Integrated services

Our integrated approach allows clients to focus on the bigger picture when it comes to claims and case management, and our technology, expertise and capabilities set us apart. Clients can access one system to obtain all necessary information along the continuum of an employee absence, with integrated reporting on the employee and workforce levels to help measure trends, guide planning and improve productivity.

Health + productivity

The breadth of our integrated solution means that clients can get the services they need throughout the lifecycle of a claim in a single package, delivered with the highest customer service levels in the industry. Our flexible model provides a data-driven, clinically focused method for clients with options to help them manage key medical costs. It includes a national provider benchmarking program, integration of health and wellness data, referrals during the claim process, and a national approach to utilization review and clinical management.

Managed care

Sedgwick’s managed care services offer multi-disciplinary resources, which include clinical consultation, medical bill review, telephonic and field case management, behavioral health and return to work services, complex pharmacy management and utilization review. A range of review and support solutions are also available, such as provider benchmarking and access to medical and specialty networks. We focus on what is medically the best option for the injured employee and what is going to produce the best overall result. We provide a carefully crafted strategy designed to ensure clients are getting the most value for their dollar at the claim level and the most efficient process at the examiner’s desk.

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Complex claims

A catastrophic injury is a life-changing moment for an injured employee and time is of the essence. Our complex claims unit engages with our claims management team to streamline the process and deliver a positive experience for all stakeholders. Sedgwick’s experts help severely injured employees recover and return to productive lives by engaging the right resources early in the process, delivering the optimal pathway to a healthy outcome. Identifying at-risk claims, including those that are initially complex and those that appear benign but have the indicators of becoming complex due to comorbidities, psychosocial issues or opioid usage, and applying the appropriate resources early in the life of the claim can positively change the path of recovery for the employee.

Whole health

Sedgwick is finding new ways to integrate health and productivity management tools along the spectrum, bridging benefit models through innovations in health advocacy. Through our whole health model, Sedgwick is the first to integrate and simplify administration of health, workers’ compensation, disability and leave benefits, linking data and resources through a single point of contact to help promote physical, emotional and financial well-being in the workforce. The whole health solution connects Sedgwick’s expertise in workers’ compensation and disability with the high-touch, high-tech healthcare solution offered by Accolade.

It’s often difficult for employees to understand all of the programs and health-related benefits their employer offers — and who to call for what. An employee’s own health issues, as well as the medical needs of their family, can impact productivity. Within this program, each plan member is assigned a health assistant, who will work with the whole health team to help the employee get the best care possible, navigate complex insurance and benefits, receive the financial assistance to which they are entitled and quickly return to their normal, productive lives.

Return to work

Research shows that employees recover faster and more fully from injury and illness when they feel connected to their workplace and their greater community. Sedgwick is committed to maintaining communication while employees are away from work and exploring creative, practical ways to return them to productivity. Our team includes return to work specialists who monitor progress and partner with employees and employers to identify and facilitate options for a safe and healthy return to work. We encourage employers to consider opportunities for transitional, light or modified duty. We help navigate the interactive process and determine appropriate workplace accommodations, remaining mindful of compliance requirements.

Safety + security

We recognize that the identification, investigation, and pursuit of fraudulent claims or fraudulent elements of claims are an integral part of claims administration. Our fraud prevention program combines specific claim techniques and a formalized special investigation unit (SIU) designed to support fraud mitigation. Sedgwick created the SIU to support employers and claim teams using high-tech fraud detection techniques, varied interventions for identified fraud and consultative advice on pursuing fraud in individual circumstances.

Our team looks for evidence that outside activities exist while remaining mindful of jurisdictional requirements that govern the use of surveillance materials at the time of trial. When we identify a case that warrants additional investigation, we create a plan with our SIU team. Once the investigation is complete, we develop the best approach to move the case forward.

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