Workers’ compensation

Expediting injury reporting can mean the difference between a good and poor clinical and vocational outcome; therefore, agency-specific injury reporting hotlines have become the cornerstone of our workers’ compensation case management process. Sedgwick Government Solutions’ proprietary contact center is staffed with security cleared, knowledgeable and trained personnel 24/7/365 to receive first reports of injury from authorized agency personnel.

The case manager’s role is to support and assist injured employees in accessing appropriate medical services in order to expedite a full recovery. Case managers provide clinical guidance and support to workers’ compensation professionals and supervisors as they collaborate to resolve cases and return employees to work. They serve as a critical communication link between all parties involved, including the employee, medical community, the office of Injury Compensation & Medical Services, human resource management staff and the Department of Labor (as appropriate).

Our case management services include:

• Early intervention: We specialize in prompt intervention on newly reported injuries with a focus on facilitating access to appropriate medical care, developing case management plans, and coordinating timely, appropriate recovery progression and return to work.
• Concentrated action towards recovery and employment (CARE): This service focuses on the resolution of long-term cases where employees’ injuries or illnesses have progressed to a chronic stage and incurred extensive lost time.

Our claims specialists collaborate with our customers’ workers’ compensation staff and injured employees to facilitate timely, accurate claims submission. Our integrated federal workers’ compensation services also include ongoing claims management.

Sedgwick Government Solutions’ medical review physicians are licensed and board certified in occupational medicine, and perform systematic reviews of complex case files referred by case managers or agency specialists following well-established protocols. Physician reviews are used for three broad purposes: to review medical documentation related to causation while a claim is still under development; to provide a rationalized medical opinion to support agency requested action with the DOL; or to offer help with strategy or case management concerns (e.g., authorization or access to care).

To meet the evolving needs of our customers, Sedgwick Government Solutions deploys a group of proprietary reporting engines developed specifically for federal workers’ compensation. Our mature, robust reporting capabilities foster more informed decisions for the end user, driving improved outcomes. We consistently work with large quantities of data from multiple sources in a secure and robust manner. We provide the necessary experience and resources to intake, process, clean and prepare diverse data sets for use by our customers. These include, but are not limited to, the Office of Workers’ Compensation Programs quarterly and biweekly eligibility and chargeback data, continuation of pay data, WebOPUS® case files and data from ancillary providers.

Claims involving the Jones Act, U.S. Longshore and Harbor (USL&H) Workers’ Act, Federal Employers’ Liability Act (FELA) and Defense Base Act are among the most challenging in the workers’ compensation industry. They are governed by a specific series of laws and regulations that are often misunderstood or overlooked, leading to greater exposure as well as hefty fines for noncompliance. Identifying the proper jurisdictional regulations for each claim is often complicated, and errors can be costly and lead to adverse outcomes for the injured employee.

Employers need a partner that understands the unique rules and regulations governing federal workers’ compensation laws to ensure compliance, support injured parties, and avoid fines. Our team has proven experience in managing recoveries with Defense Base Act losses as designated by the War Hazard Act. We also provide claim-related medical management services for losses occurring abroad.