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Business Profile

Insurance Claims Processing

Sedgwick CMS

Headquarters

This business is NOT BBB Accredited.

Find BBB Accredited Businesses in Insurance Claims Processing.

Important 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.

Complaints

This profile includes complaints for Sedgwick CMS's headquarters and its corporate-owned locations. To view all corporate locations, see

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Sedgwick CMS has 24 locations, listed below.

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    Customer Complaints Summary

    • 497 total complaints in the last 3 years.
    • 162 complaints closed in the last 12 months.

    If you've experienced an issue

    Submit a Complaint

    The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

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    Complaint status

    Complaint type

    • Initial Complaint

      Date:11/04/2024

      Type:Service or Repair Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Was hurt at work and filed a workers comp claim. Followed all instructions and have not been able to contact Sedgwick since the initial claim. Have tried to called and left voicemails multiple times to verify information and see next steps. Found that my claim was denied with no reason or details about the denial. I have an orthopedic surgeon who says I need an MRI. I would like the company to contact me and give me details as to why my claim was denied considering I have zero information.

      Business Response

      Date: 11/08/2024

      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 ****** Achesons complaint. 

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

    • Initial Complaint

      Date:11/01/2024

      Type:Service or Repair Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      During a wood pickup from ******, the operators damaged my vehicle during the loading operation. ****** reviewed the footage and asked me to get several quotes, which I did. They stated that they handed it off to Sedgwick. It has been almost a month now with no response. No one at ****** know what is going on and can give me anything in the process because they state "It with them and they are a third party, I can't do much". Well, I have called numerous times, left voicemails, and attempted to call other offices to at least talk to someone. This has been going on for almost a month and I have yet to be reached out to by this company.I have also had their phone lines just suddenly hang-up when I go through the menus and press "about a claim" and then the call immediately ends.

      Business Response

      Date: 11/08/2024

      We are unable to locate a claim matching the customer's name using the information provided. We need additional information in order to respond.

      Customer Answer

      Date: 11/27/2024

      I did finally got a hold of someone a couple of weeks ago and they did also confirm with me that they could not find a claim with my details. Upon this I went back to ****** and found out that no claim was submitted, despite being told multiple times that it is in ********* hands. 

      I now have a claim number, talked with an agent, and we are moving forward in the process. If my complaint is used, I would still like to emphasis that I had to spent countless hours over a course of two months to finally find something out from ******* and that they still have never called back from the several voice mails I left. 

      I do appreciate BBB for at least getting a response from the company, however, they should of have been able to find a claim in their system if they checked in past couple of weeks.

    • Initial Complaint

      Date:10/31/2024

      Type:Customer Service Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      The company manages my **** intermittent leave from work. I have worked hard with my case worker Kyara to make sure I new everything that I needed to know and not have an absence be denied as this will get me written up at work or even fired. This year started my 2nd year, so I earned my FLMA back on the days I took it last year, but my amounts of FLMA time available did not match what Sedgwick had, so I asked if there was any way to check on my amounts so I would not make any errors. My case worker Kyara told me just to call in and ask for my balance available. I have dates, times and names of the numerous calls I made to make sure I had time available, I have Migraines so one I have them its hard to think, calculate hours, and make sense. I had called on 09/3/2024 at 12:18 pm spoke with Tyrany(*******) | had 34 hours available. On 09/16/24 at 8:52 am I spoke with ***** who said I had 40 hours available. I called on 09/19/24 8:55 am and was told that I had 32 hours available. I had reported days out on 9/12, 9/13, 9/16. and also 9/18,9/19,9/20. I got a call from Kyara's supervisor ******** on 09/27/24 telling me that 09/20 was not covered and she would look into the phone calls to see what was said, and if they told me I had the time it would be approved. 9/21 was the next day which added a day back to my balance. She stated and promised to call me on 9/30 after 6pm with an update. So I had been in contact with my HR Dinasti ******, who on 10/24 stated that Sedgwick was not going to approve the 9/20 date. She said they asked the supervisor to take over my claim, she stated that ******** would be calling me in next 24 to 48 hours. So the problem was that they were taking so long to approve days missed, and only someone from Sedgwick would be able to see what has been approved or still pending. I have no way to see any of this. I can only take what they tell me. So its now 10/30/24 I have never heard back from Sedgwick about any of this issue. ******** didnt call.

      Business Response

      Date: 11/08/2024

      Thank you for the opportunity to respond to the complaint filed by ***** Mikaelson. 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 ***** Mikaelson 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 ***** Mikaelsons complaint. 

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

    • Initial Complaint

      Date:10/29/2024

      Type:Service or Repair Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      My family was involved in a car accident caused by their insured on 06/18/24. Their insured was found to be 100% at fault. My husband, daughter and I were all injured in the accident and had to seek medical treatment. We have also lost out financially due to our vehicle being totaled and having to be replaced. We have open claims as a result, and I cannot get any response or compliance from this company. I have made numerous calls and sent emails to the claims examiner (******** ********) and her supervisor (***** *****) without any response. Ms. ******** responded to my email 1 time in early October to answer my questions regarding what was needed to close the claims and be compensated. Since then, I have sent emails to Ms. ******** and Mr. ***** on 10/09/24, 10/10/24, 10/14/24 and 10/17/24 without any response. I have also left voice messages for Ms. ******** on 10/24/24, 10/25/24, 10/28/24 and then again today, 10/29/24. We did not choose to be involved with Sedgwick but have no choice considering their insured is the one who caused the accident and involved our family in this mess. They advertise on their website ************ of people is at the heart of what we do" and I have not found this to be the case. I need someone above Ms. ******** and Mr. ***** to call me to confirm that they have received the demand letters for claim C466568236-0001-02. Although Ms. ******** confirmed in our 1 conversation that these letters could be emailed to her, I need to know if I need to send them a different way or to someone else as I have no faith that I have been provided correct information from her (according to the "read" receipts, she has not even opened any of my emails, although confirmed that Mr. ***** has opened them with no response). This whole experience with Sedgwick has been extremely unprofessional and beyond frustrating.

      Business Response

      Date: 11/08/2024

      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, (DB Insurance).

      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 ****** Aubergers complaint. 

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

    • Initial Complaint

      Date:10/25/2024

      Type:Service or Repair Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      On Sept 3 2024 a truck from Donegal Escalating uncovered passed by my vehicle and I was hit with 2 rocks. I called the company and they told me to follow up with their insurance company Sedgwick. After a month and and half of sending in pictures and investigating they said they are not at fault. I had a video of the uncovered truck pictures of the damage and the time stamp of the call to the trucking company. Im extremely dissatisfied in ******* and the way Ive been treated from Sedgwick insurance.

      Business Response

      Date: 11/08/2024

      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, (Navigator Captive Arch).

      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 **** Tomczaks complaint. 

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

    • Initial Complaint

      Date:10/19/2024

      Type:Service or Repair Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I have an active workers comp claim open since 09/18/2024. Sedgwick has mistakenly misfiled my claim twice in this time period I received a call about a week ago finally asking for clarification on why a workers comp claim had been filed. Ive presently been with out pay for almost 5 calendar weeks. Still we have no determination on this claim. Ive had 3 claims managers and have struggled to receive timely responses from them all. Documents are submitted with no acknowledgment of receipt. Ive taken it upon myself to make a complaint with the company Sedgwick only to never receive a response. I am on a medical leave due to overwhelming stress/ anxiety caused by my employer and the way that my claim has been handled with Sedgwick has exasperated my symptoms. I am without any income at this time and there seems to be no sense or urgency when handling this claim. Claim no. 4A24106X38N0001

      Business Response

      Date: 10/29/2024

      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 ******* Newtons complaint. 

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

    • Initial Complaint

      Date:10/15/2024

      Type:Service or Repair Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      My experience with Sedgwick has been the worst Ive ever encountered. The representatives consistently seem uninformed, and the claim managersspecifically ****** *. and his supervisorhave been completely unresponsive, despite multiple requests for follow-ups, including those from monitoring authorities.On two separate occasions, my claim was closed without any notification, forcing me to involve ****** ** just to make progress. Ive experienced missed pay due to Sedgwicks failure to process my paperwork on time, despite submitting it well in advance. This negligence has pushed me into debtan especially devastating impact as I am disabled and rely on timely payments to manage high medical expenses.Adding to my frustration, I have submitted this same feedback multiple times and have never been contacted by Sedgwick regarding my concerns. This complete lack of acknowledgment only further highlights the companys disregard for those it is supposed to ******** is unacceptable that a company whose sole purpose is to assist employees with disabilities has demonstrated such a profound lack of care, accountability, and responsiveness. I am appalled by the subpar service Ive received, and it raises serious concerns about how Sedgwick operates. The failure to fulfill basic responsibilities has put my financial and physical well-being at risk.This companys operations need to be reevaluated immediately to prevent others from experiencing the same hardship.

    • Initial Complaint

      Date:10/11/2024

      Type:Service or Repair Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Filed for short term disability and a leave of absence from work for mental health reasons. Sedgwick approved the leave for the full timeline but only approved short term disability for 4 weeks. Since 9/20/24 Sedgwick has been difficult / evasive about what I needed to extend the leave. I asked several times what was needed, to be told different information by each person I spoke to. Once the initial review process timeline had passed, Sedgwick demanded more paperwork, and then the same paperwork again days later since I am receiving continuous care for my condition. They have now fallen into a pattern of taking a week to review my claim, then demanding the newest note from my care team, to then claim they need another week. My Short term disability timeline has now passed, and they have stated they are not obligated to tell me if my claim will be approved or I will receive back pay between now and when I need to file again, coming up shortly. I believe they are stalling in an effort to not pay out. I do also have recordings of my phone calls with Sedgwick.

      Customer Answer

      Date: 10/26/2024

      Thank you *****. Sedgwick finally decided they had enough information after this complaint was filed and approved my leave. Whether I had passed some determined amount of paperwork needed or this complaint spurned them to action I dont know, but my issue has resolved. 

      Business Response

      Date: 10/29/2024

      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 ******* Harrelsons complaint. 

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

      Customer Answer

      Date: 11/04/2024

       
      Better Business Bureau:

      Sedgwick finally decided they had enough information after this complaint was filed and approved my leave. Whether I had passed some determined amount of paperwork needed or this complaint spurned them to action I dont know, but my issue has resolved. 

      Sincerely,

      ******* *********
      , MN 55405

    • Initial Complaint

      Date:10/08/2024

      Type:Sales and Advertising Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      On July 20th I received a battery from ****** that was defective and started a fire in my home. I called them immediately and they started the claims process to pay for the damages. After weeks it was turned over to Sedgwick for claims processing. After having me provide the same information no less than 3 times (resending photos, estimates, description of damages etc) Since, there has been little communication. It takes weeks to receive any information and they refuse to respond. The company is impossible to reach. I have used every available option I can find. Email with my claims adjuster, messages through the claims website, attempted to chat on their website (which always errors and never connects to a person. Only offers to escalate. After escalating twice I received an email acknowledging the escalation and saying I would be contacted within a few days, that never happened. It took weeks to get a response from my claims adjuster only to be told she had forwarded my information to the wrong seller and was starting the process over. Days later I got an email that did not explain anything only said she had sent my info to the seller. I have asked for a detail of the claims process and timeline, but have gotten no answer. This process is clearly designed to make people wait so long that many give up. The idea of having a claims processing ************ to avoid litigation makes sense and initially I appreciated that they had it. But after seeing how this company operates I am coming to realize they are simply a front for trying to refuse paying claims to customers.

      Business Response

      Date: 10/29/2024

      Thank you for the opportunity to respond to the complaint filed by McKeeg *******. 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 McKeeg ******* 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 McKeeg Russells complaint. 

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

    • Initial Complaint

      Date:10/07/2024

      Type:Customer Service Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I had equipment installed by *********** and the contractor drilled into the siding and compromised our breaker box. We reported the problem to ***********, they referred us to their insurance provider *********. Sedgwick approved our claim on July 9, 2024. They said they would send a third party estimator to our home to estimate repair costs. They said it would take just a few days for them to schedule a third party estimator. I followed up on Aug 13 to get a status update. They replied on Aug 23 that they didnt know why it was taking so long, and would escalate the request for an estimator. I sent another written request for information and action on Sept 8 and included their supervisor. on I have heard nothing from them since.

      Business Response

      Date: 10/29/2024

      We are unable to locate a claim matching the customer's name using the information provided. We need additional information in order to respond.

      Customer Answer

      Date: 11/04/2024

      The claim may also be listed under my husbands name, **** *********.

      Business Response

      Date: 11/05/2024

      We have received the below BBB complaint.  However, there is not enough information to assist (namely, the Sedgwick client who was involved, name of the party of the moving vehicle, etc.).  We would need to be provided with that information to help her/him get in contact with the proper parties. 

      Please ask the complainant to provide this information, so we can respond properly.  

      Thanks!

      Sedgwick Legal 

      Customer Answer

      Date: 11/29/2024

      My complaint has been resolved. Sedgwick paid out my insurance claim. Thank you!

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