As a premises liability law firm, we know that if you fell at Home Depot or big box retailer, often times within an hour you are getting a call from a company called Sedgwick CMS. The claims representative will sound very concerned about your injury but push to take a statement from you at that very moment. Who is Sedgwick and why are they calling you? 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 workman’s compensation claims. So that means if you slip and fall at a store you can expect a call from your new “best friend” the Sedgwick claims representative.

Who are these claims representatives? Do they work for the store where you slipped and fell?  What does Sedgwick do?  What should I do? The most important question is Does Sedgwick pay injury claims – In this post we will give your some important information regarding Sedgwick and how they handle injury claims.

 * For purposes of this blog post we will refer to them all as Sedgwick who are one of the largest  TPA’s in the world.     

Scenario:  You were with you wife shopping in one of the big box stores like Target, Home Depot or even Bed, Bath and Beyond. It was a beautiful day and you were happy that you weren’t working. After you checkout, just after you pay of course, you slip on a puddle of water not 5 feet from where the cashier is standing. Your feet come out from under you and you fall backwards landing on your back and the back of your head smashes against the floor. You are dazed and black out for a few seconds before regaining your consciousness. Your wife realizes that the water was dripping from an air conditioning unit in the ceiling and based on the amount of water on the floor, it had been dripping for a long time. No cones or other warning signs are in the area. A quick incident report is made by the manager, taking a statement from you, while the ambulance is called.
After being taken to the hospital, getting checked out, it is determined you have a bad concussion. Within the hour you are getting phone calls and voicemails, not from the store, but from a “concerned” Sedgwick claims representative. You end up missing work for 3 months and even when you return, your memory is not what is was before and you continue to suffer from headaches after long days on the job or even just watching TV. You have sent in all your medical records and bills to Sedgwick, just like the claims representative asked you to do, but none of the medical bills are being paid. You decide to present a claim against the retailer for the negligent condition of the floor of the store, but now your “friend” at Sedgwick won’t give you a call back.

What does Sedgwick CMS 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 witnesses, collecting medical records and medical bills of the claimant and in short trying to minimize the risk to the company that they are working on behalf of. The TPA works at the direction of and according to the wishes of the store or business you are presenting a claim with.

Why is Sedgwick so eager to take my statement?

Sedgwick is notorious for this practice, they want to lock your statement down about your accident and injury as soon as possible. In the scenario described above, a person with a serious concussion shouldn’t be giving statements that will be held against them, even though they don’t have their full mental capacity. Let me be very clear, YOU DO NOT HAVE TO GIVE A STATEMENT TO SEDGWICK! In fact, there is no upside to giving a statement to them, your words can be manipulated and come back to haunt you later, even if you meant them in a different way. From a personal injury lawyer’s perspective, I always tell my clients not to talk to the Sedgwick claims representative, I will handle that for them.

Does Sedgwick work for the store where you slipped and fell?

No, Sedgwick does not work directly for the store or business where your  slip and fall occurred. They are hired by stores to handle personal injury claims on their behalf, the reason they are hired is because it’s their job to minimize the value of your personal injury claim.

Should I send my medical records and medical bills to Sedgwick?

This is one of the most common issues we see when people try and work with Sedgwick on their injury claim – the representative tells you “Send us all your medical records and medical bills so we can evaluate your claim”. They make it sound as if all your medical bills will be paid for by them, wrong, these are requested not for payment, but to look at your medical records and try to again, minimize the value of your injury claim. Giving Sedgwick access to your medical records and medical bills gives them what amounts to a head-start in their process of minimizing your claim – Don’t do it!

Does Sedgwick pay injury claims?

Does Sedgwick pay injury claims – technically yes, but practically, not really. What we mean is that if they pay an injury claim it is almost always at a very discounted rate; that is if they call you back at all.  We have heard the horror stories from clients, including not being able to reach the adjuster they were in contact with for months, leaving countless messages with no calls back. If you are lucky enough to get an offer to settle your injury claim, it usually is an offer far below the fair value of what it is truly worth. They are notorious for making low-ball offers, also called nuisance value, just so you go away. The Sedgwick adjuster may appear to be acting on your behalf, remember, their sole purpose for being is to save their client’s money.

You can certainly try to negotiate your claim with Sedgwick, but expect to get a very small offer if anything at all. Personally, we have settled slip and fall cases for 10 times the value of the offer our client received from Sedgwick before we were hired to represent him. Why? Sedgwick has the expertise and are paid to minimize payouts for their clients, and they do this on a daily basis. Remember Sedgwick is a huge company, working on behalf of other huge companies, they would like nothing more than to hold on to every dollar and cent, and do this by waiting out the injured person to give in to their small offer. In order to level the playing field, you need to hire a strong personal injury law firm to act or your behalf. Your lawyer has the hammer of filing a lawsuit on your behalf, which will put you in the position of maximizing your injury claim.

Click here for more Sedgwick CMS horror stories 
Click here for Secrets about Walmart’s TPA Claims Management Inc.