Sedgwick CMS

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Category: Other

Contact Information
PO Box 14568, Lexington, Kentucky, United States

Phone number: 866-697-8122

Sedgwick CMS Reviews

catmom43 May 17, 2011
disability fraud
I went on FMLA on 1-24-11 through 3-14-11. Sedgwick CMS's claims agent, Christima Muchow, denied the claim from 2-28-11 - 3-14-11, stating it was not medically necessary for me to be off of work for knee pain caused by a blood clot. My medical doctor is the one who kept me off of work all this time, thereby making it medically necessary as he felt I should not return until 3-14-11. I filed an appeal, the appeal's officer being Stephanie Fontanez. She denied the appeal stating that on 2-26-11 I was seen by a dr for a bladder infection, not a sinus infection. That date was a SATURDAY & I've never had a bladder infection. This information was used to help with the denial. I called this to her attention & she wrote a corrected letter, this time stating that their doctors, one a gastrointerologist, the other an opthalmologist, reviewed my claim & tried to get in touch with my eye dr, who didn't respond. Yet in the corrected letter, she stated that there was nothing wrong with my eye to begin with. Then why did I have to see my eye dr every Monday until an abscess cleared up. She stated that there were not signs of reddness or tenderness. Any time an abscess is present, there is always reddness & tenderness. I appealed her denial, and received a letter from Christina Muchow stating that she had received my appeals letter. Why is she reviewing my case on the 2nd level appeal when she is the one who denied it in the 1st place? All she's going to do is let it collect dust until 7-27-11 & then write the denial letter. Furthermore, I have requested the medical records which they stated I'm entitled to but refuse to send them. Why is they can get away with this stuff? And when I complained to the Director of Insurance, they said they couldn't handle the complaint, the BBB couldn't handle the complaint & referred me back to the Director of Insurance for TN. The company sending the letters is in KY. My complaint was also sent to the Department of Labor, again they wouldn't touch it. Who is over a company that is this bad & who puts fraudulent information in their claim letters, thinking a corrected letter with more fraudulant information will fix the problem? I want to know who to turn to so I can go after them full force for stuff like this. It is legally & morally wrong.
Timothyh March 31, 2011
benefits
They play games, lie, and the benefits are sporatic. They don't take care of business in a professional manner, takes a llooonnngggg time for them to approve mri's, therapy, doctor appts., etc... They just don't care about anyone, but themselves. They suck and are the ins. company out there!!!
cat312 February 19, 2011
Liars
I had a roof installed by Home Depot, and it soon began to leak causing damages in my home.
Home Depot took responsibility at the time, and said the leaks were due to faulty flashing around my sky lights, and they gave me their claim Dept to contact, Sedgwick Claims Management.
It has been 6 months of hell dealing with Sedgwick, and I received nothing but stall tactics, and listen to lies.
At first Sedgwick offered us a fraction of their own insurance adjusters estimate. After we declined weeks later they decided to not pay anything, ignore our calls. After hiring a lawyer, they finally replied saying they are sending an engineer to make a determination. That phone call took them a month to make.
After numerous calls following up with Sedgwick to solve this issue, they said they did not like their engineers report, and were sending out yet another engineer. That was pretty obvious as to why.
Clearly the first engineers report was not what they hoped for.
Engineer number two comes out, and his report is an absolute joke and complete nonsense. In this report it reads the damages to my floors is due to the rotting doors. Meanwhile the doors did not rot until the water was coming through the flashing from above! This fact I know because I sat and watched this with my own eyes, and so did Home Depot when putting water hoses all over my roof to find the leaks.
With this bogus report, now Sedgwick claims zero responsibility. It is crystal clear the faulty flashing by Home Depot casued the leaks and damages.
This company intentionally stalls, are grossly unprofessional, and clearly unscrupulous.
All that is written about them online is true. How does the attorney general and INsurance board allow this criminal behavior?!
I am pursuing exposing Sedgwick, and I will fight for my thousands of dollars of damages.
Their hoping I will get exhausted will not work, I am actually looking forward to getting justice for myself, and so many others. online, in court, and in the media.
Shame on Home Depot for allowing them to represent them when they pride themselves on customer service!
And shame on you for knowing the truth, and not having the integrity to stand behind your product!
Jenn Schafer February 2, 2011
Rude and unprofessional
My car was hit in the front right passenger corner on January 4th of this year, by a gentleman that drove a 7-11 company car. My car was undriveable. A police report was filed and the gentleman resumed full liability for the accident. Unfortunately, the car was insured by Sedgwick CMS. On January 4th, approximately 10am I filed the claim to my insurance company, Progressive. I was informed by my agent that since I only have liability on my car, that I was unable to obtain a rental car until Sedgwick was contacted and a claim was filed. I am 24 years old and in the state of New Jersey, most rental companies will not rent a car to you unless you are 25 or older. This was a huge problem seeing as I had no transportation. Anyway, both my insurance agent and I tried time and time again to contact this company and for reasons unknown, they were elusive. I could not get through to a person, all I could get were machines. After a week of trying, I finally had enough. I mailed and faxed a letter to their main office stating: if they were not going to give me the time of day, I was simply going to contact an attorney. I suppose that sparked some interest and I received a call the very next day. The call was from a man named Nabeel Nasir and he was extremely rude. I was treated like the accident was my fault and I was being bothersome. When in reality, they were assuming responsibility. The only up-side was that Nabeel was able to get me a rental car within a day of speaking to him. I obtained the rental from Enterprise on January 19th. I was told I needed insurance on my rental, again since I only have liability insurance. The gentleman at Enterprise was very accomodating and assured me that Sedgwick should be able to cover the insurance fee. He then tried to contact Nabeel... to no avail. I had no choice but to take his advice and take their rental insurance. I was not directed otherwise by Sedgwick, so I did not see it as a problem. About 2 days go by and I am contacted by Nabeel stating that my car was totaled and that he will contact me the next day with further instructions. No call and no answer when I tried to call until the following week on the 25th. I was told on the 25th by Enterprise that Sedgwick called them and told them they will only pay for one more day on my rental. I was beyond livid at this point. I received no information on my totaled car until I called Nabeel about 6 times in a row that same day. I asked to speak to his supervisor and I was not put on hold, I was hung up on. I never got a call back and could not get a hold of Nabeel for the rest of that day. The next day I took my car back to Enterprise, not wanting to use any money out of pocket. The gentleman at Enterprise explained that he was unable to contact Nabeel or anyone from Sedgwick and unless he could I was going to be charged the $160 for rental insurance. After waiting an hour in Enterprise calling Sedgwick, we finally got him on the line and asked for the reimbursement. He informed us that Sedgwick does not pay for rental insurance and would not explain further. We finally spoke to his supervisor to which she explained they will not pay for insurance, however they will lend me the rental until I had received my payout for the totaled car... but they still WOULD NOT pay the rental insurance. Thankfully, the gentleman at Enterprise had a heart and told me I did not have to pay for the insurance.

Overall, I felt I was ignored and treated very poorly by Sedgwick CMS, even though the accident WAS NOT MY FAULT. I hope no one ever has to deal with them again.
Pat Rybin October 18, 2010
Short term disability
I injured my back on a trip to S.D. There was no accident, but I've been fighting my back problems for almost 20 years (from work injury). I filed for short-term disability Aug. 17th 2010. It is now Oct. 18th 2010 and still no results. I was told it was denied because of "lack of info from the Dr.) I sent in 3 medical reports, and was told they don't have them. It is in appeal, and won't be decided intil Nov. 25th 2010. Where are my records I sent in? I was standing right there when they were sent. I am entitled to 22 weeks full pay and 11 weeks half pay, but right now...I'm not getting any pay. What is the problem here? I can't work because I'm still under Dr's care. I'm "very" dissapointed in them !!! They are very rude and don't give a hoot about you.
Screwed by Sedgwick September 1, 2010
"Great Workman's Comp - If your the Empolyer
Lauri Atoe from Sedgwick CMS is a liar and a scam artist. Not only will she lie to you on the phone, she will enable your employer to screw you out of workman's comp. She not only helps them find a "cutoff" Dr., she will with hold documents and crucial paperwork to make sure that the cut off Dr. does just that, cut you off.
ryanb3 May 4, 2010
Playing games
I injured my back while working for Kohl's. Luckily, I had Sedgwick CMS as my worker's comp carrier *insert sarcasm*. The injury happened at the end of August 2009, it is now the beginning of May 2010. The adjusters at Sedgwick will do everything in their power to delay any medical care needed and deny coverage of doctor/specialist visits + medications. The specialists that they do cover (if you are lucky) are hasty in their evaluations and incompetent at best.
I did manage to get two months of physical therapy covered, from October through December. Sedgwick then took it upon themselves to "close" my case without notifying me in January, while I was still seeing my doctor and filling prescriptions, which won't be covered.
Throughout this whole ordeal I wanted a second opinion on my back. Sedgwick sent me to my doctor for another evaluation, refused to pay the bill, and is trying to get me to see the original incompetent orthopedic surgeon for a second opinion?
Another fun-filled game they play is "ignore phone calls for as long as possible." It's a blast, really. You call your Sedgwick adjuster, leave an urgent message, and allow them to ignore you for as long as they can stand it. Leave more messages over a two week period and wait for the call to be returned (if ever).
Moral of the Story: If you get injured at work and they have Sedgwick CMS as their provider, get a lawyer early on. You can also be a fool like me and play their games until the pain wreaks havoc on your everyday lifestyle and then consider a lawyer. It's your choice, but I strongly suggest you don't be a fool.
injured09 September 17, 2009
DELAY IN MEDICAL CARE
SEDGWICK HAS THERE HANDS IN THE WORK RELATED INJURY DRS. WALLETS AND FILL THEM UP AS LONG AS THE DRS DISMISS YOUR INJURIES, DELAY TIMELY AND PROPER MEDICAL CARE . THE DRS ARE RUDE, INCOMPETENT, MAKE UP LIES AND FORWARD THE INFO TO SEDGWICK AS FACTS. SEDWICK AND THE DRS. CAN NOT BE TRUSTED WITH YOUR CARE. IF YOUR INJURED AT WORK GET A LAWYER THE SAME DAY YOUR HURT, IF SEDGWICK IS THE CARRIER. THEY DENY CLAIMS PROLONG TREATMENT, THEN DRS TELL YOU ENOUGH TIME HAS GONE BY YOUR NOT IN PAIN, MENTALLY GET ON DOWN THE ROAD DISMISS YOU LIKE TRASH OR GUM ON THERE SHOE. THE DRS.WALK OUT OF THE OFFICE BEFORE YOU CAN DISCUSS YOUR INJURY. SEDWICK DRS DONT LISTEN AND DONT CARE AS LONG AS THERE WALLETS ARE FULL FOR THERE SKI TRIPS AND FISHING OUTINGS . DONT TRUST THE DRS FANCY WEBSITE CLAIMS. ITS BUNK. I WAS INJURED SEVERAL MONTHS AGO HAVENT RECEIVED ANY TREATMENTS FOR SEVERLY INJURED BACK. I WAS TOLD YOUR FINE YOUR NOT IN PAIN GET OVER IT, AND FULL DUTY AT WORK!!! I HAD TO PAY FOR MY OWN MRI, FROM MY PRIVATE DR SHOWING THE FULL INJURY.
SEDGWICK IS A HUGE JOKE. COMPANYS WHO USE THEM DONT CARE ABOUT THERE EMPLOYEE AND COMPANYS HIDE BEHIND THE ERISA HIPE!!!
anoynomous July 8, 2009
Insurance Automotive
Sedgwick CMS claims adjuster Tina Parks is a lying, calculating dishonest person and of all the claims adjusters I have ever dealt with I got the worst. She lied from day one trying to get me to have my insurance pay for vehicle damages sustained from getting hit by one of their clients trucks. She lied and delayed for more than 30 days, only to tell me she didn't see how their truck could've hit me, my first thought was; gee were you there? I didn't knock my bumper off, but what goes around, comes around and only a judge will have the last say.
Rob Delsman May 10, 2009
False Complaint Service
DO NOT Contact the person listed below at Sedgwick CMS. This person is not interested in helping you, this person's sole responsibility is to collect information about you so that Sedgwick CMS can terrorize you and your family at a later date.

Guy DeRosa

[email protected]

work mobile 9015693422

work phone 9014153858...

File your complaints with the Department of Justice or the Attorney General in your state.

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