Business Profile

Insurance Claims Processing

Sedgwick CMS

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Additional Complaint Information

Customer Complaint:

While the BBB continues to accept and report complaints against this business and fulfill its responsibility to inform businesses of communications from its customers, this business generally responds that the Better Business Bureau online complaint resolution system is not the proper forum to respond to allegations in this complaint.

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Initial Complaint
01/10/2025
Complaint Type:
Service or Repair Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
I was rear-ended by a truck on August 9, 2024, and my vehicle had to be towed by the authorities due to the damage. I contacted a repair shop I had used previously, and they released the vehicle and had it towed to their facility. They handled everything efficiently, and I was very happy with their service.Once we obtained the police report, the shop filed the claim, and the truck company's third-party administrator, Sedgwick, represented them. On August 27, one of Sedgwick's adjusters inspected my car, but it wasn't until October 9 that the shop received a call stating that the vehicle was determined to be a total loss. Sedgwick requested the shop's charges, including towing and storage.Between the inspection in late August and the total loss determination, the shop made multiple attempts to contact Sedgwick's claim handlers but received no assistance or update on the claim's status.I was also injured in the incident and hired an attorney. During a three-way phone call with Sedgwick and my attorney, I was asked questions, but I didn't fully understand them. However, I assumed my attorney would handle the ************ mid-October, Sedgwick contacted the shop to discuss charges. but ***** was not handling anything close to fair.Throughout this process, I was provided a rental vehicle by the shop. They explained the process to me and mentioned multiple times that they believed the vehicle was a total loss but had to wait for the insurance company's determination. I was CC'd on all emails between the shop and Sedgwick and tried to encourage them to resolve the issues, but Sedgwick was **************** of January 6, 2025, my leased vehicle's account remains open and unpaid. The Jeep is still at the shop's yard, and I have an outstanding rental invoice that the insurance company needs to cover. The shop has been helpful and understanding, but they want to receive payment for their services. I am seeking advice or assistance in resolving this matter.
Business response
01/16/2025
Thank you for the opportunity to respond to the complaint filed by ******* ********. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ******* ******** filed against our client, (******************).
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ******* Drezdners complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/19/2024
Complaint Type:
Service or Repair Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
Hello my Name is ****** ******* and the reason why I am contacting you is because I'm hoping you can help get a issue resolved with the *** reimbursement department. I filed two claims October 8th #******* and ******* for repairs to my vehicle that were under warranty I paid for out-of-pocket at a *** dealership. From what I understand the claims was processed on October 28th and needed a manager's approval for payment. Since October I've had called several times requesting and call back from a manager. The Sedgwick claim manager name is ***** ****** today is December 10th and I have still not heard back from him nor has the claim been approved yet. I called December 6th and spoke with the agent who indicated that ***** was off so he referred this issue to ******* supervisor ******* ****** who is the Ops Manager for Sedgwick. The representative called me back later that day and told me Mr ****** was very sorry for my experience and that he approved the claims and that the checks would be mailed out Monday 12/9 Overnight and that I would get a phone call confirming everything. After I didn't receive a phone call yesterday I called today and was informed ***** needs more time. When I asked if I could speak to him I was told he was in a meeting. I have been a *** customer for over ********************************************************************************* BMWs quality and performance. The Sedgwick's representatives on the phone have been great, But my experience with management and Mr ***** ****** has been very unpleasant with his lack of due diligence. Maybe he needs more customer service training. With that being said I'm hoping ********************************* can do a thorough investigation and also help me get this issue resolved. Please feel free to reach out to me if you need any more information. Thank you for your time.
Business response
12/24/2024
We are unable to locate a claim matching the customer's name using the information provided. We need additional information in order to respond.
Initial Complaint
12/18/2024
Complaint Type:
Service or Repair Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
This in involving an approved short term disability claim that has been misrepresented and miscommunicated about multiple times. I am currently out on STD through sedgwick due to a severely herniated disc that is well documented through MRI scans. Common symptoms were extreme pain in back followed by collapsing which is why I was kept out of work. I met with my doctor on 12/2 to discuss surgical options where he advised to not move forward with it at this time and instead suggested a final round of injections. I was looking to extend my STD one month to account for my final injection and recovery time per my doctor. I was given a deadline of 12/14 to return my paperwork for an extension and they received my paperwork on Tuesday, 12/3. They have a 48 hour review policy which is shown in their previous replies. Despite this, I heard nothing for the remainder of the week. I called on Monday December 9th and was forwarded directly to my case manager *** alerted me she denied me last week but forgot to alert me. I asked what was needed in order to appeal the decision and she told me I needed to call my *** I explained I did not have a lot of time to meet her deadline given this miscommunication on her part and she promised to assist me and prioritize me. I called my Dr *** laughed at me and said it is Sedgwick's job to let us know what is needed. I then spent the next two days calling Sedgwick unsuccessfully, I was hung up on two times, and twice I was also told my case manager and her supervisor wanted 48 hours before calling me back despite the deadline rapidly approaching and their mistakes. I finally was told by someone not related to my case I needed the surgeon's letter which I gave them same day and was approved within the Wednesday deadline I was given to be paid despite still not hearing back from my case manager. Despite meeting the deadline even when it almost seemed impossible, I was never paid and now I once again can't get ahold of Sedgwick to fix it.
Business response
12/20/2024
Thank you for the opportunity to respond to the complaint filed by ****** *******. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ****** ******* filed against our client, Vanguard.

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ****** Slussers complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/18/2024
Complaint Type:
Customer Service Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
I receive a temporary partial disability Check from said Sedgwick I have not received a check in over five weeks and I have made 20 or more phone calls with messages, phone numbers and claim number to this company with no response and I seem to get a big runaround trying to get someone to call me about my claim this has happened before and I still received no communication with this Sedgwick and now that its a week before Christmas, I have had no checks in five weeks and I would like to have someone look into this company for wrongdoing their Clients
Business response
12/20/2024
Thank you for the opportunity to respond to the complaint filed by **** ******. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim **** ****** filed against our client, ******************** Programs.

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in **** ******* complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/16/2024
Complaint Type:
Service or Repair Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
My storage unit was robbed at public storage along with about 20 other u its in property. Sedgwick orange door insurance is the company that these people use. Ive sent in police reports reciepts and all identification needed for my claim now no one will call me back its been over a month. Something fishy is going on with these people someone in the company is stealing and they also dont want to handle business
Business response
12/26/2024
Thank you for the opportunity to respond to the complaint filed by ******************************** Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ******* ******** filed against our client, ****************************** Program).

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in Crystal ********* complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/16/2024
Complaint Type:
Service or Repair Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
Not returning phone calls emails or texts. Leaving me without payment due to this
Business response
12/20/2024
Thank you for the opportunity to respond to the complaint filed by Pandora ********************** Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim Pandora *************** filed against our client, Retailers *************************

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in Pandora **************** complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/14/2024
Complaint Type:
Service or Repair Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
I was injured on November 11, 2023 at my now former employer i twisted and rolled my foot to the right, I was sent to Med xpress once a week for a month before a ortho referral which took months. Foot went numb during the wait was then referred to Neuro who said it was my back , MRI done sent to therapy , therapist said no not the back contacted ** ordered a custom made brace for my foot. Neuro ordered a nerve test which the office has cancelled TWICE and another scan of near my rear but ** still wants to see me even though there is no results to read. Contacted my case worker ******* ***** and was informed she would contact legal to see about getting me another ** or scheduling the nerve test on her own to get answers, NOPE instead legal suspended my payments said waiting on determination of lumbar injury, ** ruled out back injury and ordered a foot brace, no notice no call nothing just suspended for a injury that either way would have been there responsibility to cover but has already been ruled out. I feel punished for the fact that they placed me with a ** that I feel is milking the system now all tests are obsolete and Ive lost income 2 weeks before Christmas, so thank you so much for making Christmas for my kids non -existant and not having the courtesy to even call or message to give me a heads up. You have all the documentation, there have been numerous calls discussing my concerns with this ** and no answers after a year, but im the one who is punished and ghosted.
Business response
12/26/2024
Thank you for the opportunity to respond to the complaint filed by ***** ****. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ***** **** filed against our client, (****************.).

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ***** ***** complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/12/2024
Complaint Type:
Product Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
In September, I had appliances delivered by **********/***************. They damaged my property while doing so. I filed a claim with them. Sedgwick Claims Management Services received the claim. I was working with an associate, ***** Hope. All items she requested were sent and I was offered a settlement in the amount of $3880.88. I was told that if I accept the offer to contact her and I will have to sign a release form. I have all of this in writing. Since November 25, I have sent 4 emails to her, have left voicemails for her, have sent an email to the Northeast Regional supervisor and an email to a main Sedgwick page and have received no response. I am trying to let them know that I want to accept the offer and need to sign that release form. They will not reply to anything. I am including evidence of all of the emails. You can clearly see where I am trying to accept the offer but can get to response to sign the release form.
Business response
12/26/2024
Thank you for the opportunity to respond to the complaint filed by **** ****. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim **** **** filed against our client, (*******************).

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in **** Doves complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/11/2024
Complaint Type:
Service or Repair Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
**** damaged my property when excavating and laying their **** line. My claim was outsourced through Sedgwick for resolution of the problem. The problem has not been resolved by Sedgwick and my claim has been wrongfully closed due to my Claim Examiner's inability to understand the situation. My property has experienced a thousand dollars of damage, it remains damaged, and Sedgwick and **** refuse to reasonably work with me toward resolution of the issue. My Claims Examiner is TaVaughn Commack **************** and his supervisor's name is ****** *** ***************************************
Business response
12/26/2024
Thank you for the opportunity to respond to the complaint filed by ***** *****. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ***** ***** filed against our client, (AT&T Services, Inc.).

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ***** ****** complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
12/11/2024
Complaint Type:
Product Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
I am attempting to sign up for school, and received a voucher from my employer through my workers compensation claim, I have been unable to reach anyone, I keep leaving messages, about to miss my deadline to finish registration, through out my whole experience, I feel like I am being taking advantage of because I have no attorney, or simply just dont know the ends and outs, I am forced to settle a claim without a hard copy of my medical report, there is no way to report it, to anyone else because I am always routed to the voicemail, and never received a response back, major insurance company, is taking advantage of me by non compliance, even though it says online how to communicate, it never works for me.
Business response
12/20/2024
Thank you for the opportunity to respond to the complaint filed by **** ******. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim **** ****** filed against our client, **********.

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in **** ******* complaint.

Again, thank you for the opportunity to respond and clarify,as able.

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