Dollar Tree Stores/Sedgwick Refuse Payment for Authorized Treatment
Sep 21, 2021
Authorization is, by definition, a promise.It’s the promise that, once a doctor obtains authorization from an employer to treat an injured worker, the employer will pa...
Sedgwick: Sketchy EOR Math for LA Unified School District
Aug 11, 2021
Sedgwick recently returned an Explanation of Review (EOR) that failed to fulfill a crucial requirement: showing how Sedgwick actually calculated the reimbursement amount paid...
Sedgwick Violates LACoFD Employer Contract, IBR Drops Ball
Jul 15, 2021
A physician agreed to serve as Independent Medical Examiner (IME) for the Labor Management Committee (LMC) representing the Los Angeles County Fire Department (LACoFD) and Lo...
Sedgwick Denies Second Review Appeals as "Duplicates"
Jul 12, 2021
Sedgwick has a Second Review problem.On too many occasions, Sedgwick incorrectly denies providers’ Second Review appeals as “duplicate submissions” of the original bil...
IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance
Jul 6, 2021
Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...
Sedgwick & Mitchell Setting Up a Legal Protection Racket?
Feb 22, 2021
Sedgwick, in cahoots with Mitchell, seems to be setting up some kind of protection racket where, in exchange for providers accepting lower reimbursement, Sedgwick/Mitchell wi...
Sedgwick Fails the University of California
Sep 18, 2020
Today we are focusing on a self-insured employer, the University of California, and its third-party administrator, Sedgwick. Unfortunately, Sedgwick is not complying with Cal...
Clearinghouse Error - WorkCompEDI Misdirects Bills
Sep 8, 2020
Recently, one of the six clearinghouses hired by claims administrators to accept electronic workers’ comp bills suffered a technical error which resulted in the clearinghouse...
Sedgwick Erroneously Rejects Provider Bills
Feb 13, 2020
Workers’ comp providers, be aware: insurer Sedgwick has recently incorrectly rejected multiple bills on erroneous grounds, necessitating that time and resources be spent inve...
Sedgwick – IBR Hall of Shame
Jan 17, 2020
All too often, insurance companies and claims administrators find unfair ways to deny, delay, and otherwise wiggle out of paying the workers’ compensation reimbursements that...
Huntington Hospital & City of Beverly Hills Change TPAs
Sep 20, 2019
Attention providers: two California employers switched third-party administrators (TPAs).Huntington Hospital transferred claims from Sedgwick to AthensCity of B...
York (aka Sedgwick) Fails Math: EORs Literally Don't Add Up
Sep 19, 2019
York Risk Services, which was acquired this month by Sedgwick, has significant math troubles. York recently returned Explanations of Review (EORs) which obfuscated the effect...