Brian White | September 6, 2024 | Personal Injury
When it comes to insurance claims, there are two main players: the insurance companies that issue policies and those that handle the claims process. Sedgwick, much like Gallagher Bassett, falls into the latter category.
Unlike an insurance company, Sedgwick is a third-party administrator (TPA). That means it manages and resolves claims on behalf of insurers, employers, and businesses but does not underwrite or issue insurance policies. This distinction creates confusion for many.
This blog provides vital information for anyone who has to deal with Sedgwick when seeking compensation after a workplace injury, car accident, or another covered incident.
How Does Sedgwick Differ From an Insurance Company?
Like Gallagher Bassett, Sedgwick does not assume the financial risks associated with insurance claims. Instead, their job is to manage the claims process for insurers and businesses, which often includes handling workers’ compensation, property damage, and other liability claims.
In this role, Sedgwick takes on the investigation, processing, and settlement of claims.
By contrast, an insurance company issues policies, collects premiums from insured individuals, and provides financial coverage in the event of a covered incident. For example, if you cause a crash, your liability insurance policy should cover the other party’s losses, such as medical expenses.
Sedgwick’s involvement can sometimes complicate matters, especially for injured parties who may not realize they are dealing with a claims administrator rather than the insurer itself.
What Are the Challenges of Dealing With Sedgwick?
One potential challenge in dealing with Sedgwick is that their claims adjusters are trained to minimize payouts on behalf of their clients – who are typically employers or insurance companies. This means that if you are injured and Sedgwick is involved, you may face resistance in obtaining the full compensation you deserve.
For example, you may provide certain information, thinking it is useful for resolving your claim and receiving money for your losses. Unfortunately, a Sedgwick representative could use seemingly innocent statements to minimize your injuries. They are working to protect their clients and profits – not you.
It’s also common for claimants to mistakenly believe that Sedgwick is the one responsible for paying their claims. In reality, Sedgwick’s job is to investigate and process the claim, but the actual payout will come from the insurance company or employer. This can lead to confusion and frustration, especially when claims are unjustly delayed or denied.
There is also a risk of bad faith practices or delayed results due to a lack of communication between Sedgwick and their client (an insurance company, for example).
What Is a Third-Party Claim in the Context of Workers’ Compensation?
Third-party claims are important to understand if Sedgwick is handling your workers’ compensation claim.
A third-party claim arises when someone who is not your employer – such as a subcontractor, vendor, or negligent driver – is responsible for your injury. For example, if you are injured at work due to a distracted motorist, you could be eligible to file a claim against them, even if you are already receiving workers’ compensation benefits.
Sedgwick may process your workers’ compensation claim, but an attorney can step in to help you pursue compensation from a liable third party. This allows you to maximize your recovery, ensuring that those who are responsible for your injuries are held accountable.
Contact Our Houston Personal Injury Lawyers If You Have Questions About Sedgwick or an Insurance Claim
If you’re dealing with Sedgwick after an accident or injury, don’t let the claims process overwhelm or confuse you. Contact Attorney Brian White Personal Injury Lawyers for a free consultation.
We can help you understand your legal options and fight for the compensation you deserve, even when dealing with a TPA like Sedgwick.
For more information, contact the Houston personal injury law firm of Attorney Brian White Personal Injury Lawyers by calling (713) 500-5000.
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