Sedgwick Claims Highlighted in Commercial Appeal Series

Workers’ Comp Woes in Memphis: Sedgwick’s Pattern of Denial and Corruption

Memphis, Tennessee — a city defined by its hard-working citizens, world-renowned logistics industry, and iconic role in American commerce — is also home to a corporation with a deeply troubling reputation: Sedgwick Claims Management Services. A recent investigation by The Commercial Appeal has uncovered disturbing details about Sedgwick’s aggressive tactics to delay or deny medical care to injured workers — a pattern that echoes my own experience.

In July 2022, the Memphis Commercial Appeal published an in-depth investigation into Tennessee's workers' compensation system, shedding light on significant challenges faced by injured workers. The investigation underscored systemic issues within Tennessee's workers' compensation framework, where injured workers may encounter undue obstacles in receiving timely and appropriate medical care. The authority granted to employer representatives to deny treatments, coupled with the state's minimal punitive measures, raises concerns about the protection and rights of employees injured on the job.

Key Findings from the Investigation

• Employer Representatives Can Deny Treatment: Companies like Sedgwick — representing employers as insurance firms and third-party administrators — have the authority to deny medical treatments recommended by treating physicians. This process, known as utilization review, allows these representatives to overrule doctors' decisions, potentially delaying or denying necessary care.

• Minimal Penalties for Misconduct: Between early 2017 and early 2022, Tennessee recorded 123 penalty cases against claims administrators. The most common outcome was a no-fine warning, followed by minimal fines — often as low as $250. Despite repeated violations, corporations like Sedgwick have faced only light penalties.

• Sedgwick's Prominent Role: Memphis-based Sedgwick Claims Management Services was identified as the most-fined company in the investigation. Despite its significant role in handling claims for major corporations, Sedgwick has faced numerous fines and maintains an 'F' rating from the Better Business Bureau, with over 300 complaints in a three-year span, many citing unresponsive communication.

Part 1: The Truck Driver’s Four-Month Wait

In 2000, Peter Montgomery, a Memphis truck driver working for Pepsi, suffered a debilitating knee injury. More than two decades later, Montgomery is still battling Sedgwick’s tactics.

In 2021, Montgomery's doctor approved knee surgery to ease his chronic pain. Yet despite this approval, Sedgwick delayed his procedure for over four months, forcing him to endure prolonged suffering.

When Tennessee finally stepped in, Sedgwick was fined a paltry $300 — a meaningless penalty for a corporation raking in billions. For Montgomery, this wasn’t just a paperwork delay — it was life-altering pain prolonged for corporate convenience.

Part 2: Sedgwick’s Penalty Pile-Up

Between 2017 and early 2022, Sedgwick faced 32 fines and warnings from Tennessee regulators — far more than any other claims administrator. These fines stemmed from repeated violations such as:

• Ignoring court orders to provide treatment

• Failing to adhere to timelines for urgent medical care

• Refusing to act on doctors’ recommendations for critical procedures

Yet the average fine against Sedgwick was just $250 — a negligible cost for a billion-dollar corporation. Meanwhile, companies like Genex, with a similar caseload, faced far fewer violations.

Despite their history of misconduct, Sedgwick’s Chief Claims Officer, Max Koonce, defended the company’s actions, claiming they follow state rules and aim for "best outcomes." Meanwhile, Sedgwick holds an 'F' rating from the Better Business Bureau, linked to complaints about delayed claims, ignored communications, and abused workers.

Part 3: The Doctor Who Never Met You

Perhaps the most shocking revelation involved Dr. Sean Lager, a New York-based orthopedic specialist hired by Sedgwick. Despite never practicing in Tennessee or meeting the patients he judged, Dr. Lager routinely denied treatments during "utilization reviews" — the corporate tool used to sidestep doctor recommendations and cut costs.

Since 2019, 359 appeals have been filed against Dr. Lager’s Sedgwick-based rulings, with Tennessee overturning 177 denials — nearly half. For workers like Peter Montgomery, this meant being forced to suffer while an out-of-state doctor overruled their personal physicians — all under Sedgwick’s control.

Part 4: Hiding Injuries, Dodging Accountability

Sedgwick’s practices align with a growing national trend where corporations manipulate injury reporting to save costs:

• Injuries are underreported to avoid OSHA involvement

• Legitimate claims are delayed or denied to push workers into giving up

• Workers face pressure to avoid seeking treatment altogether

While Sedgwick itself hasn’t been caught falsifying records, companies like FedEx, one of Sedgwick’s major clients, have faced allegations of workplace injury suppression.

My Experience: A Familiar Story

Sedgwick’s history of denying workers' care isn’t new to me — I lived it. Despite my own injuries and valid medical recommendations, Sedgwick used similar delay tactics to manipulate my case. From ignored doctor orders to unexplained denials, their pattern of delay wore me down and left me fighting a system designed to fail injured workers.

I’ve seen firsthand how Sedgwick’s tactics aren't just negligent — they’re intentional. Their pattern of obstruction mirrors what Peter Montgomery endured and what countless other workers face nationwide.

The Bigger Picture: A Broken System

Sedgwick’s Memphis roots — with 1,600 employees — have given them deep ties to Tennessee’s legal and business system. Critics argue that Sedgwick’s influence and Tennessee’s weak penalties have allowed the company to develop a "deny first, deal later" strategy — one that thrives on worker exhaustion and forced settlements.

While Sedgwick hides behind corporate language like "best outcomes" and "state compliance," their reputation — marked by fines, delays, and an 'F' BBB rating — tells a different story.

What Workers Can Do

For injured workers — in Memphis and beyond — knowledge is power. I encourage anyone facing delays, denials, or mistreatment by Sedgwick to:

• Report injuries promptly to OSHA (1-800-321-6742) and Tennessee’s Workers’ Comp Division (1-800-332-2667).

• Document every communication with Sedgwick and keep copies of all medical records.

• Seek legal counsel if your medical care is unjustly delayed or denied.

If you’ve experienced mistreatment by Sedgwick Claims Management Services, your story matters. By sharing your experience, you can help expose the tactics that leave injured workers fighting for their basic rights.

Contact me at joefulmer@protonmail.com or visit JoeFulmer.com to connect with others who are taking a stand.

Together, we can shine a light on Sedgwick’s tactics and demand accountability — because no injured worker should suffer at the hands of corporate neglect.