If you’ve been injured and suddenly find yourself dealing with a Sedgwick claims adjuster, you might be wondering: who is Sedgwick and why are they handling my claim?
Many Texans are surprised to learn that Sedgwick isn’t actually an insurance company at all. Sedgwick is what’s known as a third-party administrator (TPA) – yet this claims management giant can still have a huge impact on whether you get compensated fairly or get stuck with a denied or lowballed claim.
In this post, we’ll break down what Sedgwick does, why your employer or a big company might use Sedgwick, and how to protect yourself from their delay or deny tactics. We’ll also give some Texas-specific examples and practical tips for standing up to Sedgwick.
And as always, if you’re getting the runaround from Sedgwick on an injury claim, Jim Adler & Associates is here to help.
Sedgwick Is NOT an Insurance Company
Sedgwick Claims Management Services (often just called Sedgwick) is not an insurance company – it doesn’t sell policies or directly pay claims out of its own pocket. Instead, Sedgwick is hired by other organizations to manage claims on their behalf. In other words, Sedgwick serves as an outside claims department for employers, insurance carriers, and even some government entities.
Companies that don’t want to handle claims in-house (or insurers that need extra help) pay Sedgwick to investigate, administer, and attempt to settle claims for workplace injuries, car accidents, slip-and-fall injuries, disability benefits, and more.
Because Sedgwick only administers the claim, the money for any payout comes from the employer or insurance company that hired Sedgwick – not from Sedgwick itself. This is an important distinction.
Sedgwick’s adjusters are trained to minimize payouts and protect the financial interests of their clients (the employer or insurer), rather than to look out for you.
In fact, Sedgwick proudly advertises how much money it saves its clients. (One Sedgwick marketing piece even boasted about denying 54% of injured workers’ treatment recommendations to cut costs!)
The bottom line: Sedgwick operates behind the scenes of many claims, but their loyalty is with the company that hires them, not with the injured person filing the claim.
Why Are You Dealing with Sedgwick After an Injury?
If Sedgwick is involved in your injury claim, it means your employer or the company responsible for your injury has contracted Sedgwick to handle the claim administration. Sedgwick has become one of the largest claims administrators in the country, so plenty of big Texas companies use them.
For example, Amazon is a well-known Texas non-subscriber (an employer that opts out of the state workers’ comp system) and uses Sedgwick to manage its employee injury claims. Major retailers and businesses like Home Depot, Kroger, Target, Walgreens, and the former Sears have also used Sedgwick as their TPA for customer injury claims and workers’ comp cases.
If you got hurt at work or on the premises of one of these companies, or even hit by one of their commercial vehicles, it’s likely Sedgwick will be the one calling you about your claim.
Companies turn to Sedgwick because it saves them money. Sedgwick has over 30,000 employees and handles millions of claims, giving it a large infrastructure aimed at controlling costs.
Businesses using Sedgwick to handle claims means aggressive oversight of payouts – which often translates to tight-fisted settlement offers and frequent denials from the perspective of an injured person. It also creates an extra layer between you and the insurer or employer.
Sedgwick might appear to be just “the insurance company” to you, but remember, they work for the other side. This dynamic can make the claims process more confusing and frustrating for everyday people seeking compensation.
Common Challenges When Dealing with Sedgwick
Dealing with any insurance claim can be tricky, but Sedgwick tends to add an extra degree of difficulty. Here are some common challenges and tactics you might face when Sedgwick is handling your injury claim:
- Delays and Lack of Communication: Sedgwick is notorious for moving slowly. You might experience unreturned phone calls, repeated requests for more information, or long waits for approvals. Some delays are by design – dragging out the process can pressure claimants to give up or settle cheaply. It’s not uncommon for injured Texans to feel like they’re chasing Sedgwick for updates while their medical bills pile up.
- Denials of Claims or Treatment: Sedgwick adjusters often look for reasons to deny your claim outright or deny specific treatments. They might argue your injury isn’t work-related, blame a pre-existing condition, or claim lack of evidence. In fact, Sedgwick’s own reports have touted a high denial rate as a cost-saving achievement. For workers’ comp claims, Sedgwick might refuse surgeries or therapies recommended by your doctor, forcing you to fight through appeals. These denials can be incredibly disheartening – and they often happen even for valid claims.
- Lowball Settlement Offers: Even if Sedgwick accepts liability, be prepared for a skeletal settlement offer. Sedgwick’s adjusters are trained to minimize payouts. They commonly dispute medical bills as “unreasonable,” downplay your pain and suffering, and cite “company policy” or industry guidelines to justify offering pennies on the dollar. For example, Sedgwick uses computer programs to audit medical charges and will only reimburse what they deem “reasonable,” which can slash your compensation. The first offer from Sedgwick is almost never what your claim is truly worth.
- Aggressive or Tricky Tactics: Sedgwick adjusters may come across as friendly and concerned but be on guard – their job is to protect their client’s interests, not yours. They might ask for a recorded statement soon after your injury, hoping you’ll say something that hurts your case. They could pressure you to sign a release or accept a quick check before you know the full extent of your injuries. In premises liability cases (like a slip and fall), Sedgwick might drag its feet so that important evidence (like store surveillance video) gets erased before you can obtain it. These tactics are meant to give Sedgwick and its client the upper hand in denying or reducing your claim.
Overall, going up against Sedgwick often feels like an uphill battle. They handle claims daily and know the loopholes, whereas you’re just trying to get medical bills paid and your life back on track. But don’t lose hope – understanding their playbook is the first step to beating them at their own game.
Texas Work Injuries: Sedgwick and Your Rights
Work injury claims in Texas can be especially complicated when Sedgwick is involved. Texas is the only state that doesn’t require all employers to carry workers’ compensation insurance. Some big employers opt out of the state system (becoming “non-subscribers”) and set up their own injury benefit plans, often administered by companies like Sedgwick.
If you’re hurt on the job at a non-subscriber company such as Amazon, Sedgwick may handle your work injury claim – but that claim is not traditional workers’ comp. It’s essentially a liability claim against your employer’s injury plan.
In these cases, you may have the right to file a lawsuit for negligence against the employer (since non-subscribers lose the usual legal protections of workers’ comp). This is a complex area of law, and it’s crucial to understand the difference between a workers’ comp claim and a third-party claim in Texas.
(See our guide on how workers’ comp vs. third-party claims work in Texas to learn more about your options if you’re hurt on the job and a third party or non-subscriber is involved.)
Even if your employer does carry workers’ comp insurance, Sedgwick might still be the administrator handling the claim. They will follow Texas workers’ comp rules, but that doesn’t stop them from delaying treatment approvals or disputing your impairment rating.
Always report your workplace injury promptly and in writing and be mindful of Texas’s strict deadlines (you generally must notify your employer within 30 days and file necessary comp forms within one year).
If Sedgwick is dragging its feet or denying a valid on-the-job injury claim, you have the right to challenge that decision – and a Texas work injury attorney can be your strongest ally.
(For more on your rights in work injury cases, especially if a negligent third party caused your injury, check out our resource.)
Sedgwick in Car and Truck Accident Claims
Sedgwick doesn’t just handle workplace injuries – you might also encounter Sedgwick after a car accident or truck accident, especially if a commercial vehicle or company driver was involved. Many large companies with vehicle fleets or delivery services use Sedgwick to manage their accident claims.
For instance, if an Amazon delivery van or a company truck from Kroger or Home Depot hits you, you may find yourself dealing with a Sedgwick adjuster instead of a typical insurance company. The process is similar: Sedgwick will investigate the accident, determine fault (and they may be quick to argue you were at fault or partially at fault), and control the settlement negotiations on behalf of the company.
It’s important to treat Sedgwick just like you would any liability insurance adjuster – actually, with even greater caution. They might request a statement about the car accident or ask you to sign papers for vehicle damage.
Remember that Sedgwick’s goal is to save the company money, which can mean downplaying your injuries or offering a low settlement for your car damage and injuries.
Always get a copy of the police report, gather witness info, and don’t admit fault. If the accident wasn’t your fault, you shouldn’t have to pay a dime – and Sedgwick knows that, even if they act like they’re doing you a favor by covering some costs.
Be firm and consider getting a lawyer involved if Sedgwick gives you the runaround on a car or truck accident claim.
Sedgwick and Premises Liability Claims
If you were injured at a business (like a slip and fall in a store, a trip over a hazard, or any accident on commercial property), there’s a good chance Sedgwick might be handling the premises liability claim behind the scenes.
As noted earlier, big retailers in Texas such as Kroger, Target, Home Depot, and Walgreens rely on Sedgwick to manage injury claims from their stores. So, after a store injury, instead of hearing from the store’s insurance company, you’ll likely get a call from a Sedgwick claims examiner.
In these cases, Sedgwick will investigate whether the business was negligent. Don’t be surprised if they deny liability by saying things like “our client had no notice of the spill” or “we have no evidence of negligence.” They may also try to get you to admit you weren’t watching your step or otherwise shift blame onto you.
Sedgwick’s adjusters will use any delay or missing evidence against you. If they do offer a settlement, it may barely cover your medical bills, ignoring things like pain, suffering, or future treatment.
Premises liability claims in Texas require proving the company knew or should have known about the dangerous condition and failed to fix it. Sedgwick is adept at arguing a lack of evidence on those points. That’s why it’s critical for you to gather evidence immediately (photos of the hazard, names of any witnesses, etc.) and notify the business about the incident right away so there’s an official report.
Don’t settle for less than you deserve just because Sedgwick is tough – with legal pressure and a solid case, they often reconsider those lowball offers when they see you mean business.
6 Tips for Dealing with Sedgwick and Protecting Your Claim
Facing Sedgwick can feel intimidating, but there are steps you can take to strengthen your position. Here’s a handy checklist for dealing with Sedgwick on any injury claim:
- Report the injury or accident immediately: Whether it’s your employer or a store manager, make sure the incident is officially logged as soon as it happens. Prompt reporting not only bolsters your credibility but also forces Sedgwick to open a claim file.
- Document everything: Take photographs of the accident scene, your injuries, and anything relevant (unsafe conditions, vehicle damage, etc.). If there were witnesses, get their names and contact info yourself – don’t rely on Sedgwick to do it. Keep copies of all documents, forms, emails, and letters related to your claim. A paper trail can save you if Sedgwick “loses” paperwork or tries to dispute facts.
- Don’t give a recorded statement without advice: Sedgwick might ask for a recorded statement or signed authorization early on. It’s usually safer not to provide a recorded statement without first speaking to a lawyer. You can politely decline or say you will provide a written statement of the facts. Never sign broad medical releases or anything you don’t understand – you could be signing away privacy or rights.
- Be mindful of medical treatment and follow-ups: Get the medical care you need promptly. Follow doctor’s orders and keep records of all treatment. If Sedgwick delays approving a treatment (in a workers’ comp case) or refuses to pay a medical bill, continue treating as needed and keep documentation. Gaps in treatment or not following up can give Sedgwick an excuse to downplay your injury.
- Push back on unreasonable requests or delays: If your Sedgwick adjuster is unresponsive or asking for unnecessary information, document each contact attempt. You can firmly (but politely) remind them of any deadlines or that you’ve provided what was asked. If they continue to stall, consider escalating the matter – sometimes a letter from an attorney or even a complaint to the Texas Department of Insurance (which licenses TPAs) can light a fire under a slow claims process.
- Consider legal help – sooner rather than later: Sedgwick has professionals working to protect the company’s interests. Having your own professional (a personal injury attorney) to advocate for you can make a huge difference. An experienced Texas injury lawyer will know Sedgwick’s tactics and how to counter them. They can handle communications, make sure evidence is preserved (for example, sending a letter to save any surveillance footage of your accident), negotiate for a fair settlement, and file a lawsuit if necessary.
Remember, Sedgwick’s job performance is measured by how much money they save their client – your attorney’s performance is measured by how much you recover. Even the playing field by getting legal muscle on your side.
The Texas Hammer® Can Take on Sedgwick for You
Sedgwick may not carry a hammer, but they certainly try to nail down your claim and prevent you from getting what you’re owed. Don’t let them.
If you’re dealing with Sedgwick in Texas – whether it’s a tough work injury case, a commercial vehicle accident, or a slip-and-fall at a store – you don’t have to go up against this giant alone. Jim Adler & Associates has battled third-party administrators and insurance bullies for decades. We know their tricks, and we know how to fight back to get our clients the justice and compensation they deserve.
Contact our team today for a FREE consultation. We’ll review your situation, cut through Sedgwick’s excuses, and help you plan a strategy to secure the maximum recovery possible.
Sedgwick works for them – let us work for you. We’ll stand up to Sedgwick and any other company that tries to deny or lowball your injury claim.
When you’ve been hurt and the stakes are high, we don’t back down. Give us a call, and let’s hammer out a fair result for your claim. 🚀
