Dealing With Sedgwick on a California Workers' Comp Claim

What is Sedgwick, and what does it mean for my workers' comp claim?

Sedgwick is a company that employers and insurers hire to handle workers' compensation claims on their behalf. If Sedgwick is handling your California claim, the same state deadlines and benefit rules apply as with any other claims administrator.

Yazdchi Law P.C. is not affiliated with Sedgwick in any way. This page explains what Sedgwick is, how to reach the company about a claim, and what California law requires no matter who is handling your file.

On its own site, checked November 6, 2026, Sedgwick describes itself as a company that provides claims administration, benefits administration, loss adjusting, and product recall services. It also lists a dedicated workers' compensation claims line of business. Sedgwick is not an insurance company that sells policies to the public. Instead, an employer or an insurance company pays Sedgwick to run the daily work of a claim. That means taking the first report, assigning an adjuster, deciding on medical treatment, and issuing payments.

California regulations use the term "claims administrator" for whichever company is legally responsible for your claim. That can be an insurer handling its own claims. It can be a self-insured employer doing the same. It can also be an outside company hired to do that work (Title 8 section 9811(a) of the California Code of Regulations). Sedgwick is one of the outside companies that insurers and self-insured California employers hire for this job. Some self-insured employers bring in an outside company to run their claims. California law calls that company a third-party administrator. It must hold a certificate of consent to do the work (Labor Code section 3702.1).

Some California employers and insurers use Sedgwick. Others use a different claims administrator, such as State Fund. Either way, the California rules below apply the same.

How do I report a claim or reach my Sedgwick adjuster?

Sedgwick's own site points claimants to its mySedgwick portal and to their assigned adjuster, rather than to one public phone number.

On its claim help page, checked November 6, 2026, Sedgwick directs claimants to a portal it calls OmniClaims, also known as mySedgwick, at login.mysedgwick.com. Through that portal you can start a claim, check your claim status and payment history, send secure messages to your claims team, and upload documents such as medical notes. The same page describes a virtual chat assistant for general questions, available at any time.

Sedgwick's claim help page does not list one phone number that works for every claimant, since an assigned adjuster or examiner handles each file. The most reliable number is the one printed on your claim letters, benefit notice, or the paperwork your employer gave you. If you cannot find it, ask your employer's human resources office who is adjusting the claim.

Once your employer learns of your injury, California law requires your employer to give you a claim form, often called the DWC-1, within one working day. This applies to any injury causing lost time or medical treatment beyond first aid (Labor Code section 5401). That form is what starts your file with Sedgwick.

What deadlines and payments does California law require, no matter who the administrator is?

California sets the same claim deadlines and payment rules for every claims administrator, Sedgwick included.

Once you file your claim form, a 90-day clock starts. Sedgwick then has 90 days from that date to accept or deny your claim. If 90 days pass with no denial, the law presumes your injury is covered. Only evidence discovered after the 90 days can rebut that presumption (Labor Code section 5402). While Sedgwick decides, the law already requires treatment to be authorized. Up to $10,000 in care must start within one working day of your claim form being filed.

If your injury keeps you off work, your first temporary disability check is due within 14 days of your employer learning about the injury and the lost time (Labor Code section 4650). A late check adds an automatic increase on top, without you having to ask for it.

Behind the scenes, Title 8 regulations also control how Sedgwick does its job. It must run a reasonable, timely investigation once it has notice of your injury. The goal is to gather the facts needed to pay what you are owed, not just to build a defense (Title 8 section 10109). The same regulations require specific written notices along the way. One example: a notice about your first disability payment, due no later than the 14th day after your employer's date of knowledge of the injury and disability (Title 8 section 9812).

Medical care in your claim may run through a medical provider network, the approved list of doctors set up under Labor Code section 4616. If no such network applies to your claim, Labor Code section 4600(c) lets you choose your own doctor once 30 days have passed since you reported the injury.

Step	Deadline	Law
Report injury to your employer	Within 30 days	Labor Code 5400
File your workers' comp claim	Within 1 year	Labor Code 5405
Insurer must accept or deny	Within 90 days	Labor Code 5402
First disability check	Within 14 days	Labor Code 4650
Appeal a denied treatment	Within 30 days	Labor Code 4610.5

What happens if Sedgwick delays, denies, or disputes part of my claim?

A disputed medical decision goes through utilization review and then independent medical review. Most other disputes go before a WCAB judge, with further appeal rights inside the board.

Say a doctor requests treatment and Sedgwick's utilization review denies, delays, or changes it. You can then ask for an independent medical review, often shortened to IMR: a neutral doctor's review of your medical record, not Sedgwick's own opinion. Most other disagreements, such as whether your injury is covered at all or how much permanent disability you are owed, go before a workers' compensation judge first. To formally open that kind of case, you or your attorney file what is called an Application for Adjudication of Claim with the WCAB. Either side can then ask the board to reconsider the judge's decision.

Say a payment is unreasonably delayed or refused, not simply mistaken. California adds a penalty on top: up to 25 percent of the payment or $10,000, whichever is less (Labor Code section 5814). This rule applies to Sedgwick the same as it applies to any other claims administrator. Our page on California workers' comp penalties walks through the full penalty structure.

The DWC's Information and Assistance Unit answers questions about any California workers' comp claim for free, no matter which company is handling it, at 1-800-736-7401. If your claim is denied, the steps to challenge a denial follow the same path no matter which company issued it.

When does a lawyer help with a Sedgwick claim?

A lawyer tends to help once Sedgwick denies or disputes part of your claim, delays payment, or you are heading toward a permanent disability rating or settlement.

Many straightforward claims move through Sedgwick without a dispute. A lawyer tends to help once there is a disagreement: a denied claim, a stopped or late check, a fight over medical treatment, or questions about how a permanent disability rating or settlement is calculated. The firm reviews each potential case individually and does not take on every matter.

If you hire a lawyer, California law controls what that lawyer can charge. Fees in workers' comp cases are usually 15% to 18% of the benefit obtained, and a workers' compensation judge must approve the fee before the attorney can collect it (Labor Code section 4906). See our page on what a workers' comp lawyer costs in California for the full picture.

Whether Sedgwick, a different claims administrator, or an insurance company you have never heard of is handling your file, Yazdchi Law P.C. reviews each potential case individually. The firm does not take on every matter, and nothing on this page is advice about your specific claim.

Call (661) 273-1780 or use the contact form. Tell us about your injury, which company is handling your claim, and where things stand now.

Related questions

Keep reading to understand the claim process, your options after a denial, and what a lawyer costs.

• How does a California workers' comp claim move from report to resolution?
• What should I do if Sedgwick or any insurer denies my claim?
• What if my employer's claim is handled by State Fund instead?
• How much does a workers' comp lawyer cost in California?