When it comes to insurance claims, there are two main players: the insurance companies that issue policies and the entities 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). This means they manage and resolve claims on behalf of insurers, employers, and businesses—but they do not underwrite or issue insurance policies. This distinction often creates confusion for injured victims seeking compensation after a workplace accident, car crash, or other covered incident.
At Orange Law Firm, our Houston personal injury lawyers help accident victims understand how TPAs like Sedgwick operate and how to protect their rights during the claims process.
How Sedgwick Differs From an Insurance Company
Sedgwick does not assume the financial risks associated with insurance claims. Instead, their role is to manage the claims process for insurers and businesses. This includes:
- Workers’ compensation claims
- Property damage claims
- Liability claims
- Vehicle accident claims
- Slip and fall or workplace accident claims
In this role, Sedgwick conducts investigations, processes claims, and negotiates settlements. They are the intermediary between the injured party and the insurance company that ultimately pays the claim.
By contrast, an insurance company collects premiums, issues policies, and provides financial coverage when a covered incident occurs. For example, if a negligent driver causes a car accident, the driver’s liability insurance is what pays for medical bills, lost wages, and other damages—not Sedgwick.
Many accident victims mistakenly assume they are dealing directly with the insurance company. This misunderstanding can lead to serious mistakes during the claims process, including statements that could unintentionally reduce the compensation you are entitled to.
Challenges of Dealing With Sedgwick
One major challenge in dealing with Sedgwick is that their adjusters are trained to minimize payouts on behalf of their clients—typically employers or insurance companies. This can make it difficult for victims to receive the full compensation they need for medical bills, lost wages, pain and suffering, and other losses.
Some common challenges include:
- Statements used against you: Adjusters may use your own words to argue that your injuries are less severe than they truly are.
- Confusion over responsibility: Many claimants think Sedgwick is responsible for paying their claim, when in reality, the insurance company or employer funds the settlement.
- Delayed claims: Miscommunication between Sedgwick and their clients can result in frustrating delays or even denials of claims.
- Bad faith practices: In some cases, TPAs may act in ways that are unfair or intended to minimize the amount of compensation paid to claimants.
Understanding these challenges is essential for anyone navigating a Sedgwick-managed claim. With the right guidance, victims can avoid common pitfalls and maximize their recovery.
Understanding Third-Party Claims in Workers’ Compensation
If Sedgwick is handling your workers’ compensation claim, it’s important to understand third-party claims.
A third-party claim arises when someone other than your employer—such as a subcontractor, vendor, negligent driver, or property owner—is responsible for your injury. For example:
- You’re injured at work because a delivery truck hits you in a warehouse parking lot.
- You fall at a client’s site due to unsafe conditions maintained by a contractor.
Even if you’re already receiving workers’ compensation benefits, a third-party claim allows you to pursue additional compensation from the responsible party. This may include damages for medical bills, lost wages, pain and suffering, and long-term care if your injury is catastrophic.
Sedgwick may process your workers’ compensation claim, but it cannot replace the benefits you may be entitled to from a liable third party. Having an experienced Houston personal injury lawyer on your side is crucial to ensure your rights are protected and that you can pursue all available avenues of recovery.
Why You Need a Houston Personal Injury Lawyer
Insurance companies and TPAs like Sedgwick are focused on protecting their profits—not you. Navigating the claims process alone can result in:
- Receiving less compensation than you deserve
- Accepting a settlement that doesn’t cover medical expenses or lost income
- Missing out on legal avenues such as third-party claims
At Orange Law Firm, our Houston personal injury attorneys help clients:
- Understand how TPAs like Sedgwick operate
- Communicate effectively without jeopardizing claims
- Maximize compensation for medical bills, lost wages, and pain and suffering
- Pursue third-party claims when appropriate
- Navigate complex workers’ compensation and personal injury cases
With our guidance, accident victims can focus on recovery while we handle the legal complexities and fight for their rights.
Common Types of Cases Involving Sedgwick
Sedgwick handles a wide range of claims. Some common types include:
- Workplace injuries – Slip and fall accidents, machinery accidents, or repetitive stress injuries
- Car and truck accidents – Injuries from motor vehicle crashes involving company vehicles or third parties
- Property damage claims – Accidents that cause damage to your vehicle or personal property
- Workers’ compensation claims – Injuries at work where third-party liability may also exist
No matter the type of claim, having a Houston personal injury lawyer to guide you can make a significant difference in the outcome.
📞 Call Orange Law Firm today at 713-885-9787 for a free consultation. Let our Houston personal injury lawyers help you navigate your claim and maximize your recovery.
