How to Manage Sedgwick Claims in 5 Simple Steps

What to Expect When Dealing with Sedgwick

Sedgwick claims are managed by Sedgwick Claims Management Services, a third-party administrator (TPA) that handles claims for employers and insurance carriers. They are not an insurance company. If you’ve been injured and Sedgwick is handling your claim, you must understand their role to protect your rights.

Sedgwick is a global TPA that works for its clients—employers and insurers—to minimize claim costs. They manage claims for workers’ compensation, general liability, auto liability, and more. Unlike an insurer, Sedgwick doesn’t sell policies or carry financial risk. Their adjusters are trained to protect their client’s financial interests, which often means offering you the lowest possible settlement. You may face tactics like lowball offers, claim delays, and requests for recorded statements that can be used against you.

Universal Law Group has years of experience helping injured people steer the complex world of third-party administrators (TPAs) like Sedgwick. With former prosecutorial insight and over a decade handling personal injury and workers’ compensation matters, the firm understands how challenging Sedgwick claims can be without strong advocacy. This guide explains the process in plain language so you can protect your rights, avoid common pitfalls, and move your claim forward with confidence.

Step 1: Understand Sedgwick’s Role as a Third-Party Administrator (TPA)

When Sedgwick contacts you about an injury, it’s easy to assume they’re an insurance company. However, Sedgwick is not an insurance company. They are a third-party administrator (TPA), a company hired by your employer, an insurer, or a large corporation to manage claims on their behalf. Think of them as an outsourced claims department.

This distinction is critical. Sedgwick claims are managed with their client’s financial interests as the top priority, not yours. While you need fair compensation for medical bills and lost wages, Sedgwick’s job is to minimize what their client pays. They are the gatekeeper between you and the money you deserve.

Sedgwick’s Services and How They Differ from Insurers

Sedgwick manages a wide variety of claims, including:

• Workers’ compensation: For injuries that happen on the job.
• General liability: For incidents like a slip and fall on business property.
• Auto liability: For accidents involving a commercial or company vehicle.
• Property claims, workforce absence, and product recalls.

Understanding how Sedgwick differs from a standard insurance company is key to protecting yourself. Here are the main differences:

• They don’t sell insurance policies or collect premiums. Sedgwick is paid a fee by their clients for management services.
• They don’t hold financial risk. The settlement money comes from the employer or insurance carrier that hired Sedgwick, not from Sedgwick’s own funds. This means Sedgwick is motivated to keep their client happy by keeping costs down.

Many large corporations self-insure, setting aside their own funds to pay claims. For these companies, Sedgwick acts as their entire claims department. Even traditional insurance carriers outsource claims to Sedgwick to improve efficiency.

The bottom line is that Sedgwick’s goal is to resolve your claim for as little money as possible. This creates a direct conflict with your need for fair compensation. While many adjusters are professional, the system is designed to protect their client’s interests, not yours. Having an advocate who understands how TPAs operate is crucial.

Step 2: Immediately Document and Report Your Injury

The moments after an injury are chaotic, but what you do immediately can significantly impact your Sedgwick claim. Documenting everything from the start builds a foundation of evidence that is difficult to dispute later. Don’t wait—crucial evidence can disappear and memories can fade.

What to Do After a Workplace Injury

If you’re hurt at work, your health is the priority, but protecting your legal rights is a close second.

• Report the injury immediately. In Texas, you must notify your employer within 30 days, but you should do it the same day if possible. Get written confirmation that your report was received.
• Seek prompt medical attention. This creates a medical record linking your injury to the incident. If it’s an emergency, go to the ER. Follow all doctor’s instructions, attend every appointment, and adhere to all work restrictions. Sedgwick will look for any reason to argue you made your injuries worse.
• Document everything. Keep all medical records, bills, pharmacy receipts, and proof of mileage to appointments. Track your lost wages with pay stubs and written confirmation from your employer about missed time.
• Complete the First Report of Injury form accurately. This is an official record that Sedgwick will scrutinize. Be specific about how, when, and where the accident occurred. If you’re unsure about anything, consult an attorney before submitting it.

What to Do After a Car or Premises Accident

For car accidents or slip-and-falls, your documentation strategy is just as critical.

• Call 911 and report the incident. A police report provides an official, neutral account of a car accident. For a premises accident, insist that the property manager file an incident report and try to get a copy.
• Gather information and evidence. Exchange names, contact details, and insurance information with all parties. Use your smartphone to take extensive photos and videos of the scene, vehicle damage, the hazard that caused your fall, and any visible injuries. Capture the area from multiple angles.
• Collect witness information. Get names and phone numbers from any independent witnesses. Their testimony can be invaluable.
• Never admit fault. Fault is a legal determination. Stick to the facts when speaking to police or other parties. Apologizing can be used against you.
• Get a medical evaluation right away. Adrenaline can mask pain, and some serious injuries like whiplash or concussions have delayed symptoms. Waiting to see a doctor gives Sedgwick an opportunity to argue your injuries aren’t related to the accident. For more guidance, see our page on car accident claims.

Thorough documentation is your best defense against tactics Sedgwick may use to deny or minimize your claim.

Step 3: Navigating the Sedgwick Claims Process

After you report your injury, your Sedgwick claim is assigned a claim number and an adjuster, who will be your main point of contact. The adjuster’s job is to investigate your claim by collecting statements, reviewing medical records, and assessing property damage. Sedgwick uses technology and data-driven processes designed for one primary purpose: efficiency and cost control for their client.

How Sedgwick Handles Workers’ Compensation Claims

For a Texas workplace injury, the Sedgwick adjuster will review your First Report of Injury to determine if it qualifies for benefits. They will scrutinize whether the injury occurred within the course and scope of your employment.

• Approval and Disputes: If your claim is approved, Sedgwick will specify which medical treatments are covered. This can lead to disputes if their approved list doesn’t match your doctor’s recommendations.
• Independent Medical Examinations (IMEs): Sedgwick may require you to see a doctor they choose and pay for. These doctors often produce opinions that favor Sedgwick, such as recommending less treatment or questioning the severity of your injuries.
• Return to Work: Sedgwick will push for a quick return to work, either through modified duties or a phased program, to reduce the ongoing cost of your claim. They manage temporary income benefits (TIBs) but are motivated to get you off them as soon as possible.

Navigating a workers’ comp claim with a TPA is complex. For more information, visit our page on workplace accidents.

How Sedgwick Handles Liability and Property Claims

For general liability, auto, or property claims, the investigation is intense. The adjuster will gather evidence to identify reasons to reduce or deny your claim.

• Recorded Statements: You will likely be asked to provide a recorded statement. This is a strategic move. Adjusters are trained to ask questions that can elicit responses they can use against you later. You might inadvertently minimize your injuries or say something that suggests you were at fault. We strongly advise against giving a recorded statement without consulting an attorney.
• Settlement Authority: After the investigation, the adjuster makes a settlement recommendation to their client. Their authority to settle directly depends on their agreement with the client; larger claims always require approval.
• Damage Assessments: In auto cases, Sedgwick uses its own appraisers and repair networks to control costs, which may result in lower estimates or the use of aftermarket parts. For property damage, their adjusters will evaluate the loss with the goal of minimizing their client’s financial exposure.

Every step in Sedgwick’s process is designed to protect their client’s bottom line. For more on navigating these types of cases, explore our resources on personal injury claims.

Step 4: Overcoming Common Challenges with Sedgwick Claims

Dealing with Sedgwick claims can feel like an uphill battle. Sedgwick’s loyalty is to its client—the employer or insurer—not to you. Their adjusters are measured by how much money they save, creating a direct conflict with your need for fair compensation. Understanding their common tactics is the first step to protecting yourself.

Common Tactics Used to Minimize Payouts

Sedgwick uses a predictable playbook to limit what they pay on claims. Knowing what to expect can help you avoid falling into common traps.

• Lowball Settlement Offers: The first offer is almost never the best. It’s a test to see if you’ll accept less than your claim is worth, and it rarely accounts for future medical care, long-term disability, or pain and suffering.
• Requesting Recorded Statements: Adjusters use these friendly-sounding calls to find inconsistencies or statements they can use against you. A simple comment like “I’m feeling a bit better” can be twisted to suggest your injuries aren’t serious.
• Claim Processing Delays: Dragging out the process puts financial pressure on you. As bills pile up, you may feel forced to accept a lower settlement out of desperation. These delays are often a deliberate strategy.
• Denying Legitimate Claims: A denial is often an opening negotiation tactic. They might cite insufficient evidence, pre-existing conditions, or late reporting, hoping you’ll give up instead of fighting back.
• Surveillance: For larger claims, Sedgwick may hire investigators to film you. They look for any activity that appears inconsistent with your claimed injuries to discredit you.
• Using Their Own Medical Examiners (IMEs): You may be required to see a doctor paid by Sedgwick. These IME reports frequently downplay injury severity and recommend less treatment than your own doctor suggests.

Responding to a Claim Denial or Low Offer

A denial or a low offer is not the final word. It’s the start of a negotiation.

• Never Accept the First Offer: It is almost certainly less than what you deserve. Don’t act out of desperation.
• Demand a Reason for Denial: Sedgwick must provide a written explanation for a denial. This tells you what you need to address in an appeal.
• Gather More Evidence: If they claim insufficient evidence, work with your doctor to get detailed records and statements that strengthen your case and prove causation.
• Write a Formal Appeal: A well-crafted appeal letter should directly address the reasons for denial and present your supporting evidence. An attorney can be invaluable here.
• Don’t Sign Anything Without Legal Review: Settlement agreements and medical authorizations contain language that can waive your rights. Once you sign a release, you can’t reopen your claim. This is especially critical in cases involving long-term consequences, such as those detailed on our page about brain injury claims.

Going up against a sophisticated operation like Sedgwick alone is a disadvantage. With the right knowledge and legal help, you can level the playing field.

Step 5: Know Your Legal Rights and Options

Facing a Sedgwick claim can be legally confusing. TPAs like Sedgwick operate in a complex legal environment, and their adjusters use this to their client’s advantage. Many injured people mistakenly believe they must accept whatever Sedgwick offers, but you have rights and options that extend far beyond what an adjuster might tell you.

Workers’ Compensation and Third-Party Liability

If Sedgwick is handling your Texas workers’ compensation claim, you’re dealing with a system that has statutory limits on benefits and typically prevents you from suing your employer for things like pain and suffering. Sedgwick operates strictly within this framework.

However, many injured workers miss out on significant compensation by overlooking third-party claims. A third-party claim is a separate personal injury lawsuit against a negligent party other than your employer who caused or contributed to your injury. Examples include:

• An injury caused by defective equipment made by another company.
• An accident caused by an unsafe contractor on your worksite.
• Being hit by a negligent driver while on the job.

Under Texas law on third-party actions (Texas Labor Code Chapter 417), you can pursue these claims. Unlike workers’ comp, a successful third-party claim allows you to recover damages for pain and suffering, full lost wages, and all future medical needs. The difference can be life-changing. A Sedgwick adjuster has no obligation to inform you of these rights.

Legal Strategy for Your Sedgwick Claims

An effective legal strategy begins with hiring an attorney who understands how TPAs work. When you hire Universal Law Group, the dynamic with Sedgwick changes immediately.

• We handle all communication. No more calls from adjusters trying to get a recorded statement or pressure you into a low settlement. You are protected from their tactics.
• We conduct a thorough evidence evaluation. We gather and analyze all medical records, accident reports, and witness statements. We work with medical and vocational experts to build the strongest possible case.
• We negotiate for a fair settlement. We know what your claim is truly worth, including all current and future damages. We counter Sedgwick’s lowball tactics with facts and legal precedent to secure the maximum compensation you deserve.
• We are prepared to file a lawsuit. If Sedgwick refuses to be fair, our experience as former prosecutors gives us an edge in the courtroom. We are not afraid to take your case to trial to fight for your rights.

You don’t have to steer this complex process alone. With experienced legal representation, you can focus on your recovery while we handle the legal battle.

Frequently Asked Questions about Sedgwick Claims

When dealing with a Sedgwick claim, it’s natural to have questions. At Universal Law Group, we’ve helped countless clients who were confused and frustrated by the process. Here are answers to the most common questions we hear.

Why is Sedgwick handling my claim instead of an insurance company?

Sedgwick is a Third-Party Administrator (TPA), not an insurance company. Your employer or the at-fault party’s insurer hired Sedgwick to manage the claims process for them. This is common for large, self-insured corporations that pay claims from their own funds. Sedgwick’s job is to handle the administration and, most importantly, control costs for their client. They are essentially a claims department for hire, and their success is measured by how much money they save the company that pays them. You can learn more about TPAs here: What is a third-party administrator (TPA)?

Why would Sedgwick deny my claim?

A claim denial is a common strategy used to protect their client’s finances. Sedgwick may deny your Sedgwick claim for several reasons, often as a negotiation tactic. Common reasons include:

• Insufficient evidence: Claiming your medical records don’t prove your injury.
• Timing issues: Arguing you didn’t report the injury or file the claim on time.
• Not work-related: For workers’ comp, contending the injury happened outside the scope of your employment.
• Pre-existing conditions: Blaming your symptoms on a prior injury or condition.
• Discrepancies in your story: Using minor inconsistencies to question your credibility.

A denial is not the end of the road. It’s often the beginning of the fight for fair compensation.

Do I need a lawyer to deal with a Sedgwick claim?

While you are not legally required to hire an attorney, trying to handle a Sedgwick claim alone is a significant risk. Sedgwick adjusters are trained negotiators whose job is to minimize your payout. They know the law and use tactics to undermine your claim.

Hiring an experienced lawyer levels the playing field. We know what your claim is actually worth, including damages for future medical costs and pain and suffering that Sedgwick won’t offer. Claimants with legal representation consistently receive higher settlements. An attorney also manages all complex legal procedures and deadlines, allowing you to focus on your recovery. At Universal Law Group, we offer a free consultation to discuss your claim and explain your options.

How a Houston Personal Injury Lawyer Can Help with Your Claim

If you’re facing a Sedgwick claim in Houston, you don’t have to go through it alone. At Universal Law Group, we provide personalized and responsive service to every client. We understand the stress of fighting a third-party administrator whose goal is to pay you as little as possible.

My background as a former prosecutor gives our firm a distinct advantage. I learned how to build compelling cases from evidence and win them. We apply these same skills to personal injury cases, digging into the details of your claim to counter the tactics used by TPAs like Sedgwick.

When you hire us, we take over all communication with Sedgwick, protecting you from leading questions and pressure to accept a low offer. We handle the paperwork, deadlines, and evidence gathering. We will thoroughly evaluate your case to determine the full value of your damages—including medical bills, lost wages, future care, and pain and suffering—and negotiate aggressively for a fair settlement.

If Sedgwick refuses to be fair, we are always prepared to take your case to court. Our litigation experience means we are not afraid of a trial, a fact that often leads to better settlement offers.

Your focus should be on your recovery, not on fighting adjusters. Let us handle the legal battle. We offer a free, no-obligation consultation to review your case and explain your options.

Don’t let Sedgwick determine the value of your future. Reach out to Universal Law Group today and let us put our experience to work for you. Contact us for help with your personal injury claim.