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
03/03/2025
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 am dealing with a nightmare situation regarding incorrect info being entered for my maternity leave. My examiner, who has been IMPOSSIBLE to get ahold of, put an incorrect payout percentage that has resulted in me getting about 30% of the pay I am owed. I have spoken to numerous phone **** and have been dealing with this for 3 weeks straight. My examiner has been *** and only a couple of the phone **** have been helpful. This is unacceptable and the last thing a brand new parent should have to worry about. This company is horrendous.
Business response
03/10/2025
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 Maddison ******** 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 Maddison Mccombers complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
03/03/2025
Complaint Type:
Product Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
I filed a property damage claim in September 2024. Unfortunately, Sedgwick and the company they represent denied liability for the incident. However, after submitting the requested paperwork, we were offered a good faith gesture of $200. Now, its March 2025, and we still have not received the promised payment. As with many other complaints about Sedgwick, neither the adjuster nor any representative has responded to me. Ive made countless attempts to contact my adjuster via email and phone, but there has been no response. Calls to the main office have proven equally unhelpful, with promises of return calls that never materialize. While $200 may seem like a small amount, its frustrating to be offered a payment that never gets fulfilled.
Business response
03/10/2025
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, (The Parking Spot).

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 *******/**** Beaverss complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
03/03/2025
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.
1. Attached are conflicting documents from the current case manager for my work place injury that she sent to my work email address, and included a HIPPA protected medical document that she sent to my supervisors. 2. When I filed the claim in Sedgwick, I did not include an email address and stated that I prefer text messages. I have received zero text messages from Sedgwick. **** ********* has sent me a variety of short email messages to my work email saying "are you at work", "you need to fill in a Return to work form first", and the attached message demanding that I should be a work, despite the fact that I was at the hospital for hours on Feb 26, 2025 and learned that there is a new problem with my neck. My work email address is subject to FOIA, and our employer said to not use it for personal reasons, therefore, no matter what, **** ********* from Sedgwick should not be sending my HIPPA protected medical information to my job. Furthermore, on Feb 28 2025 she forwarded the tru health note, she wrote to my employer the opposite of the content of the note and stated that I should report to work on Feb 25, 2025 (a date in the past that contracts the work note). Again, I did not give Sedgwick permission to contact me via email and, effective immediately please have her cease and desist emailing me on my work email and please have her cease and desist sending my medical information to my employer. 3. She sent me a message on Feb 25, 2025, after I had gone to an urgent care, to only go to doctor's on your list. Feb 28, 2025, she sent me a contradictory message saying I should not have gone to your listed urgent care and PT at ********* Sterling, ** on Feb 28, 2025. 4. **** ********* sends incoherent messages, without regard to proper punctuation that left me wondering if she's working from home, unsupervised, is drinking on the job, or another issue. Please see the attached example. Please notice how she contradicts herself.
Business response
03/04/2025
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 ***** LaRues complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
02/28/2025
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.
On 2/6/2025 I incurred a workplace injury. My employer is *********************** and their workers compensation company is Sedgwick Claims Management Services******* I was supposed to be called by a Sedgwick Claims examiner, and still haven't as of 2/28/2025. My claim for my left arm (Sedgwick has reported as my left shoulder. But my entire arm from collarbone to hand has been affected, which I notified Sedgwick of and they have not updated) was accepted. My claims examiner was changed on 2/10/2025, which I didn't receive notice of until at least 2/17/2025. My 1-week urgent care provider specified I need a referral to orthopedics re the extent of my injury and collarbone/shoulder bony protrusions. I promptly submitted all medical documentation and was told in writing in my claim communication center authorization would be sent to the referral clinic my urgent care provider referred me to. However. The ****************** has still not received authorization, despite the clinic calling my claims examiner and her supervisor daily. My manager told me to stay home from work though I had light duty restrictions specified on my visit summary from my medical provider. The no communication from Sedgwick is prolonging my full diagnosis and recovery. My medical condition is not improving and is healing in the wrong position, making my health outcomes poorer. I need to see orthopedics to get appropriate medical care and get work forms filled out to retain my employment. I have tried calling, emailing. Messages in the claim communication center, contacting my employer's disability HR team, and contacting *******'s main phone daily since 2/17/2025 without any communication back from Sedgwick to me, my employer's disability HR, my nurse case manager with *****, or my ************* Summary: no communication from and lack of following appropriate, timely procedures to receive medical care is greatly affecting my physical and mental health outcomes. This is unacceptable and unethical.
Initial Complaint
02/20/2025
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 filed a claim with Sedgwick (Claim Number: [4A24112PFSK-0001]) regarding a serious incident involving Sephora. Throughout the entire process, Sedgwick has exhibited poor communication, failed to provide updates in a timely manner, and ultimately denied my claim without a clear, specific reason. I was promised a response by [original deadline date], but no decision was provided until [actual response date], after I had to repeatedly follow up.The claims examiner, ***** ******, and her supervisor, ***** ********, failed to thoroughly investigate my claim. They did not review all relevant documents, including critical emails and chat transcripts that prove Sephoras negligence. Additionally, they did not acknowledge the full medical impact of the situation, despite the hospital and doctor records I submitted.Sedgwicks lack of transparency and disregard for my health concerns have caused me severe emotional, physical, and financial distress. My mental distress has been on the decline due to their failure to handle this claim properly. This process has forced me to relive the experience over and over, worsening my condition. Sedgwick is representing ******* in this matter, and I am seeking compensation from them for the damages Sephora has caused me.
Business response
02/21/2025
Thank you for the opportunity to respond to the complaint filed by Neahndl *******. 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 Neahndl ******* 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 Neahndl Batistes complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
02/20/2025
Complaint Type:
Customer Service Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
Email submitted to business:Good day,This is in attempt to be indemnified as a result of property being damaged by equipment under the operation of your client ******** located at **************************************************. To recap events, I purchased a car wash from this location in December of 2014. During the event of vehicle being washed the brushes damaged my vehicle by ripping off multiple belt molding off my vehicle. I have presented all required document requested of me to include receipts, pictures and estimate for repair. I have attempted to resolve this matter cordially and patiently as this matter is exceeding 3 months with Sedgwick and its employee failing to provide any response and supporting the technique of delaying a claim with intent to avoid remedying the situation.I am requesting confirmation if my claim is to be resolved or denied As a reminder:In *******, bad faith occurs when an insurance company doesn't settle a claim fairly and promptly. This can include denying a claim without a valid reason, failing to investigate, or using threatsPer Florida stutue ******* Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests;
Business response
02/21/2025
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 Joram Perezs complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Business response
02/24/2025
Date Sent: 2/21/2025 5:59:01 PM
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, (7-Eleven, 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 Joram Perezs complaint.

Again, thank you for the opportunity to respond and clarify, as able
Initial Complaint
02/17/2025
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.
On *** delivery people hired by ********** took off the hose in the back of my old washing machine after i told them the water was not yet turned off but to follow me and i would show them. as I walked down the lead took off the hose, causing gallons and gallons of water to spill and spray all over my laundry room. When i went downstair to see the damage to my garage ceiling and tried to remediate the water since it was freezing, mins later i went back upstairs to see the delivery people driving off. they basically ran away leaving my front doors wide open. The man in the pass seat laughing at me. i called the delivery company while they were driving away and made a claim.Sedgwick adjuster Ms. ***** was assigned -Her initial email was sent 1/2 and requested my statement and photos/docs of the loss area. I immediately replied that night. 1/13 I sent a follow up req status. 1/14 they req. more photos, I responded w/in the hour. It took 7 more days for them to make an offer of $750. I rejected,explaining that barely covers the work I put in and demanded $2k. Another three days passed, I had to write again requesting a response or to set up an appraisal. 1/27 They demanded I get a contractor. I asked if that is Sedgwick policy and again req appraiser. 1/29 I asked for update as it has been a month with a hole in my ceiling. I called 1/31 since no one responded. ****. does not have direct numbers. Their answering company refused to provide her managers information but said they would tell them i called. Sedgwick purposefully delays providing contact information. All numbers provided are for an answering service. it wasn't until 2/3 that they raised their offer to $1k. I rejected asking for an appraiser. They replied refusing to send an appraiser until i sent an estimate from a contractor. I asked if they are accepting liability. and after no reply on 2/4 sent email with 1750 demand or an appraiser by the 7th or i would send this complaint. Again, no answer.
Business response
02/20/2025
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 **** Brandenbergers complaint.

Again,thank you for the opportunity to respond and clarify, as able
Initial Complaint
02/15/2025
Complaint Type:
Customer Service Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
My car was hit by ****** ******* ******* on 12/20/2024. Mr. ******* is a truck driver employed by ************************** in ******, *** The accident was promptly reported to the police. Once the accident report was completed, the incident was reported to the trucking company insurance agency (********************************* of **********).***** ******* was the claims adjuster assigned to my claim number 4A25015KWWS0001 for Sedgwick Claims Management Services, Inc. The adjuster requested additional information and on 1/14/2025 I emailed the information back to the adjuster. I contacted the adjuster via email on 1/21/2025 to inquire about the status of my claim. I did not hear back from the adjuster until 1/29/2025 at which time the adjuster reported via email that the incident was under investigation. As of 2/6/2025 at 2:44 central time, I had not heard or received anything else from the adjuster. I have called the adjuster several times but my calls go unanswered. I consider myself a practical man and understand that issues like this take time to resolve. However, my vehicle remains damaged due to no fault of my own and I am being made to suffer mental anguish and needless stress.I emailed the adjuster on 2/6/2025 to express my frustration and asked for a response by 12:00 noon on 2/11/2025. I have yet to receive a response. I am including in this complaint the contact information for the adjuster and hope that you can help me resolve this issue. ***** *******-Claims Adjuster *.******, Qualified Manager, CA license #***************************** CA license #************* # ***************# ***************** ****************************************
Business response
02/20/2025
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 ***** Fennells complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
02/12/2025
Complaint Type:
Customer Service Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
Hello,I am trying to get in touch with Sedgwick for a waterline emergency. We recently had our **** cable buried. The technician hit our neighbors waterline thats in our front yard. We were not notified at all. Our neighbors had to shut their water off. Our neighbors are not happy at all and we are struggling to get this fixed in a timely manner. Our neighbors have no water for the past 2 days. I have not heard from Sedgwick regarding the ticket so that the waterline can get repaired and our neighbors can have water again. This is the waterline that the neighbors would be responsible for. The water company came to look at it. Its leaked about 100 gallons of water. There is water leaking in our yard since yesterday before it was turned off. This is at *************************************************************. I would like this to be fixed ASAP, please. The claim number I have with Sedgwick is 2502000715-01.Thank you,******** ******
Business response
02/14/2025
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, (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 Savannah ******* complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
02/10/2025
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 am writing to formally address a matter of grave concern regarding my ongoing claim( 4A2408WPT0R001) and the behavior exhibited by ***** *******, a representative from Sedgwick. Since September 2024, I have been trying to resolve an issue related to a GE refrigerator that experienced chronic problems and ultimately failed, resulting in significant damage to my hardwood flooring. Throughout this period, I have made multiple attempts to reach a satisfactory resolution. I have provided a video, pictures, and numerous documents. When I first spoke with *****, he advised me that the claim is under ****** dollars it can be easily approved by him. Unfortunately, I have encountered numerous obstacles, including verbal abuse and demeaning treatment from *****. His tone and approach have been unprofessional and disrespectful, which has only added to the stress and frustration of an already challenging situation. As a customer, I expect to be treated with dignity and respect, and I have not received this from ************* further complicate matters, the refrigerator's malfunction caused a serious issue with my hardwood floors. When the fridge ultimately died, it leaked and ruined my floors, and the damage has been extensive. I have explained the situation clearly and requested assistance from *****. He keeps mentioning that I should use my homeowners policy to repair the flooring, but I have not received any meaningful assistance or resolution from Sedgwick.I respectfully request that you review the details of this claim and take appropriate steps to rectify both the ongoing damage to my property and the inappropriate behavior exhibited by your representative. My homeowner's policy should not be used to cover the necessary repairs to my damaged flooring, and I am requesting that Sedgwick honor this agreement without further delay.I appreciate your prompt attention to this matter and would like to resolve it in a professional and timely manner.
Business response
02/12/2025
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, (Haier, dba GE Appliances).

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 ****** Pipposs complaint.

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

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