• Report: #764321

Complaint Review: Sedgwick Claims Management

  • Submitted: Fri, August 12, 2011
  • Updated: Fri, August 12, 2011

  • Reported By: Anonymous — Tampa Florida United States of America
Sedgwick Claims Management
Lake Mary, FL Internet United States of America

Sedgwick Claims Management Sedgwick CMS Horrible customer service and bogus excuses not to cover Internet

*Consumer Comment: Extremely difficult to deal with and unresponsive

*General Comment: Im with you....

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I have been having carpa-tunnel problems for a while now since I work in a office all day long and use the computer/mouse up to 10-11 hours most days.

At first is one of those things that you think will go away but little by little got worse and the pain became more noticeable in my hand. Based on personal experience worker comp cases are usually denied or hard to get. I used to be in HR before so I have been in the employer side fighting and coordinating with the insurance carrier, so that is why I know. Companies always try to fight it so they do not have to pay.

Well, unfortunately it was my turn to be sick and was on the other side of the equation . I needed for Workers comp to help me cover my medical treatment.  Sedgwick is the carrier that my employer chose and it has been a horrible experience. Since I know how they work , I tried to get my medical  treatment started and went to an orthopedic doctor becuase I did not wanted to wait and wait to get an answer from Sedgwick before I got an approval to get treatment. It has taken 3 months or so before I get even something going (just to get some official correspondence) and I filed my claim with them 3 months ago.
I have been assigned to 3 different adjusters, 2 of them being really incompetent. You call them, leave VM and email them in a very professional and courteous manner and they never get back to you. In fact, a couple of times one of their adjustors a Tonya in the Lake Mary location, accidentaly answer the phone (they never do) so when I mentioned my name and case number, cut me off and sent me to some other voice mail (like I would get an call back !). I called right away a few times right away and did not answer, I tried once more and was cut off again and xfr with no further explanation.
I was able to get her supervisor phone #, never heard back from the superisor either. The phone goes into VM automatically every single time.
I complained to my employer and only when someone here in HR told them to call me, they did.. just a quick message..., but again when I call back never, never answer the phone.

This oddyssey has been happening for while now. Very furstrating to get an answer, nobody is available. Until now (becuase I copied in my follow up email a big manager here), the adjuster did call, and gave me the most stupid excuse... that becuase I was pregnant 2 1/2 years ago and study on my own at home, that this is causing my carpatunnel and that they will denied it!!
How can this be? Somehow a baby causes my hand to go bad? come on!  and even if it was related to pregnancy, I never had any issues while pregnant, my symptons started much later.. I only wanted to get a reimbursement for my out of pocket expenses since I took care of my condition with my regular insurance than waiting to get something from them approved. It is not like I am asking them to pay thousands of dollars.. the most it would have been a few hundred dollars..
They are so cheap!

This is just an FYI about Sedgwick and that they can be less than proffesional when dealing with their claims. They will come up with any stupid excuse to avoid paying anything. Good luck if you find yourself in a similar situation.

It is a shame that large employers hire these third party administrators to just save themselves some buck. Before coming up to such stupid arguments they should have medical proof (which they don't on my case). I am sure thinking about seeking legal counsel on this.

This report was posted on Ripoff Report on 08/12/2011 11:26 AM and is a permanent record located here: http://www.ripoffreport.com/r/Sedgwick-Claims-Management/internet/Sedgwick-Claims-Management-Sedgwick-CMS-Horrible-customer-service-and-bogus-excuses-not-to-764321. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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#1 Consumer Comment

Extremely difficult to deal with and unresponsive

AUTHOR: disgruntledBizEmp - ()

I have recently been diagnosed with a serious brain condition, and have been recieving intense treatment.  Sedgewick has been nothing but difficult to deal with, I properly filed the claim as instructed by my employer, Comcast Cable, and was instructed to take the packet I recieved within 1-3 days to my doctor and have them completed and returned in order to have my claim approved.  I recieved the packet as promised 2 days after filing the claim as promised, and I immeditly took it to my doctors office.  The office staff assured it would be completed and faxed back within 24 hours, and that they would email me a copy of the forms sent as well as the confirmation page their fax machine spit out confirming it was sent and on what date.  

A week passes and my claims manager calls to tell me that they have not recieved the paperwork and I only had an additional 2 weeks to return the forms or the claim would be denied.  I immeditly (tried) to tell her that the forms were faxed and that I could provide her with the forms my doctor has sent me as well as the fax confirmation form, she continued to talk over me even though I had asked multiple times to have a moment to speak.  

I finally firmly asked to speak with her supervisor, her response "Go For It!", then continued to tell me i would not be paid if the forms were not back by blah blah blah.  I again demanded a supervisor, she again said I'm seeing if they are available, and kept on repeating the same information over and over.  I finally got a supervisor on the phone and the first thing she said was, "is there something I can tell you that Katie hasnt already told you??"  

I snapped, I repeatedly asked for her email address so that I could provide the forms they stated were not returned by the doctors office and she again repeated "is there something i can tell you that katie didnt already??"  This went on for so long that I finally asked to speak with her supervisor, at which point she hung up on me.  I immeditly called the 855 number back and was told by the person that answered that both my claims manager Katie, as well as her supervisor Jess were not in the office today and that I must be mistaken about when I spoke to them.  Figures.  Worst customer service ever (this coming from a Comcast employee, who's customer service is also TERRIBLE).

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#2 General Comment

Im with you....

AUTHOR: CTSHooter - (United States of America)

Im with you on this one....

My employer uses them also - hurt my back (outside of work) one time - woke up in the morning and fell as i tried to get up - back was completly messed up - i was out of work for weeks - not able to sit or lay flat..had to sleep in a recliner - the only position that I was able to bear was in the recline position...not flat, but not straight up...numerous letters from my doctors but some doctor at a desk 2K miles away said I was able to sit at a desk and work no problems...

in the end 3 weeks of lost pay....but I guess we should not expect anything more from a company that gets finacial rewards for saving other companies money.
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