Sedgwick is what is known as a third party administrator. In plain English that means that in Illinois workers compensation cases, they will process claims of their big corporate and government clients. So they act like an insurance company even though the bills are really being paid by your employer.
They have a reputation for being aggressive and sometimes even ruthless. Their big clients like Amazon or the City of Chicago surely love this as it saves them money they have to pay out for work injuries. And I do think they do a good job for their client’s interests. Injured workers tend not to like them so much.
I’ve heard a bunch of crazy stories of things done by their claims handlers. Some are legal but super aggressive. Others certainly border on the possibility of illegal or at least really scummy.
One in particular told me that a couple months after their case started, the adjuster said the case would be closed in a month. In my opinion, that’s a scummy thing to say because while they can say their internal file is closed and they won’t do anything else, it’s misleading to the injured worker.
It’s misleading, in my opinion, because it implies that the case is done and there’s nothing the worker can do. If the worker isn’t savvy enough to know the difference or call an attorney, they very easily could lose some rights. Specifically in this case, the worker might have needed medical care beyond that month. If a doctor says they do and it’s work related, the employer, via Sedgwick, should pay for it.
Beyond that, this worker, at some point, would be entitled to a settlement. What Sedgwick did here is what a lot of insurance companies do. They made the worker think that there wasn’t the possibility of a settlement because the case was “closed.” And if they can get the worker to wait too long, the case really will be closed because they won’t have filed paperwork in time with the Illinois Workers’ Compensation Commission. This particular worker would have lost tens of thousands of dollars. I’ve seen this happen to hundreds of people over the years based on misleading statements from just about any work comp insurance company you can think of.
The good news in this case is we were able to connect this worker with an attorney in his area who was able to file the case and surely will make a great financial recovery for him. By filing the case officially, it will be open and Sedgwick will have to deal with it.
The bottom line is that if the insurance company is telling you something, you don’t have to believe them. It may be true, it might be b.s. Verify for yourself. If you want to speak with a lawyer for free you can call us any time at 312-346-5578.