Your claim

Understanding the claims process – U.S.

Sedgwick is ready to assist you throughout the claims process. You can count on us if you have a question or need guidance. Our goal is to help you get back to your normal life as quickly as possible. We will be with you every step of the way.

Once you have started your claim (check with your human resources department on the best way to do that), mySedgwick’s user-friendly graphical interface and enhanced dashboard, employees can quickly view claim notifications, update their information, see recent and upcoming payments, and more. Learn more about mySedgwick by watching this video or downloading this flyer.

Click below to learn more about what to expect for your specific type of claim or case.

Click here to watch a brief video on what to expect from the workers’ compensation claim process. For Spanish version, click here.

1) Claim is reported

Once your claim has been reported (please check with your company to make sure you do this according to their policy), an information packet will be sent to you by mail or email.

2) Complete the forms

It is important that you complete the forms in the information packet and return them to Sedgwick as soon as possible so we can handle your claim promptly.

3) Qualification notice

Sedgwick will let you know whether you qualify for benefits, the amounts and when they begin, based on state law.

4) Finding treatment

If your employer provides access to our network of highly qualified medical providers, Sedgwick can help you find a local, authorized provider to treat your injury or illness.

Remember to check with Sedgwick before making a change to your medical provider, because coverage of your medical costs and benefits could be put at risk if the change is not approved. Your provider should submit bills for your treatment directly to Sedgwick and include your claim number.

Learn more about the disability claims process by watching this video.

1) Request for disability or leave

When your request for disability or leave is received (please check with your company to make sure you do this according to their policy), a specialist will contact you if additional information is needed.

2) Complete the forms

You will also receive a packet of information, including forms to be completed by your provider. This information should be returned to Sedgwick as soon as possible so we can review your request for disability or leave, process your case promptly and avoid a delay in payment.

3) Decision notice

Once the decision is made on your case, you and your employer will be notified of the status. Before the end of the allowed disability or leave period, the specialist will contact you to confirm your return to work plans.

4) Return to work

If an extension is needed, we will outline the updated medical information required from your provider. Always report your actual return to work date to your specialist.

1) Claim is reported

Although we are not an insurance company, we manage claims on behalf of insurers and our clients. One of our adjusters will contact you to discuss the cause and extent of your damages and request any necessary additional information from you.

2) Field inspection

Next, a field inspector will take measurements and determine the extent of the damage. If a business is involved, business interruption will be included in the assessment. You will receive a copy of the completed loss estimate.

3) Payment + repairs

Your insurer will send you a check for the actual cash value of your property loss without additional documentation – this amount is typically the fair market value for your property, minus the deductible. In this scenario, you coordinate the repairs or replacement and apply the actual cash value payment to its cost.

If your policy covers full replacement value, coordinate with your adjuster and a qualified contractor to make the repairs. You can also ask your adjuster if our repair network can help. In this scenario, you would cover your policy’s deductible and apply your actual cash value payment toward repairs. You can then submit repair receipts to the insurer for reimbursement of the remaining costs.

Looking for more information?

Clear up any lingering questions by starting a chat with us or searching our help center.