FedEx is a massive American company with over half a million employees. The shipping giant has chosen to entrust Sedgwick Claims Management Services, Inc. with managing the care of those employees in the event of a work injury.

We urge FedEx to take a closer look at how Sedgwick executes that important responsibility.

We’ve shared example after example of Sedgwick’s abysmal compliance with workers’ comp laws and regulations, and have reported this Third-Party Administrator (TPA) to state authorities for 359,626 specific violations so far. Sedgwick consistently imposes needless administrative burdens and payment torture on providers (and hasn’t exactly earned workers’ love, either).

Sedgwick has bungled FedEx cases specifically on multiple occasions, in tandem with its bill review vendor, Genex. Today, we offer another example.

After Segwick failed to respond to one original bill and five different Second Review appeals disputing payment denials and reductions for a single FedEx employee’s care, daisyCollect called Sedgwick for an explanation. Per the instructions in Sedgwick’s automated message, we left a voicemail requesting compliant Explanations of Review (EORs) in response to those bills and appeals.

Instead of the EORs, we received a fax instructing us to contact Genex to obtain them.

We’ve been down this road before. Previously, when investigating a payment denial for the same FedEx employee’s claim, we contacted Genex. Genex directed us to Sedgwick’s FedEx claim unit, where no one returned our calls. In a separate incident for a different FedEx claim, both Sedgwick and Genex insisted that only the other could provide an EOR.

In both previous cases, we called Sedgwick’s “dedicated” FedEx claim line, where no one answered.

Providers, be aware of this dynamic if an injured FedEx employee seeks care at your practice. FedEx, consider your company notified that your TPA is giving doctors valid reasons to steer clear of your workforce.

Sedgwick & FedEx: One (Payment) Battle After Another

In the first incident with this particular FedEx claim, Sedgwick sent an electronic EOR (e-EOR) denying payment for authorized treatment. In violation of state law requiring EORs to include “The basis for any adjustment, change, or denial,” the e-EOR listed no denial reason.

Since Genex conducts bill review for Sedgwick’s FedEx claims, we called Genex to obtain a paper version of the e-EOR with denial reasoning. Genex claimed that only Sedgwick could provide it, and directed us to Sedgwick’s dedicated FedEx claim unit. When we called, no one answered or returned our messages.

With no other option, daisyCollect submitted a Second Review appeal disputing the (literally) baseless denial.

Subsequently, Sedgwick improperly denied or reduced payment for four other bills on this FedEx worker’s claim, forcing us to submit a total of five Second Review appeals. Sedgwick ignored all of those appeals, along with yet another original bill, sending no EOR or e-EOR whatsoever by the legal deadline.

For those keeping score, for a single FedEx worker’s injury, Sedgwick:

• Failed to explain the denial reasoning for one original bill
• Improperly denied payment for three original bills
• Improperly reduced payment for one original bill
• Ignored five separate Second Review appeals
• Completely ignored one original bill

The Sedgwick/Genex Loop of Doom

Once again, our agent got on the phone, calling Sedgwick to demand the required EORs.

An automated message instructed our agent to leave a voicemail requesting any missing EORs; they did so. In response, daisyCollect received the fax below, stating that Sedgwick is not the bill reviewer and to contact (you guessed it) Genex.

And so, the infinity loop of mutual, circular ineptitude begins again.

Experience has shown us that if we call Genex, Genex will direct us to Sedgwick. Sedgwick will direct us to Genex. The snake will eat its own tail, the law will remain broken, and the provider will remain unpaid.

As a reminder, California law and regulations dictate that Sedgwick and only Sedgwick bears the legal responsibility for compliant responses to bills for FedEx treatment, even when they farm bill review out to Genex.

Sedgwick Can’t Stop Failing

The California Division of Workers’ Compensation (CA DWC), in theory, is legally required to collect billing and payment data for every claim in the state to monitor for patterns of non-compliance and abuse.

Since the agency has utterly failed to do so (along with many of its other responsibilities), daisyBill maintains our own database of every single bill that moves through our system.

Sedgwick is the largest payer in that system (and the nation) by far. It’s also among the worst, as measured by hard data on its compliance rates. The TPA earns a “Grade” of D for its handling of providers’ electronic bills (e-bills) for comp treatment.

While the TPA performs well in accepting e-bills and acknowledging receipt, its consistent failure to send e-EORs, including in response to Second Review appeals, has been an ongoing issue for the past several years.

Sedgwick’s persistent violations and indefensible treatment of California doctors are made possible by the CA DWC, which has received truckloads of formal Audit Complaints from daisyBill documenting serious violations at scale and has done nothing of substance.

California workers’ comp stakeholders should be aware of this agency’s failure. Doctors should be aware of the pitfalls of treating workers when Sedgwick manages the claim. FedEx should be aware of Segwick’s impact on providers and its employees.

There are no excuses for any of this.

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