Business Profile

Insurance Claims Processing

Sedgwick CMS

Headquarters

This business is NOT BBB Accredited.

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Important information

Customer Complaint:
While the BBB continues to accept and report complaints against this business and fulfill its responsibility to inform businesses of communications from its customers, this business generally responds that the Better Business Bureau online complaint resolution system is not the proper forum to respond to allegations in this complaint.

Complaints

This profile includes complaints for Sedgwick CMS's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

538 total complaints in the last 3 years.
156 complaints closed in the last 12 months.

If you've experienced an issue

Submit a Complaint

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:06/29/2024
Type:Product Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was issued paperwork for a workers comp settlement from Sedgwick on 4/18/24. I filled out and promptly mailed back those forms to receive my settlement check of $6090. I have tried to contact my claim manager via email several times throughout the months of May and June to no avail. I have tired calling not only her but her supervisor as well. Everything time I try and call it goes straight to voicemail. I have called the main office and was promised I would receive a call back within an hour and that call never came. They refuse to answer any and all communications and refuse to issue my legally owed check. This is completely unprofessional that I can't get a simple answer or call back. I am owed that money.
Business Response
Date: 07/02/2024
Thank you for the opportunity to respond to the complaint filed by ***********************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim *********************** filed against our client, ********** Ready Mix, LTD.
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ****************** complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
Date:06/28/2024
Type:Customer Service Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
We have attempted to get a claim processed for a patient; however, we have not been able to get the appropriate address for claims to be submitted. Each time we submit a claim to the address ***** gives us; the claim is sent back to us. The Claims processor is *************************. This is an urgent matter and ***** is aware that we have not been able to get our claim processed and paid on behalf of the member.
Business Response
Date: 07/02/2024
Thank you for the opportunity to respond to the complaint filed by ***************************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim *************************** filed against our client, UnitedHealth Group.
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in Marlyssa Binnss complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
Date:06/20/2024
Type:Sales and Advertising Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My husband has been dealing with this company since March. He has gotten the runaround for months. He recently asked this company to stop payment and send the second check next day. *************************** made seem like a mistake to put the remaining payment in regular mail. We never received it . After waiting for months. They hardly respond, no one answers his calls. We have sent all the required documents. My husband wreck was not his fault. This is not an insurance company your ever want to do business with. This has been such a strain on my husband. He needed a vehicle because the car was total . How much longer should he have to wait
Initial Complaint
Date:06/17/2024
Type:Sales and Advertising Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
While installing a fiber line our neighborhood in August 2022 a contractor for **** cut our water main line, did not notify us, and completed a bad patch on the line. In October of 2023 we noticed a puddle of water in our front yard, we had to excavate the front yard and have the line repaired. When contacting Sedgwick they informed us we needed to contact the contractor. We did and the contractor told us we needed to speak with Sedgwick. I have left several voice-mail at the number provided by Sedgwick over the last couple of months and have not heard back.
Business Response
Date: 06/25/2024
Thank you for the opportunity to respond to the complaint filed by *******************************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ******************************* filed against our client, AT&T.
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ********************** complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
Date:06/14/2024
Type:Customer Service Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Sedgwick denied 3 claims falsely. I was notified on 05/18 by my manager that the absences i reported for 05/04 and 05/11 as well as 05/18 had not been sent to her. I RESUBMITTED them on 05/18 per my manager request and today on 06/13 i am being written up because she received notification that the absences were denied. How could i notify my manager of the absences on the day of absences without submitting them? Makes no sense. Now Sedgwick approved 05/18 after i pointed out i reported the absence ON 05/18. I submitted all absences on their FAULTY website that either is never working or always down. Nobody calls you back when requesting to speak to someone.
Business Response
Date: 06/25/2024
Thank you for the opportunity to respond to the complaint filed by *************************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ************************* filed against our client, ********************* Corporation.
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in *************************** complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
Date:06/13/2024
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
We filed a rain damage claim through our home insurance and had *** with Sedgwick come to ***** and adjust for damages, who gave us the worst experience we have ever had. She grossly misrepresented us to USAA and is solely responsible for us not receiving any compensation for the damage that we had VIDEO evidence of. She was a complete B**** to my wife, didnt know the difference between plaster and drywall, and refused to look at the time stamped video evidence of water coming in our house from the wind damaged roof. We spent over 20k on repairing our roof, and all of our plaster now needs to be replaced. She claimed that the drywall wasnt stained so it wasnt water damaged. We have plaster. Plaster doesnt stain. It bubbles the paint and cracks. But she was so incompetent that she couldnt even tell or listen to us when my wife said it wasnt drywall. Or even do a simple ****** search. Its laughable that me getting the coverage that I pay for, hangs on the shoulders of someone with such a lack of knowledge. Its no wonder they have a 1/5 stars rating with the BBB with over 100 reviews. How USAA uses such a poorly rated company is mind blowing.
Initial Complaint
Date:06/13/2024
Type:Delivery Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.

Complaint: 21715371

I am rejecting this response because: I appreciate the follow up. Just understand my frustration is the lack of communication and the fact that we cannot Fully move into our new home until this is resolved. It Added so much stress and frustration to an already stressful situation. My family and I just want it resolved as quickly as possible so we can start living a normal life with a fully furnished house.

Sincerely,

***************************
Business Response
Date: 05/21/2024
Hello *****,
We apologize for the inconvenience and understand how frustrating this situation can be. Our Claims specialist spoke with you on Wednesday, May 15th and there is an appointment scheduled to inspect your refrigerator on Friday, May 24th to determine where the leak is coming from. If it is determined to be from the 2nd ice maker that was installed in our warehouse, our Claims team will continue to work with you to get this resolved. If the leak is not coming from the 2nd ice maker, GE will be able to process your claim. You were given our claims specialists direct contact information to reach out to if you have any other questions. Have a wonderful day!
Business Response
Date: 05/29/2024
Hi *****,
Thanks for your response. We have set up an even exchange to return the unit in your home and deliver a new unit on June 5th due to the improper installation of the secondary icemaker by warehouse staff. An insurance claim case #4A2405XXZZLH0001 has also been filed for the property damages in your home. You will be contacted by the insurance company no later than May 30th to assist with the property damage claim. Please let us know if you have any further questions and enjoy your week!
Customer Answer
Date: 05/31/2024

Complaint: 21715371

I am rejecting this response because: once again, I truly believe that you were going to do what you said you were gonna do. I was told by ****** that I would have a call on either Wednesday or Thursday and I got no call. I was also told that within 24 to 48 hours. That expired yesterday I dont know whats going on with you folks up until six weeks ago. I had never purchased anything from Nebraska furniture Mart. I made three major purchases in the last six weeks from there. It really seems that you are trying to run me off. I just want one person to do what they said they were going to do when they talk to me on the phone. I have a new house that Im trying to get furnished, but I cant do that until we have a resolution on the floors. H*** we were even shopping in ******** furniture Mart last weekend, I really dont know what got into my head. Im not someone that grips A lot. This company has pushed me to the limits. In the customer service business. I manage a collision center DFW and I would never treat my customers the way youve treated me.

Sincerely,

***************************
Customer Answer
Date: 05/31/2024
Well here it is again on Friday and this should be no surprise to anybody but the insurance company hasnt called like they said they would on Thursday and ****** from FM has not called as she said she would do on Thursday. I have asked ****** for her supervisors name, and she has yet to give it to me. I have not found anybody with this company with **************** skills or even the ability to call an individual back when they said they would.
Business Response
Date: 06/07/2024
Hello *****,
We appreciate your reply. Sedgwick, the insurance company,has contacted you to resolve the claim # 4A2405XZZLH0001. They advised you provided one bid for the repairs needed to the property and were going to obtain a 2nd bid. Has that 2nd bid been provided to Sedgwick yet? Hope to hear from you soon. Have a good day!
Customer Answer
Date: 06/10/2024

Complaint: 21715371

Good evening,
I gave the other bid to the appraiser when he came out on Friday. I am waiting to hear back from the adjuster from ******. Keep in mind, we cannot purchase furniture in fully move into our house until the floors are replaced.
Thank you for the follow up
************************;
Business Response
Date: 06/12/2024
Hi *****,
Thank you for your reply. Have you heard a reply from Sedgwick regarding your claim? We look forward to your reply. Please enjoy the rest of your day!
Customer Answer
Date: 06/13/2024
on 5/6 a refrigerator was delivered damaged to my house. It filled my freezer with water and then drained onto my hardwood floors. I spoke with someone on 5/7. They said someone would call in 24 to 48 hours. I NEVER got a call from anyone. I made several calls and was told the same lie by everyone. Saturday morning I reached a manager names **********. She assured me that someone would call that day and it they didnt to call her before 5 and she would get it straight. I called and emailed ***** at 4:30 that day and still have not been contacted by her. I called ******* who works with Cardinal delivery who delivers for NFM. She set up an inspection time for 5/13 from 7-9. I had no one show up. I then talked to another nfm manager who told me she was so sorry too(about the 100th time that I heard that) She passed the buck to a "manager" for Cardinal. We got "disconnected" and I had to track him down. He told me he would have a resolution in 5 minutes and would call back. It has now been almost 2 hours and I have heard nothing. Absolutely EVERYONE at NFM that I have talked to has lied to me. We made our first ever purchase with NFM just weeks before this fiasco. We bought two bedroom sets and an entertainment center and it went great. That is why we came back. If you want me gone, fix my floor and bring my refrigerator and we will take our business elsewhere. I would appreciate a call back from someone that can stand behind their word.
Business Response
Date: 06/14/2024
Thank you for the opportunity to respond to the complaint filed by ***************************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim *************************** filed against our client, Nebraska Furniture Mart, Inc.
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ******************** complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
Date:06/11/2024
Type:Customer Service Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Please review my claim against Lowes Home Improvement for more details. Didn't know that Sedgwick was the 3rd party to Lowes. Learned this after I filed a complaint with the BBB. Currently been trying to contact the claims adjuster for weeks about the claim. They have sent 3 letters to an address that I didnt reside at the time of the initial contact. As of today several attempts to make contact thru phone and email. As of today still no response.
Business Response
Date: 06/14/2024
Thank you for the opportunity to respond to the complaint filed by ***********************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim *********************** filed against our client, ****** Companies, INC.
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in Chauncy Bells complaint.
Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
Date:06/10/2024
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was recently sick and filed a claim with Sedgwick for my short term disability. I filed the claim on 5/30/24 and was told that I will receive a call from the adjuster/examiner within 2 business days. I never heard anything from anyone and called several times regarding my claim. I was only told it was pending and a request was made by the representatives that I spoke with to have the adjuster/examiner call me back. No one did and on Friday 6/7/24 my claim was denied due to the waiting period that was never explained to me that was supposed to take place 2 business days after I filed the claim with the adjuster/examiner. I have called since Friday trying to see how I can speak to a supervisor to get the case appealed or reviewed on why I was not properly contacted from the beginning. I keep being told that messages are being sent to the supervisor ******** who has yet to call me. I just need help on what to do because I was not treated as a customer and nor was my claim handled in ********************** protocol.
Business Response
Date: 06/14/2024
Thank you for the opportunity to respond to the complaint filed by *******************************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim ******************************* filed against our client, Memorial Hermann Health System.

A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.

Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ********************************* complaint.

Again, thank you for the opportunity to respond and clarify,as able.
Initial Complaint
Date:06/10/2024
Type:Order Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
For over 2 years I rented a large storage locker that had mandatory insurance that was paid every month. Upon moving out of the locker it was clear there was water damage on many of my items, mold and vermin - none of which should have occured based on the statements the locker was secure and climate controlled. I immediately filed a claim, followed all steps and have been ignored for months on end. I send 2,3, 4 emails to ***********************, the person tasked with my claim - he waits months to respond. Upon calling the toll free number a woman named ******* assured me she would assist but would only provide the standard inbox and never again responded outside of requesting I reformat photos to PDFs which I promptly did. Any time the company has asked me for anything I provide it within 24 hours maximum and usually within minutes - I have not been given the same courtesy and have now been batted to a third person named ******************************* who just repeats that files are blank despite that not being factual. I have forwarded the correspondence I had with every agent and they just seem to play hot potato hoping claims will go away. This company operates like a fraud, collected years of insurance money and will not pay for the few items I actually chose to claim that were of noticeable value. There were many other items damaged that I did not bother with. I want them to fulfill the contractual commitments outlined in our agreement as I have repeatedly, for 6 months, fulfilled what has been asked of me.
Customer Answer
Date: 06/24/2024
The business confirmed over voicemail they had all required documents from me, I have now submitted them to 3 different people. Later that week one of them responded that they needed additional information which I immediately provided. It has been two weeks. We are no closer to resolution as once again they have stopped responding.
Customer Answer
Date: 06/24/2024
Please see attached documentation with claim number, my contact history, the amount of times I have followed up and their most recent response that they are just now filing despite a voicemails stating otherwise.
Business Response
Date: 07/03/2024
Thank you for the opportunity to respond to the complaint filed by ***************************. Please note that Sedgwick CMS is not an insurance company. Sedgwick CMS is a third party claim administrator. This complaint arises from a dispute related to a claim *************************** filed against our client, Orange ********************** Program.
A review of the claim file reveals that Sedgwick CMS has administered this claim in compliance with the laws and regulations governing the alleged loss.
Sedgwick CMS respectfully maintains that the Better Business Bureau online complaint resolution system is not the proper forum to respond to the allegations contained in ******************** complaint.
Again, thank you for the opportunity to respond and clarify,as able.

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Sedgwick CMS is NOT a BBB Accredited Business.