirely different entities, including QBE North American, National Interstate Insurance, and AmeriTrust Group, Inc.

When viewed through the lens of these 566 payments, employers face an opaque system that makes it extremely difficult to track their money through Sedgwick’s vendor relationships.

Just as alarmingly, daisyData from Sedwick's electronic Explanations of Review (e-EORs) show that:

  • 32% of Sedwgick payments contain reimbursement errors—the amounts are invalid or don’t reconcile
  • 100% of Sedgwick payments contain adjustment errors—Sedgwick misapplied or misreported bill reductions

Sedgwick pools employer dollars with funds from hundreds of other employers and routes them through Careworks. The result is that employers may have no choice but to rely on Sedgwick’s reporting to understand where payments went. This obscures financial accountability and creates administrative chaos for employers and providers trying to reconcile records, resolve disputes, and ensure compliance.

Additionally, all 566 payments were untimely under California law and failed to include the mandatory e-EOR. This forces practice staff to spend hours manually parsing and posting payments to each bill.

Sedgwick’s practices result in an accounting and revenue management nightmare for providers in violation of state requirements. The 139 employers we list below deserve to know where their money is going, to whom, and for what purposes.

Employers, Start Paying Attention

daisyBill will file Audit Complaints for every single one of Sedgwick’s violations of state workers’ comp law.

Unfortunately, employers should harbor no illusions that the California Division of Workers’ Compensation (CA DWC) will step in. The agency’s track record suggests that ignoring Sedgwick’s abuses outweighs any obligation to protecting providers or injured workers.

Employers expect that their money will cover the care of their injured employees. But when Sedgwick funnels employer dollars through Careworks, those dollars enter opaque processes that employers can’t follow. Employers must rely on Sedgwick’s reporting to determine whether their money funds treatment and recovery.

Of course, as history and daisyData make clear, Sedgwick’s compliance record is dismal, and the payment data they send to daisyBill is consistently error-filled.

While doctors can choose to leave the system, employers cannot—they must continue paying for workers’ comp coverage and hoping to get what they’re paying for. If you’re one of the 139 companies below whose money was tossed into this opaque payment system—which resembles a game of 139-Card Monte—it’s time to demand answers.

Employers must pressure Sedgwick to:

  • Stop commingling their funds with those of other employers
  • Pay providers on time and in compliance with California law
  • Provide verifiable, transparent accounting of where their workers’ comp dollars are spent

The CA DWC won’t force Sedgwick to change its behavior. Providers are powerless to do so. It’s up to employers to demand better for their employees.

Claims Administrator

Employer

Bill Count

Payment Amount

Sedgwick Claims Management Services, Inc.

Northrop Grumman

71

$13,281

Target Corporation

33

$6,041

Amazon.com, Inc.

29

$5,531

AT&T SERVICES, INC

24

$4,414

The Boeing Company

11

$3,504

Traders Joe's Company

21

$3,406

Compass Group USA

13

$2,897

Pacific Bell Telephone Company

13

$2,551

Glendale Unified School District

9

$2,420

Valley Village

11

$2,273

AHGL-Adventist Health Glendale

12

$2,272

ABM INDUSTRIES

9

$2,174

ANHEUSER-BUSH, INCORPORATED

11

$1,803

General Motors

8

$1,719

DESKMAKERS, INC

6

$1,578

Express Services Inc

8

$1,557

ENTERPRISE RENT-A-CAR

8

$1,415

Housing Authority CIty of Los Angeles

7

$1,353

Ross Stores, Inc

7

$1,321

Ventura County Sheriff

4

$1,320

YRC INC FREIGHT

7

$1,214

Long Drug Stores California, LLC

6

$1,194

Wells Fargo Bank

7

$1,193

Hobby Lobby Stores

6

$1,127

DOLLAR GENERAL CORPORATION

7

$1,086

Mongomery Ward

3

$1,015

VILLAGE JOANN FABRIC AND CRAFTS

4

$953

Macy's

5

$865

BAKERSFIELD ARC, INC

3

$827

Montague Charter Academy

2

$803

DHL EXPRESS, INC

3

$752

ARCHDIOCESE OF LOS ANGELES

3

$752

PERFORMANCE TEAM LLC

3

$729

TRINITY HEALTH

2

$631

Humangood

3

$624

D.D.R. PIZZA, INC

3

$624

2452 CENTRE POINT/VILLAGE JOANN FABRIC & CRAFTS

3

$603

Hub Group Inc

3

$594

PUBLIC STORAGE

4

$590

STARR COMPANIES

2

$551

Saputo Cheese

2

$551

RANCHO SIMI RECREATION AND PARK DISTRICT/CAPRI WORKERS COMP

2

$551

MILLCREEK ELECTRICAL, INC

2

$551

M S AEROSPACE INC

2

$551

Skywest Airlines, Inc.

3

$549

MCKESSION CORPORATION

3

$549

AVELO AIRLINES, INC

2

$516

VONS COMPANIES, INC

3

$496

THE HERTZ CORPORATION

3

$496

HERITAGE CARE, LLC.

2

$486

TRUSTAFF MANAGEMENT, INC

2

$476

Super King Market

2

$476

Panda Express

2

$476

JURUPA RECREATION DISTRICT/CAPRI WORKERS COMP

2

$476

LAKEWOOD REGIONAL MEDICAL

3

$442

GROUND SERVICES INTERNATIONAL

3

$442

ALBERTSON'S

2

$423

Sony Corp of America

1

$421

RESTAURANT FRANCHISE CAPTIVE PROGRAM

2

$402

Montebello Unified School District

2

$402

American Textile Maintenance

2

$402

Morley Builders Inc.

2

$398

SCHNEIDER NATIONAL CARRIERS

2

$348

SANTA CLARITA VALLEY SCHOOL FOOD SERVICES

2

$348

RTW RETAILWINDS, INC

2

$348

Prime Communications L.P.

2

$348

Langham Hotels Pacific Corporation

2

$348

LA Missions Hills

2

$348

Farmers Group, Inc.

2

$348

COUNTY OF VENTURA FIRE DEPARTMENT

2

$348

7-Eleven

2

$348

1556 Cahuenga Partners, LLC

1

$328

WKS Restaurant Corporation

2

$295

WESTERN ROADIES INC

2

$295

VANGUARD CAR RENTAL USA

2

$295

Transdev Services

2

$295

Tradesmen International, Inc

2

$295

SAS RETAIL SERVICES

2

$295

SAS OVERHEAD GENOPS ALB SO CAL

2

$295

RITCHIE TRUCKING SERVICES INC

2

$295

SAFELITE GROUP, INC

2

$295

PJCA-6

2

$295

McGee Air Services

2

$295

LA ARENA COMPANY, LLC

2

$295

Golden State Water Company

2

$295

GOLDEN ROAD BREWERY-SAN FERNANDO

2

$295

Glendale Memorial Hospital and Health

2

$295

FIRST TRANSIT INC

2

$295

Excel, INC

2

$295

Ecology Auto Parts, Inc.

2

$295

DOLLAR TREE STORES

2

$295

Delta Air Lines, Inc

2

$295

CVS Pharmacy

2

$295

CEC ENTERTAINMENT INC

2

$295

BLUE SHIELD OF CA

2

$295

AHSV-ADVENTURES HEALTH SIMI VALLEY

2

$295

Whittier Area Schools Insurance Authority

1

$276

Penny Lane Centers

1

$276

Northridge Hospital Medical Center

1

$276

National Alamo/ Enterprise Holding

1

$276

Big Lots

1

$276

AGGCAO Arch #3

1

$276

3B HOLDING COMPANY

1

$276

AHWM- Adventist Health White Memorial

2

$215

William S. Hart High School

1

$201

JC Penney

1

$201

Avibank MFG., Inc

1

$201

ASCIP

1

$201

Walgreens

1

$147

TCI TRANSPORTATION SERVICES, INC.

1

$147

ST. JOHN'S PLEASANT VALLEY HOSPITAL

1

$147

SAS OVERHEAD-GENOPS-KROGER-FOOD 4

1

$147

MOMENTUM

1

$147

LOS ANGELES SEPULVEDA/ THE PARKING SPOT

1

$147

Jetsuite, Inc

1

$147

Hilton Los Angeles/Universal City

1

$147

High Desert Gateway

1

$147

DHL Global Mail

1

$147

DFA Dairy Brands Fluids, Inc

1

$147

Cor Restaurant Services

1

$147

Calportland Company

1

$147

Brightspring Healthcare Services

1

$147

Bank of America Corp

1

$147

ADVANCED STERLIZATION PRODUCTS

1

$147

Lee's Maintenance Service Inc

1

$49

EVERGREEN PHARMACEUTICAL OF CALIFORNIA

1

$18

Cal-South Hampton

1

$14

Sedgwick Claims Management Services, Inc. Total

542

$106,017

QBE North American

BLUE CITY HOLDINGS, LLC

1

$610

IDG HOLDCO, LLC

2

$476

Tower Wav, LLC

2

$402

GREEN 16, LLC

2

$348

MSX INTERNATIONAL, LLC

1

$147

QBE North American Total

8

$1,984

National Interstate Insurance

STORER TRANSPORTATION

4

$581

Thompson & Harvey Bay Area, LLC

3

$507

STUDENT TRANSPORTATION OF AMERICA

2

$448

National Interstate Insurance Total

9

$1,537

AmeriTrust Group, Inc.

Kern Harvesting, Inc

2

$402

TROPHY AUTOMOTIVE DEALER GROUP

2

$348

Cal Enterprise Labor Solutions

2

$295

POZZI HILL, INC

1

$276

AmeriTrust Group, Inc. Total

7

$1,320

Grand Total

566

$110,858


 We can’t track where premiums go—but we can track every cent of providers’ reimbursements. Click below to learn more:

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