A question for California employers: If Sedgwick Claims Management Services, Inc. (Sedgwick) treats doctors as poorly as our data reveal, what is the impact on your injured employees?

The verifiable data are undeniable. In 2024, Sedgwick denied 17,941 Second Review appeals that providers compliantly submitted to secure lawful payment for treating injured workers. Shockingly, Sedgwick denied 55% of these appeals—9,873 in total—by mislabeling them as “duplicates” of the original bills. 

Based on available data, Sedgwick’s ‘errors’ occur at a significantly higher rate than other claims administrators. Given its current and historical data, it is implausible these incorrect Sedgwick denials reflect a glitch or occasional error.

Below, see the data confirming Sedgwick’s errors—and learn why California employers whose injured workers’ care is subject to Sedgwick’s practices have cause for concern.

Sedgwick: In a (Non-Compliance) League of Its Own

Sedgwick’s non-compliance appears more pervasive than that of other claims administrators, disproportionately negatively impacting providers who treat California’s injured workers. To grasp the scale of Sedgwick’s misconduct, the 2024 data presented in this article compare Sedgwick to other large California claims administrators and demonstrate the following:

• Sedgwick, the worst offender, incorrectly labeled 55% of the Second Review appeals it denied as “duplicates.”
• CorVel, the second-worst offender, incorrectly labeled 6% of the Second Review appeals it denied as “duplicates.
• Gallagher Bassett, Travelers, and most other claims administrators denied 0% of Second Review appeals as “duplicates.”

As previously reported, this is not a new development. Since 2022, daisyBill has submitted Audit Complaints to the California Division of Workers’ Compensation (CA DWC) documenting 27,570 instances of Sedgwick’s failure to respond compliantly to providers’ Second Review appeals.

Sedgwick’s 55% ‘duplicate bill’ denial rate in 2024 raises serious concerns about potentially systematic issues, inefficiencies, or both. All “explanations” should alarm employers whose injured workers’ care is managed by Sedgwick.

Why Sedgwick Should Alarm Employers

If Sedgwick consistently violates California’s payment requirements to doctors—professionals who (allegedly) have legal protections and avenues for appeal—how do you think they treat injured workers, who are far more vulnerable?

• Until recently, Sedgwick advertised denying 54% of workers’ doctors’ requested treatments.
  
• If Sedgwick ignores providers’ rights with impunity, how much easier is it to trample the rights of injured workers who lack the resources to fight back? 

Employers should be deeply concerned by Sedgwick’s lack of compliance. Mismanaged injured workers are often compelled to hire an attorney, which can significantly increase an employer’s costs.

The CA DWC Knows—and Does Nothing

The CA DWC is fully aware of Sedgwick’s repeated violations.

Yet, despite being armed with exhaustive data and undeniable evidence, the CA DWC has not taken decisive action on Sedgwick’s non-compliance. Sedgwick’s violations go unchecked.

The table below shows Second Review appeal data for the 25 largest claims administrators, measured by the volume of bills our provider clients submit to each. For 2024, for each claims administrator, we list:

• Original Bill Count: The number of original bills our providers submitted
• Second Review Count: The number of Second Review appeals our providers submitted
• Second Review Deny Count: The number of Second Review appeals the claims administrator denied
• Second Review Deny "Duplicate" Bill Count: The number of Second Review appeals the claims administrator incorrectly denied as “duplicates”
• Second Review Deny “Duplicate” Bill Percent: The percentage of Second Review appeals the claims administrator (incorrectly) claimed were “duplicates” of the original bill in question

The Cost of Doing Nothing

This TPA’s pattern of non-compliance raises concerns about adherence to workers’ compensation laws and regulations, potentially impacting both injured employees and their employers.

Employers who value their workforce may wish to carefully review Sedgwick’s handling of provider payments and compliance practices to ensure alignment with their expectations.

If Sedgwick treats the doctors caring for your employees this way, consider how it may reflect on your business.

daisyBill makes treating injured workers easier, faster, and less costly. Request a free demonstration below.

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