Third-Party Administrator (TPA) Sedgwick Claims Management Services, Inc. continues to deny California providers’ Second Review appeals at high rates for an incorrect, laughably implausible reason: Sedgwick calls them “duplicate” bills.

To be clear, these are not duplicate bills. They are valid appeals that providers were forced to file to dispute instances in which Sedgwick failed to correctly reimburse a bill the first time.

When Sedgwick mislabels a Second Review appeal as a "duplicate" bill, the provider's only remaining option is to pay $195 to request Independent Bill Review (IBR) from the state within 30 days. That 30-day clock starts from when a provider receives Sedgwick’s wrongful denial, leaving little time to scramble together an IBR application and a filing fee.

If the provider fails to timely request IBR or can't absorb the cost, the provider forfeits the reimbursement owed, which Sedgwick keeps by default.

New data for November 2025 through March 2026 show that, of the 12,243 Second Review appeals daisyBill clients submitted to Sedgwick, the TPA improperly denied 4,024 (33%) as “duplicate” bills, forcing providers to choose between requesting IBR or forfeiting reimbursement. At $195 per request, that’s potentially $784,680 in costs that Sedgwick forced onto providers in five months, before counting a dollar of the improperly withheld reimbursement.

This is not a new problem. Since 2022, daisyBill has filed formal Audit Complaints with the California Division of Workers' Compensation (CA DWC) documenting 36,226 instances of Sedgwick denying Second Review appeals as “duplicates.”

There is no excuse for the largest TPA in the nation to make this basic error over and over, year after year, at scale. No other large payer approaches Sedgwick’s volume of “duplicate” denials.

Sedgwick is either knowingly violating the law or unbelievably incompetent; there is no third option.

daisyData: November 2025 – March 2026

The table below shows Second Review appeal data for the 25 largest claims administrators, as measured by the volume of bills daisyBill provider clients submitted to each between November 1, 2025 and March 31, 2026.

Sedgwick denied 33% of its denied Second Review appeals as “duplicates,” a rate 8x higher than the next worst offender, CorVel, at 4%. Statistically, Gallagher Bassett, Travelers, The Hartford, Intercare, Athens, Helmsman, Next Level, LWP, Republic Indemnity, and others denied appeals as “duplicates” 0% of the time.

Unmistakable Second Review Appeals

In California, when a payer improperly denies or reduces reimbursement, the provider's only option to dispute that decision is to submit a Second Review appeal within 90 days. Miss that window, and the amount in dispute is forfeit.

Every Second Review appeal submitted through daisyBill is unmistakably that: a compliant appeal, not a duplicate bill.

• We submit the appeals on DWC Form SBR-1, the standardized form for Second Review appeals since 2014.
• Box 10d of the accompanying CMS-1500 billing form states ‘BGW3,’ indicating an appeal and not an original bill.
• Box 22 of the CMS-1500 includes the resubmission code and the original Explanation of Review reference number.
• The word “RECONSIDERATION!,” in all caps, is in Box 19 of the CMS-1500.

It’s nearly impossible to mistake one of our clients’ Second Review appeals for a “duplicate” of the original bill. Yet, Sedgwick manages to do so anyway, at rates that no other payer can touch.

A Long History of the Same “Error”

Since 2019, daisyNews has documented and publicized Sedgwick’s inexplicable habit of denying Second Review appeals as “duplicates.”

• July 2019: daisyNews first reported that Sedgwick was incorrectly denying Second Review appeals as "duplicates."
• July 2021: daisyNews questioned the plausibility of Sedgwick’s frequent “duplicate” denials.
• June 2022: daisyBill filed a formal Audit Complaint with the California Division of Workers’ Compensation (CA DWC) reporting 4,930 “duplicate” denials.
• January 2024: daisyNews published Sedgwick’s “duplicate” denial data for 2021-2023.
• June 2024: daisyBill filed another Audit Complaint reporting 17,225 improper denials.
• December 2024: daisyBill publicly challenged the CA DWC to assert its ability to address Sedgwick’s “duplicate” denials.
• December 2024: daisyBill filed an Audit Complaint reporting 5,415 “duplicate” denials.
• March 2025: daisyBill reported that in 2024, Sedgwick labeled 55% of its denied Second Review appeals as "duplicates.” That’s 9,873 “duplicate” denials in a single year.
• October 2025: daisyBill filed an Audit Complaint reporting that Sedgwick denied 7,343 Second Review appeals as “duplicate bills” in the first three quarters of 2025.

Sedgwick’s violations are thoroughly documented, and state authorities are well aware of the problem. In total, daisyBill's Audit Complaints have documented 36,226 improper "duplicate" denials since 2022. Yet, Sedgwick’s behavior continues.

The CA DWC Failed Providers. New Leadership Must Do Better

The prior CA DWC administration has been aware of this issue since at least 2022. That administration imposed no consequences on Sedgwick that we are aware of.

The CA DWC's new leadership inherits that failure. The data are comprehensive, the pattern is irrefutable, and the authority to act exists. The only question is whether the agency will use it.

daisyBill will continue to file Audit Complaints and publish data as long as Sedgwick continues this behavior.

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