Claim

The Claim page provides all the information you may need to know about a disability claim. It also allows you contact the claim’s examiner and learn more about the claims process.

Note: This topic pertains specifically to disability claims. For features specific to other types of claims, select the applicable type from the menu to the left.

Accessing the Claim Page

To access this page, select a claim number from wherever it appears.

Claim Page Features

To collapse a section of this page, click the Collapse this section icon at the top of the section. To expand a section, click Expand this section . Sections on this page may be collapsed by default if no information is available for display.

The Messages Messages button icon in the top-right corner of the page display the number of unread messages in the Communication Center. Click the icon to view the Communication center section of the Claim page. For more information about its features, refer to the Communication center section below.

If you have more than one claim available in mySedgwick, a View a different claim link is available near the top of the page. Click this link to select and view a different claim.

The following sections are available from this page.

Claim Information

The section at the top of the page is labeled with the type of claim and the claim number. This section contains the following tabs and features.

Summary Tab

Provides basic information about your claim. Some fields containing no information may not be displayed.

See a list of features available in this section and their descriptions.

Summary Tab
Feature	Description
Message	If available, a message at the top of this tab provides additional information related to the claim.
Claim	Provides basic information about the claim. Available fields and their descriptions include: Name: Employee’s name. Claim: Claim category (e.g., Short Term Disability) and the number assigned to the claim. Begin Date: Date the time away from work began. Status: Claim’s current status, such as Open or Closed and its substatus (e.g., Approved). Companion Claims: Claim number of any related claims. This field is not displayed if no companion claims exist. Claim in Appeal: Indicates if the claim’s status is currently being appealed.
Actions	The Actions section provides links to a number of ways to interact with your claim. Click an action below to learn more about it: Report return to work Upload documents Manage direct deposit (not available when viewing another’s claim) Visit helpful resources Communication preferences (not available when viewing another’s claim) Chat with us
Claim Tracker	Displayed at the bottom of the Summary tab, the claim tracker depicts steps in the claim’s progress. Completed steps are shown with a green check mark. The steps required to complete a claim depend on the type of claim.

Payments Tab

This tab lists payments issued for your claim within the past 12 months. It is only displayed if allowed by your employer.

If applicable, a message near the top of the tab informs you of the date the next payment will be sent to you.

See a list of features available in this section and their descriptions.

Payments
Column	Description
Issue Date	Date the payment was mailed or direct-deposited.
Payee	Individual or provider to whom the payment was issued. An icon also indicates whether the payee is the claimant or, for disability and workers’ compensation claims, a medical provider.
Amount	Actual amount of the check issued to the payee.
Payment Method	Method by which the payment was issued, such as Direct Deposit or Check. If present, the payment’s Mailing Address is also shown. A Void indicator is displayed if a check was voided.
Detail	For payments issued to you, this section lists the mailing address to which the payment was issued (if applicable) It also displays the dates for which the payment applies. For payments issued to a provider, this section may also include a link to view the Explanation of Bill Review describing the line-item services billed by the provider, the adjusted amounts paid for each, and explanations of adjustments. This option is only available for payments issued to some providers. This feature is not available to managers or others viewing their employees’ claims.

Click Export Export icon to download a .csv file containing the details listed in this section.

Benefits Tab

This tab provides information about your benefit plan details and work status changes.

All past work status changes are shown.

See a list of features available in this section and their descriptions.

Benefits
Feature	Description
Work status
Work Status	(missing or bad snippet)
As Of	The date the work status began.
Benefits Begin	Beginning date of paid benefit days for this absence. Not displayed for employees At Work.
Benefits End	End date of paid benefit days for this absence. Not displayed for employees At Work.
Benefit Status	The benefit's status. The status indicates whether benefits can be paid for that benefit status.More Approved (Pay) Denied (No Pay) Pending (No Pay) Provisional Pay Approval (Pay) Waiting Period — Not Paid (No Pay) Not displayed for employees At Work.
Benefit plan
Benefit Plan	Displayed for managers viewing an employee’s claim, this field lists the type of benefit plan to which the claim applies.
Maximum Benefit Duration Date	The last date through which disability benefits are available to the employee based on the benefit plan coverage.
Begin Date	Beginning date of paid benefit days for this absence.
End Date	End date of paid benefit days for this absence.
Benefit Frequency	Frequency with which benefits are paid for the plan.
Benefit Rate	Benefit amount for the specified frequency.

Documents Tab

The Documents tab lists documents associated with your claim. It may display documents sent to you via email, files you have uploaded, and forms relating to your claim.

If available, you can upload a document by clicking Upload Documents.

Note: Supervisors and managers can only access this feature for their own claims, not those of others.

The following sections may be available to you from this tab.

My documents

This section lists claim-related documents sent to you via mail or email. This section is not displayed when viewing another’s claim.

All files are in .pdf format. You must have Adobe Acrobat Reader (or similar) installed to view these documents.

See a list of features available in this section and their descriptions.

My documents
Column	Description
Document	Type of document; always shows Claim Correspondence. A New label displays when the file is unread.
Date	Date the document was originally sent.
Open	Open the file in a new browser tab or window.

Upload documents

This section allows you to upload files related to your claim and lists files you have previously uploaded.

See a list of features available in this section and their descriptions.

Upload documents
Feature	Description
Upload	Click to select one or more files to upload from your device. See the Upload Documents help topic for instructions.
Document	Uploaded file’s name.
Date	Date the file was uploaded.
Status	Current status of the file. Options include pending (the file is in the process of being uploaded and complete (the file was successfully uploaded). Files that cannot be successfully uploaded display the reason for the error.
Open	Click to view the file. Files in pending status cannot be viewed until they are complete. Files that cannot be successfully uploaded display . Click to remove the file.

My forms

This section contains forms you can fill out and submit. Forms available here may include those allowing Sedgwick to release your medical information for claim purposes, forms required by your claim’s jurisdiction, or Medicare-related forms. This section is not displayed when viewing another’s claim.

See a list of features available in this section and their descriptions.

My forms
Column	Description
Document	Form name.
Open	Click to view and complete or download the form. See Forms for details.

Restrictions Tab

Displays a list of work restrictions, along with dates for each restriction.

See a list of features available in this section and their descriptions.

Restrictions
Feature	Description
Working With Restrictions	Dates the claimant was working with the specified restriction.
Recommended Dates	Dates the claimant was recommended to be under the specified restriction .
Type	Type of restriction, such as Permanent or Temporary.
Activity	Type of restricted activity, such as Drive.
Restriction	Duration or frequency of the restriction.

Important Contacts Tab

Provides information about how to contact the examiner. If available, click Contact Examiner to open the Communication Center page where you can send a message to the examiner.

Claim activity

The Claim activity section shows you all milestone dates relating to your claim, with the most recent activity listed first.

To locate specific entries, click Filter and enter a term in the search bar.

Communication center

The Communication center section provides a simply way to send a message to an open claim’s examiner and view their responses.

If messages already exist for the claim, they are displayed here in descending order (with the most recent shown last). The sender’s name as well as the date and time the message was sent are displayed above each message. Also, an icon is displayed beside each message to help identify who sent each:

: Message you sent.
: Messages from the examiner.

To send a message, type it in the field provided and click Send. Messages cannot exceed 1000 characters each.

If available, you can also click Upload Documents to open the Upload Documents window and submit files pertaining to your claim.

Claims calendar

This section provides a calendar view of your time off work, approved accommodation period, or reduced work schedule for the currently displayed claim.

The current month is displayed by default, with today’s date highlighted with a blue border. The status of each absence is displayed based on their color. A legend at the bottom of the section describes each status color.

If there are no off work periods associated with your claim, this section is collapsed by default. Click to expand the section.

Actions you can take from this section include:

To view the previous or next period, click the left and right arrows at the top of the section. Click Today to return to the current month or week.
To view a week at a time, click Week. To switch back to a month-by-month view, click Month.
Click Export to download a .csv file containing absences for a specified period of time.
Click an absence to open an Event pop-up providing details about the absence’s claim. See a list of information available in this window.

Event window (Claims calendar)

Field Description

Claim Number Claim number to which the absence pertains. Click to open the Claim page.

Claim Type Category of claim (e.g., Short Term Disability, Continuous Leave, Accommodation Request).

Benefits Begin Date disability benefits begin.

Status Current status of the claim (Open or Closed) and the claim’s substatus (e.g., Approved or Pending).

Examiner Examiner assigned to your claim.

Loa Specialist Leave of absence specialist assigned to your claim.

First Absence Date of first absence from work for a disability claim.

Current Work Status Employee‘s current work status.

Actual Return to Work Date Date the employee returned to work.

Anticipated Return to Work Date Date the employee anticipates returning to work.

Event window (Claims calendar)
Field	Description
Claim Number	Claim number to which the absence pertains. Click to open the Claim page.
Claim Type	Category of claim (e.g., Short Term Disability, Continuous Leave, Accommodation Request).
Benefits Begin	Date disability benefits begin.
Status	Current status of the claim (Open or Closed) and the claim’s substatus (e.g., Approved or Pending).
Examiner	Examiner assigned to your claim.
Loa Specialist	Leave of absence specialist assigned to your claim.
First Absence	Date of first absence from work for a disability claim.
Current Work Status	Employee‘s current work status.
Actual Return to Work Date	Date the employee returned to work.
Anticipated Return to Work Date	Date the employee anticipates returning to work.

Your contact information

Displayed for open claims, this tab displays your current contact address and electronic notification preferences and provides links to update them. This section is not displayed when viewing another’s claim.

Contact Address: This address is used for any communication sent by mail pertaining to your claim if you have opted to receive it by this method. Click Change Contact Address to change you preferred contact address.
Electronic Notifications: Displays the email address and text/SMS number at which you will receive electronic notifications about your claim, if enabled. Click Change Communication Preferences to update your selections. Refer to the Change Communication Preferences section of the Account Settings help topic for more information.