Often times when you experience an injury at work, you will be getting a call from your employer’s workers’ compensation insurance carrier or “TPA”. Sedgwick CMS is one of the largest “TPA’s” in the world and is involved in thousands of work injury claims every year.
Companies like Sedgwick CMS and Claims Management Inc. are called third-party administrators or “TPA’s”, they act as insurance adjusters and process insurance claims on behalf of stores and businesses. Sometimes the TPA’s work in this capacity for small insurance companies as well. They handle many claims arising out of slip and fall accidents and other premises liability claims, car accidents and even workers compensation claims.
So after an injury at work, you will very likely hear from Sedgwick shortly after the incident. The claims representative will sound very concerned about your injury but push to take a statement from you as quickly as possible. BE AWARE, the representative or Adjuster from Sedgwick will likely record your statement and possibly ask some questions about your injury. However, even if you are being 100%honest, they can still trip you up with that recorded statement – I always recommend consulting with an attorney about your injury before you give any statement for this very reason!
Why the Rush?
The sooner the adjuster or representative can get a recorded statement from you about you injury, the less likely you’ll be prepared to give a good statement (like talking to a lawyer beforehand!). Also, if you were just injured you may have foggy or clouded memory of the details due to pain medications, or even an head injury.
What else does Sedgwick do?
Sedgwick will do the same work as an in house insurance adjuster would, including things like:
collecting evidence like incident reports and photographs
taking statements of the injured person and sometimes witnesses and supervisors
collecting medical records and medical bills
collecting your wage information
Once Sedgwick has completed their investigation into your work accident, they can make a formal determination on whether they are going to pay you workers’ compensation benefits either by way of medical care or medical care and lost wages. This process can sometimes take a few weeks and after that initial recorded statement is done, you might even notice that your claims adjuster is no longer so eager to get in touch with you. This can be really frustrating and you’ll want to make sure you are taking all necessary steps to protect your benefits. This is why I always recommend talking to an experienced workers’ compensation lawyer!
So, Does Sedgwick Work for my Employer?
Sort of. Sedgwick is the insurance company or the TPA for the Employer. That means that your employer pays workers compensation insurance dues so in the event of an injury on the job, Sedgwick can step in and pay for medical care and lost wages.
Sounds pretty straight-forward, right? WRONG!
I get a lot of calls from injured workers telling me that someone at Sedgwick told them that their claim was denied for this or that completely bogus reason. Sadly, that claims adjuster is just hoping you will go away quietly and not cost the company any money or exercise your legal rights (and they most certainly won’t advise you of your legal rights or what steps to take!). If you don’t take any action at that point, nothing happens! Unfortunately, this is a great way for an insurance company to save boat-loads of money.
However, I always recommend talking to a lawyer before you even get to this point so you can be 100% prepared to deal with adjusters and claims representatives who have years of experience and unlimited resources to put an injured worker under a microscope.
Even when your claim is approved and you are receiving workers’ compensation benefits, there are things you need to be made aware of that Sedgwick may not tell you. For example, do you know the importance of an Award Order? Have you received your mileage reimbursement? Has a Nurse Case Manager been assigned to your claim? Ever heard of a Cost of Living Adjustment? What is vocational rehabilitation? This list goes on……..
Sedgwick is a business. At the end of the day, they need to remain profitable in order to remain in business. The more claims that they can deny, the more money they save!
So, What Should I Do?
You need someone to guide you through this process. Call us! Even if you don’t necessarily need to hire a legal representative at this moment, you need an ADVOCATE who can prepare you and steer you through this confusing and sometimes frustrating process. That’s where my office comes in. My free book, The Ultimate Guide to Workers’ Compensation was meant to do just that. It’s your roadmap to this process and will be your constant advocate along with my highly trained staff. I’m a workers’ compensation lawyer, but at this office, we do more than just practice law, we are advocates for all injured workers throughout the state of Virginia.
About the Author: Michele Lewane
The Injured Workers Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers' compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia workers’ compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia” , or call our office today (804) 755-7755.