Report: #380244

Complaint Review: Sedgwick CMS

  • Submitted: Fri, October 10, 2008
  • Updated: Tue, April 21, 2009
  • Reported By: Chesapeake Virginia
  • Sedgwick CMS
    P.O.Box 14482
    Lexington, Kentucky

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With all due respect, I have written to you in Re: Workman's Compensation in Virginia, and Specifically AIG Sedgwick CMS Workman's Compensation Insurance Company and Insurance Co.of the State of PA, they are intermingled but under the same umbrella AIG I didn't write to you because I wanted you to make the insurance pay that will never happen, I am trying to explain how Workman's Compensation Laws here in Virginia are outdated and need to modified and changed, Additionally I believe there needs to be Bill put in place and Federal Intervention for Insurance Companies providing Worksman Compensation Insurance Such as AIG, I don't believe its just a State Issue and responsibility and Virginia should be the only Governing Authority due to the impact the unfair and greedy Insurances have on America's injured Workers , This is Epidemic thru out United States, Workers Comp forums on the internet suggest such and any one whom has been injured on the job isn,t wanting a hand out remember they were working ,There is a 5 year cap on any benefits and than your on your own, The Federal and State Government is than left with the providing Public Assistance to the permanent injured and disabled. Most often the injured get or develop permanent disabilities some serious some slight, some have to take medications a life time and will still need Continued care, AIG Sedgwick is a Workmans Compensation Provider and the same company that has put thousands of injured workers on the street , denied basic medical care and we the American people have just bailed them out , I ask what has Congress,Senate, Senators of Virginia, House of Delegates done to look into this matter and done for the injured worker whom pays taxes on every workers comp check they get and who has paid taxes since they were old enough to work before injury, and those partially disabled and those whom work with injuries and those whom have recovered from injuries we all pay taxes too. Please read on Its important , I give you permission to look at my file at worksman comp, and I invite you to call me for further discussion, it is my experience that worksman comp insurance companies, have manipulated every law in Virginia to escape paying for injuries and its related care, I am asking you to personally change these laws so thousand of injured workers are better protected. When I'm better I intend to be in Richmond to continue get these laws changed Federally and In the Commenwealth of Virginia and I am hoping you will support the much needed changes. The Workman's Compensation laws are very old devised in early 1900s to protect the injured worker and prevent injured workers from becoming a public burden and stop law suits, Laws were put into place that would give injured workers health care and treatment and 2/3rds of thier pay, in trade for a no fault law and inability to sue protecting the employer and the insurance company, I am informing you that it is no longer effective and doesn't work, if a study was done , I'm certain you would come to the realization that Virginia citizens are not getting a fair deal and are being hurt. Do you trust the integrity of Greedy Insurance Companies and their Practices? I want to tell you my story, I've been a nurse 25 years I am a registered voter, a tax payer ,a home owner, On June 13th 2008 I was injured at my place of employment Nansemond Point a Nursing Care facility in Suffolk, Virginia I slipped and fell on water on the floor. Since that time my life has been turned upside down, and I have suffered and continue to suffer extreme pain due to several injuries 2 of which are 2 torn miniscus, 1 in each knee, left and right, I have had MRIs they indicate the tears and have clinical indicators of such, The Orthropeadic Surgeon Dr. R. Neff of Othropedic Associates is a Workman's Compensation designated Physician in his opinion I need surgery to correct these injuries and they are causal to the fall, I can not walk due to the pain is excrutiating and I cannot work, A simple 30 minute surgery is all that is keeping me from getting better and returning to a normal life and work and to releave this pain {arthroscopic knee surgery}, AIG Sedgewick insurance company has done everything to avoid from paying , everything from telling me that the were going to contact me and send me to another physician for a Independent Medical Examine (second opinion) of which never happened, to denying the claim, to determining it was not medically necessary , Now saying I can appeal, Ok the problem here Is I am in extreme pain and I'm suffering 24 hours a day 7 days a week each day is much worse than the day before I have and am developing other problems due to delayed care and proper treatment, Time is of essence! I am now almost non ambulatory and do not sleep nights due to excruciating pain , The Orthopedic Surgeon Dr. Robert Neff is a Great Doctor and exhausted everything, However he is the Workman's Compensation Designated Physician of which Sedgewick AIG sent me to, His practice is largly composed of Workman's Comp. Cases so his practice is dependent upon its Income and Business , without questioning Dr. Neff's integrity and with respect for him and his practice, Im certain he is a shrewd business man and wouldn't want to loose a customer and potential future income from Workman's Compensation Insurance Companies and or AIG Sedg Wick , Having said that he has tried to seek surgery and has done what he could reasonably do with the complexity of the his circumstances and mine, AIG Sedgewick has made it impossible for him to do what he should do and prevents him from what most independent non associated work comp Doctors would do thats Is (what is in the best interest of the patient), Dr, Neff's payroll and business cost are no more unusual and probably higher due to the red tape and unnecessary procedures and paper work Workmanscomp Insurance Companies have forced designated physicians and there practices to comply with as if they are you worst imaginable HMO and as if they are a defense team for the biggest liability case of the century and they get away with practicing as such because they fall under the umbrella of liability insurance and not health insurance , Although they practice as the worst HMO you can imagine, Injured Workers are not post accident motor vehicles where it is usual amoung most, you call your motor vehicle insurer and they pay for the repairs, Workman's Compensation Insurance is not health insurance either where if your doctor makes the judgement that you have a serious injury and orders a MRI for diagnoses within a day or 2 you had an mri, and if he feels you need surgery you are scheduled and with in a week your surgery is over and done, Workman's Compensation Insurance doesnt work that way, You have to wait months for approval if they approve it at all for medical care and treatment as well as any type of test or diagnoses and you wait and wait and wait and wait and suffer and suffer and suffer and suffer and than it may or may not happen, in the mean time your physician is obligated to get you back to work even if its means forcing you to drive a motor vehicle to work while you are on many medications that impairs you ability to drive and function and perform your job duties pre injury and even if you are diagnosed with severe injuries that impair you ability to walk and drive and even if your pain and injuries are so bad that pain medications do very little to help and you cannot focus on anything but your pain, and in the mean time your pay is reduced to nothing , and all those test the doctor orderedand any other related care you may have received are now into collections on your credit report because they didn't pay the bill or there was some mistake somewhere or they didn't approve it, Physicians are afraid of Workman's Compensation Insurance Companies they are on the payroll of the Insurance company and are very willing to even protect the Insurance company and their jobs and income and break from standards because its your word against theirs, your at their mercy , Don't question or disagree with the physician there are consequences, Thats Workman's Compensation and Thats AIG Sedgwick and thats the way I have been treated and I'm certain Im not alone, Your only recourse is take it to the Workman's Comp Commission and they have to follow the laws of Virginia and the Rules of the Commission and they are back logged and overwhelmed , often trying to mediate between Big Money Insurances and their lawyers and the financially devastated and injured and suffering worker , It isn't fair and it isn't working and you have no recourse you aren't even allowed to use your own private health insurance , seek a non bias and independent physician and submit his opinion and medical care treatment , because he or she is not a designated Workman's compensation physician. These insurance Companies Specifically AIG Sedgewick dictate care, have care protocols unregulated ,have poor to no standards of care unregulated, and are unregulated in health care and health insurance practices although they behave and proceed as a unregulated health care insurance company when they are a Liability Workman's Compensation Insurance and thier CEO's are making big money and have no regulations and or over sight and its our fault because they have been able to get away with it so long and we citizens of Virginia have allowed them to get away with it, I believe there is a crisis in the Workman's compensation laws and its associated industry, they use every tactic possible and often injured workers give up and go untreated and/or if they dont give up they receive less than standard care and the worse care and treatment if any , You are treated differently than patients using private insurance , you are stigmatized and stereo typed , In addition more often than not injured workers develop more complications as a result of Workman's compensation leaving them with long term medical problems for life and eventually disabled and or death. I am certain that if a study was done the results would be astonishing and shocking.You may say that my theory is purely speculative, I say to you Im living proof and a witness to the atrocities, This insurance company has unreasonably delayed care, diagnostics, put constraints and burdans on physicians and injured workers. has caused prolonged suffering and additional complications as result as well as treated me and probably thousand of others like my self with the most uncivilized conduct and less than standard care, has violated every patient right and the injured worker has no recourse and bound by the law of this Commonwealth Workman's Compensation Law and there isnt any Federal law so you are forced to suffer and take the pain while your world crumbles. Thier operations are located thru out the world (others countries) Asia mainly and others states throughout the United States and are not and cannot be held accountable here in Virginia , In Addition I think it is a conflict of Interest for treating physicians to have investment of any other financial relationship with Workman's Compensation Insurances other than provider paid for service as this undermines the patient and physician relationship and has negatively affected the injured workers outcome, Workman's Compensation Insurance is big business for profit and their profits are at the expense of the health and welfare of the injured ,Let me ask you what you would do if someone was screaming in pain and suffering crying every day due to the pain, forced to walk on 2 severely injured knees and there dreams and life is turned upside down and they are refused and or denied proper care and treatment a chance for hope, relief, and chance to be whole again, The Commonwealth of Virginia Workman's Compensation laws denies your rights to proper care and treatment relief from pain so excruciating that you want to die, denies the right for hope and your future and the future of your family. There is no Federal oversight or laws protecting Injured Workers. Insurances have free reign to do what ever they wish here in Virginia and any where else. It is inhumane and unjust to its citizens, I have been informed by many physicians and persons whom ever had to deal with worksman comp insurance companies that I am not alone and often injured people go untreated and give up on the system in place. The insurances have big money and drag out hearings and use every loop hole they can to get away with it. Since my injury I have been forced and bound by Virginia law to follow workmans comp laws which violate my civil rights and dignity and cause me prolonged suffering and additional injuries and of course continued inability to work and earn my wage of which I am accustomed, if you can imagine that some crazy law forbides you from seeking care from physicians of which you feel and believe would do what is best for you as a patient ,not the insurance company, Allowing Worksman compensation insurance to treat you and do to you what ever they wish, forcing you to seek care from thier doctors, than dictating to these physicians what they can and cannot do and how to treat you, then denying you proper care and treatment, mismanaging your care and every contact this insurance company has with you in a tape recorded conversation, they devise case managers whos purpose is to try and get a confession or personal information which has nothing to do with arranging your care and treatment and putting into place what is medically neccessary for your recover, I HAVE BEEN A NURSE 25 YEARS and that wasn't case managing, I had to buy my own wheelchair,I had to buy my own durable medical equipmant , ace wraps, etc. and my husband had to transport me every where because I could not drive, they told me they would arrange transportation and did not, they were aware I had a tri level home and no restroom on the first level, I was told I needed a wheelchair and should go by one by this insurance companies nurse case manager and than told let the lawyers work it out, When physicians that they sent me to ordered Diagnostics such as MRIs it took months for them to approve it, While I sufferred in Pain and not knowing what was wrong with me.They have not paid medical bills and I have had to use my own private insurance to get care , worksmans comp insurance companies have no oversight, have no regulation and no concept on reasonable time , no standards of care , they give misleading titles to nurses as case managers whom are not licensed in the State of Virginia and have no regulation and do not have to answer to Boards of Nursing in Virginia and have basically abused Virginia Law and the Injured Worker, The only persons or governing authority they have to answer to is the their board of directors, and stockholders and CEO's. The employer gets away with not being held accountable because all they have to say is take it up with the insurance company or the commission, which takes months to get a hearing if you can get there and in the mean time you suffer and get worse, . Had I had the right to have control over my own health care decisions seek care of my choosing, and or had the right to submit documents from the treating physician outside of thier panel of physicians with special interest, I can promise you with confidence that I would have been well by now and back to work. But because of the current laws and lack there of, I don't even have the right to sue or hold any one accountable as well as the right to seek care and not suffer anymore . How can it be decisions are being made by consulting physicians to the Insurance company that care and treatment is not medically necessary when they haven,t even examined me and yet Two other physicians liscensed in Virginia, Dr. Robert Neff of Orthopeadic Associates of Virginia in Norfolk Virginia and Dr. A. Jamali of Orthopeadic Sports Specialist in Chesapeake Virginia both whom are highly respected in the community and with the Board of Orthopaedic Surgery and Dr Jamali professors at Eastern Virginia Medical School whom have seen and examined me say it is much needed, Again I have no idea who this AIG consulting physician is, their credentials, are they even liscensed in orthopaedics, I have a right to know and i want to know so i may sue for malpractice , they certainly cant be held accountable by licensure boards in Virginia as no one knows who they are and where they are and their opinion can be entered to the Workman's Compensation Commission without right of discovery and to be crossed examined or sued for malpractice, However I cant submit opinion from a physician liscensed here in Virginia who has examined me. I cant even seek the care of physician with my own insurance and its network of providers unless its approved by the commission and Im not allowed to submit to the commission, his opinion and care plan and findings unless its approved by the commission first which takes months to get a hearing for approval, this in not fair so I'm exspected to wait for a hearing which takes months' fight with Insurance company attorneys to get permission to see a Independent Doctor with my insurance and wait for months and Im the patient and in severe pain with serious injuries and developing complications and have developed complications from the lack of proper care and treatment.
If this system was more carefully monitored and over seen it would be discovered the inhumane standards of care are less than any reasonable and prudent person would or should accept. Long term care facilities have more monitoring ,This is a Public health concern, What was meant to be a good thing in its day is now a terrible nightmare to most and unfair law in Virginia, Worksmans Comp Insurance Companies have learned to take advantage of these laws and manipulated them and gotten around them long enough. I have become so Fustrated I want to go wavy TV 10 on your side . Unfortunately I have no other option but to go forward and seek care on my own and pay for it on my own and as a result will be denied the right to submit the treating Physicians Finding Medical Treatment,Opinion ,Cost to my self and family and to my private health insurance because I don't want to suffer any more in pain and wait months while I suffer, loose further income income and deteriorate, I want desperately to be free from pain and to get better and because I am desperate to get better I am penalized, They already win and get away with it again because of the out dated laws of Workman's Compensation in Virginia and No Federal oversight and laws. Can you help me lead these much needed changes? Can you tell me how I can get these laws changed? Will you share this with your house of Delegates and Senators and Congressman. Your only recourse in Virginia is to hire an attorney and they have to follow and are restricted by the laws of workmans compensation, any hope for regaining your health to its optimal level and recovering loses to you and your family are virtually impossible. Its a crying shame that it has reached to this point and there is no accountability. I am requesting your assistance to get these laws changed Bills put into place and modified and new laws in place. I am requesting an investigation of this Insurance company AIG Sedgwick. My objective is to help others like myself in hopes that no one will ever have to go thru what I went through and still going through. Isnt it strange and ironic that American tax payers are bailing out this company, the very same company that may cause me to go into foreclosure or file bankruptcy and go on public assistance, because I not able to work and because of thier unregulated health care system, I may even have to file for medicaid or medicare if my Insurance doesn't cover it and my children may be homeless and without health insurance and on medicaid because I cannot afford the premiums any longer because I cannot work because I cannot get better becase Im denied propercare and treatment and because the system is red tape and AIG fights every request fro care even after they have agreed to accept the claim with the Virginias Workers compensation Commission, I was once prescribed a medication by a designated worksmans compensation physician and had a severe allergic reaction causing difficulty breathing , I was struggling to breath AIG refused to pay the bill saying that I needed a note from this doctor to go to the Emergency room for an emergency and life threatening circumstances, In addition I offered to pay the treating the Orthopaedic physician for care of my knees and use my private insurance just to get my knees cared for he scheduled me for surgery sent for all pre op labs and test than cancelled the surgery the next day without explanation, how ever I learned later that a Consulting Doctor to AIG who has never examined me and I have no idea whom this physician is or where this physician is located believes that surgery is not medically neccessary I thought Workmans Compensation was to protect the injured worker from becoming a public burden, Gee when they get done with me I,ll need food stamps for me and my family, medicaid and Medicare , and disability for me, be sleeping on the streets with children, I won't be able to obtain credit because Im not working and my credit report is ruined because they didn't pay the medical bills, the hospital and doctors and every other creditor I owe wont be getting paid because Ill be filing bankruptcy and have no means to pay them, I have been nursing 25 years and worked all my life as a public servant, it only takes 1 accident to cause you and your family financial ruin and devastation as well as, ruin your ability to work, you may be able to hold on for a little while but it will catch up to you, In my 25 years of nursing I have seen Doctors, Nurses, Teachers, Lawyers and people of all professions and walks of life become disabled and public charges to the state and federal government, I have worked all my life and tried to save do the things to prevent this from happening to me and my family, I have never been a public charge or needed any assistance, I only hope it never happens to you its a painful and hard pill to swallow, Only god knows what will happen Although we all work hard and do the right things, It can still happen to anyone even you. Tell you readers to Contact call and write their Senators and Congressman and state represenatives and senators and Governor to amend workmans Comp laws and get bill for laws

Chesapeake, Virginia
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This report was posted on Ripoff Report on 10/10/2008 07:47 PM and is a permanent record located here: 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. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content

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#1 Consumer Suggestion


AUTHOR: Sedgwickcms - (U.S.A.)

Submit follow up and/or complaints about Sedgwick CMS service to:

Guy DeRosa


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#2 General Comment


AUTHOR: happylady420 - (United States of America)

Hello:   I'm sorry you are going through this horrible experience.   I looked up SedgwickCMS under the Better Business Bureau and I didn't know if I should laugh or get mad.   They have an A+ rating.   If everyone who is reporting their case here, please I wish everyone would take a few extra moments to file your complaints with the Better Business Bureau.   The more complaints they receive the rating score with go from A+ to hopefully an F- rating.   PLEASE PLEASE PLEASE get the word out to everyone who is experiencing these horrible acts from these Mafia wanna be known as Sedgwick CMS.
Thanks for reporting..
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#3 Consumer Comment


AUTHOR: Robert - (U.S.A.)

My goodness, stop being so verbose. Not many people want to read a dissertation.
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