The Sedgwick Claims Management Services, Inc. (Sedgwick CMS) commitment to disability is unrivaled in the claims industry. We are the largest provider of ASO services, offering a combination of services integrating short- and long-term disability claims management, workers’ compensation, leave administration, and supporting ancillary services designed to improve productivity and reduce costs. Our appeal to employers results from our focus on highly customized, integrated absence management programs.
We continuously enrich our intellectual capital through interactions with sophisticated clients and maintain leadership roles in the Disability Management Employer Coalition (DMEC), the National Business Group on Health (NBGH), and the Integrated Benefits Institute (IBI), which keeps us on the cutting edge of absence and productivity management.
We are the only administrator with a solid focus on tailoring our risk, disability, FMLA, and absence management services to the unique needs of each of our clients. The culture of our organization is driven by client satisfaction, quality, and results. We expect to be evaluated on successfully accomplishing these objectives and delivering industry best practices for each of our clients. Based on these best practice solutions, we have developed a model to ensure that our client’s needs are met.
Our philosophy is to consider both duration and return to work issues in the management of disability cases. The success of the program requires the participation of the employer, employee, and treatment providers and includes the assessment of medical evidence as well as the functional, vocational, and motivational aspects of the disability. The key components of our approach are detailed below.
Sedgwick CMS provides a common intake of all claims through a single source via toll-free first report, faxing capabilities, or online through viaOne® intake.
This ensures timely, efficient assignment to the appropriate resource, as well as an early decision about medical management intervention. Claims that meet pre-defined triggers benefit from early, assertive medical case management. This process ensures that acute cases are assigned the appropriate treatment immediately.
Deployment of medically and administratively driven action/resolution plans involving specialty support groups (EAP, independent medical examinations, vocational rehabilitation, physician advisor, SSDI, etc.) when needed, keeping the focus on applying the right resources at the right time during the claim.
Consistent and ongoing disability duration management leverages evidence based tools.
Established expectations for timely return to work with major emphasis on employee specific return to work initiatives, including rehabilitation and job accommodation.
Seamless transition relieves employees of the burden of filing a new application upon becoming eligible for FMLA, LTD, or any other type of available absence.
Our ability to integrate plan design with statutory and regulated disability and workers’ compensation claims assures proper offsets including SSDI advocacy, which begins informally during our initial investigation and continues through the life of the claim.
Our Total Performance Management quality program builds close partnerships with clients based on consistent procedures that assure an appropriate disability management response for all claim/absence types. These include benchmarking, reports, and specific means of measuring our performance. Trend analysis, including predictive modeling indicators, is used to partner with employers to prevent future time loss and to reduce the length of disability.
Common or compatible claims/data management systems lead to efficiency gains, better communications, benchmarking opportunities, and more useful data analysis for all claim types.
Our unrivaled service commitment takes into consideration the specific laws, codes, and jurisdictions we must work within to deliver excellence and great value. Sedgwick CMS educates clients through seminars, news bulletins, and consultation to ensure that we are prepared to meet new legislative challenges together.
To meet the growing needs of our clients and the marketplace, Sedgwick CMS has developed and integrated the provision of absence administration into our claims administration service offering. Intake for disability, FMLA, and other absence types is received through our internal call center. This common intake requires only one call to initiate a STD claim, a FMLA leave, and/or a casual absence.
Sedgwick CMS’ Total Absence Management System (TAMS) allows absences to be monitored and managed based on JURIS® off-work entries made during the beginning stages of a disability claim. TAMS can track FMLA, state specific leaves, or casual absences such as jury duty and military leaves, all of which may run concurrently depending on eligibility and the reason for leave. Our online system, viaOne, gives managers and HR representatives access to view live data and to add comments or notes for the examiners or specialists.
The system offers complete tracking of FMLA leaves and is able to calculate both used and remaining federal leave entitlement and program calendar FMLA type (rolling twelve month period, calendar, other fixed twelve month period, or twelve month period from first absence). Additionally, through use of the viaOne suite of services, clients can review both state and federal leave regulations online. We employ FMLA specialists who ensure that these regulations are updated in the system as they change.
Through the JURIS system, Sedgwick CMS is able to separate FMLA time associated with STD and/or workers’ compensation claims and those not related to other claims. TAMS also tracks and monitors intermittent time-off.
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