Who Is the University of California’s TPA? Not Sedgwick, Says Sedgwick.
Third-Party Administrator (TPA) Sedgwick Claims Management Services, Inc. makes frequent appearances in daisyNews for its persistent, well-documented pattern of violating California workers’ comp payment laws and regulations.
Adding to its voluminous record of failure and general provider torture, Sedgwick representatives are asserting that Sedgwick is not the TPA handling claims for the University of California (UC), when it is.
Sedgwick is the largest workers’ comp TPA in the state and the nation, handling claims for a massive portfolio of employers and insurers. While Sedgwick maintains an internal bill review department, some Sedgwick clients also engage Genex to conduct bill review on their behalf. UC is one such Sedgwick client, as hundreds of UC bills sent through our system over the last several months demonstrate.
However, on multiple occasions, Sedgwick representatives have told daisyBill agents inquiring about unpaid electronic bills (e-bills) that Sedgwick is not the University of California’s TPA.
When our agents contacted Genex to track down the missing payments, a Genex representative claimed that Sedgwick does not accept e-bills, which is patently untrue (and would be illegal if it were true).
Between Sedgwick and Genex, providers treating injured UC employees face far too many unnecessary obstacles to payment. This is the predictable result of UC engaging one of the least compliant payers in the state (Sedgwick) and engaging a bill review vendor with its own misinformation problem (Genex).
Ironically enough, two UC health systems refuse to treat injured workers.
According to a June 2026 white paper from the American Association of Payers, Administrators & Networks (AAPAN), UC Los Angeles and UC San Francisco, along with Stanford and Cedars-Sinai, have chosen not to treat workers’ comp patients.
AAPAN attributes this to a general nationwide physician shortage. A UC clinical director offered daisyBill a simpler explanation: they “won’t touch workers’ comp because we can’t get paid.”
UC’s health systems have experienced how hard it is to get paid for treating injured workers. Yet, its choice of TPA to handle its own employees’ comp claims exacerbates the exact problems driving providers out of the system.
Sedgwick Denies Its Own Client
daisyBill called Sedgwick to investigate one of several missing payments for one of our client’s UC e-bills. On the call, a Sedgwick representative asked for the claim number and the injured worker’s name before (incorrectly) reporting that Sedgwick is not the TPA for UC, stating (emphasis ours):
“Alright. See, I’m showing that this client is University of California and it says that we need to refer you to the employer or the claimant because we are no longer the TPA or bill review...”
We then contacted Genex, the designated bill reviewer for UC claims, to confirm whether they had the bill on file. The Genex representative confirmed the claim and provided the Sedgwick claims adjuster’s contact information, but reported that the e-bill was not on file.
Genex Claims Sedgwick Doesn’t Accept e-Bills
daisyBill placed another call to Sedgwick regarding a different missing payment. After requesting the bill date of service and the charge amount, a Sedgwick representative once again claimed that Sedgwick is no longer the TPA for UC claims (emphasis ours):
“...upon checking here, yeah, we do receive this bill. But as upon checking here we’re not the TPA or…bill review for this client. So, I suggest to reach out [to] the employer for this one.”
Once again, we followed up with Genex to confirm that daisyBill was submitting the missing e-bills using the correct Payer ID number for Sedgwick. On the phone, a Genex representative bafflingly stated “I don’t think they have a Payer ID,” before claiming that Sedgwick doesn’t accept e-bills and instructing us to snail-mail the bills (emphases ours):
“Okay, so they just answered and they said that no…they only have mailing option right now. So would you like the mailing address? Yeah, unfortunately…no electronic filing, yeah. Okay, so the mailing address I have for them is gonna be PO Box 14533, Lexington, Kentucky, ZIP code 40512.”
For the record:
- California Labor Code Section 4603.4 requires all workers’ comp payers to accept e-bills
- Sedgwick accepts hundreds of thousands of our clients’ e-bills annually, as reflected in our data (Sedgwick is abysmal at handling those e-bills, but it does accept them).
Of course, this isn’t the first time Genex incorrectly claimed that one of its clients doesn’t accept e-bills.
UC pays Sedgwick and Genex to handle its injured employees’ claims, and should demand that both stop misrepresenting the facts. Providers treating UC employees deserve straight answers and timely payment, and UC is the only party with the leverage to make that happen.
Meanwhile, providers should know the facts: Sedgwick is the University of California’s TPA, and the law requires it to accept e-bills. If a Sedgwick or Genex representative tells you otherwise, they’re astoundingly misinformed.
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The moment I started working for my boss, Ann at Work Comp Medical Services (woman-owned, small business) my supervisor at the time, explained that we work for the underdogs. The providers, who do work comp and their patients -indirectly. I saw how true this was, even for me as a collector, I get confused, exhausted and defeated dealing with the MPN's, the insurance carriers and the TPA's and who is actually responsible. DAISY BILL had a great article once, and I believe a video class... that showed exactly the chain of command, its still very helpful for me today! It may allow plausible deniability to insurance companies, their adjusters and TPA's but ONLY if you're un-informed. On an insurance follow up call, adjusters get to say, "Oh please speak to our bill review, we have nothing to do with the payments!" THEN bill review says, " The adjuster denied this bill, please call the adjuster." Their system is built for the rich to get richer without taking any accountability and passing the buck. On calls, my co-workers and I get volleyed back and forth AND we know the game. How much harder is it for patients and providers just trying to navigate WORK COMP.
Work Comp Medical Services submit IBR's for our providers, and yesterday I received a call from a claim adjuster, who has been in the business for 21 years and our IBR was the first one he has ever seen. He stated that IBR's are rare and most providers don't submit them! It costs to submit an IBR ($195.00), and many providers don't have the resources or staff to correct/dispute underpayments. So a provider who is just starting out and doesn't know the law, DWC regs, will accept the underpaid bill and not know their rights or OMFS fees and that they'd owed more. Most just accept it and move on. That is how insurance carriers keep making money and passing the buck... I really hope this new Insurance commissioner does right by the UNDERDOGS and those who fight for them.
Sedgwick has had issues for years and yet here we are decades later fighting to get paid. For an organization with Sedgwick’s experience and resources, the ongoing problems are hard to understand. I’m hopeful that the new AD, will bring real accountability and that we’ll finally see meaningful change. Fingers crossed!