FMLA Claims Processing Procedures

In March, Sedgwick implemented changes to temporary claims handling procedures in response to the healthcare system emergency related to the COVID-19 outbreak. While there are areas where treatment providers are starting to re-engage in non-emergency situations, there are still many states, cities, and counties where providers are still focused on only the most pressing of cases. Because of this, please find the updated claims handling procedures, effective May 1st, below.

• New Claims

  • Sedgwick is no longer automatically approving leaves without paperwork at the onset of a new case

  • If medical documentation has not been received by the due date, Sedgwick will allow an additional 2 weeks to submit paperwork

  • If no paperwork is received, approval will be granted for 30 days (continuous and intermittent) or the requested length of leave (whichever is less)

• Frequency and Duration

  • No recertification for excessive usage. Recertification required for end of certification period

• Return to Work

  • At the end of leave, one courtesy extension is allowed if unable to RTW

  • No additional approval after the final courtesy extension unless medical documentation isreceived

• No change to the fast track approval for COVID-19 related claims