Claim

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

Note: This topic pertains specifically to leave of absence 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.

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. Note that some features are specific to the type of claim or your access in mySedgwick.

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., Continuous Leave, Intermittent Leave) 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). Leave Type: Type of leave of absence (e.g., Family Medical, Employee Medical). Leave Caused By: Cause for the leave of absence (e.g., Pregnancy, Disability). Companion Claims: Claim number of any related claims. This field is not displayed if no companion claims exist. Relationship: Relationship to the dependent for which the leave of absence pertains, and the dependent’s name.
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 Visit helpful resources Communication preferences (not available when viewing another’s claim) Report an absence (intermittent leave claims only) 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.

Work Schedule Tab

Displays the most recent work schedule (i.e., number of hours scheduled to work per day) on file for the employee . Multiple work weeks may be available depending on the employee's schedule.

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

Work Schedule
Feature	Description
Effective Date	Date the displayed week starts on.
Week # Hours: Total	The total number hours the employee is scheduled to work for the week.
Weekly calendar	The hours per day the employee is scheduled to work for the week.

Certifications Tab

Provides information about medical certification information applicable to the leave claim.

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

Certification Details
Feature	Description
Certified Absence Frequency & Duration	Lists the frequency and duration of absences certified by a healthcare provider for leave due Illness or Appointments (x absence(s) every y weeks with a duration of z hour(s) per absence). Only displayed for intermittent leave claims.
Certifications	Lists current certifications related to your leave (if applicable), including the status of the certification and a time line of certification dates. A timeline of important information pertaining to current certifications is also shown. Completed milestones are shown with a green check mark and the date completed, while incomplete certification steps are shown with a numbered marker. If clarification is needed for a current certification, this information is shown below the timeline and includes the type of clarification and dates related to the clarification request.
Previous Certifications	This section is not displayed by default. To view previous certifications, click the toggle beside the heading. When shown, all previous certifications are listed with their certification dates, status, and whether clarification was requested.

Leave Balance Tab

Lists any leave policies applicable to the current leave claim, as well as the amount of time used for each policy.

To learn more about leave rights in your state or view a leave balance summary for all of your related claims, click the appropriate link at the bottom of this tab.

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

Leave Balance
Feature	Description
Policy	Description of the leave policy applicable to the employee. The most generous policy is listed first. Note: The policy information shown in this table applies only to the claim listed at the top of the page. For information about all policies, including time used, pending, and remaining on those policies for all of the employee's absence claims, refer to the Leave Balance Summary.
Time Used	Total amount of the policy’s time that has already used for the displayed claim only.
Policy Exhausts	Date the policy expires for the current claim.

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.

Important Contacts Tab

Provides information about how to contact the LOA Specialist. If available, click Contact LOA Specialist 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 or approved accommodation period 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.

Note: On the morning of an absence for continuous leave cases, the calendar displays the day’s absence status as Pending if the daily balancing process for that case has not yet finished. Once this process is complete (typically during the first six hours of the day), the absence status is updated to reflect the final evaluation (e.g., Approved or Denied).

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).

Date of Injury Date the injury or illness occurred that resulted in a workers’ compensation claim.

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

Absence Status Status of the intermittent absence (e.g., Approved, Pending).

Examiner Examiner assigned to your claim.

Leave Type Type of leave of absence (e.g., Family Medical, Employee Medical).

Date of Absence Date the intermittent leave began.

Leave Caused By Reason for a leave of absence.

Exhaustion Date Date that a leave of absence’s benefits (e.g., FMLA) are exhausted.

Relationship Employee‘s relationship to the individual for whom a Family Medical leave of absence is taken (e.g., Self, Parent).

Duration of Absence Length of a leave of absence.

Absence Reason Reason for an intermittent absence.

Date Absence Reported Date an intermittent absence was reported.

Absence Confirmation Number Confirmation number assigned to an intermittent absence.

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).
Date of Injury	Date the injury or illness occurred that resulted in a workers’ compensation claim.
Leave Status	Current status of the leave claim (Open or Closed) and the claim’s substatus (e.g., Approved or Pending).
Absence Status	Status of the intermittent absence (e.g., Approved, Pending).
Examiner	Examiner assigned to your claim.
Leave Type	Type of leave of absence (e.g., Family Medical, Employee Medical).
Date of Absence	Date the intermittent leave began.
Leave Caused By	Reason for a leave of absence.
Exhaustion Date	Date that a leave of absence’s benefits (e.g., FMLA) are exhausted.
Relationship	Employee‘s relationship to the individual for whom a Family Medical leave of absence is taken (e.g., Self, Parent).
Duration of Absence	Length of a leave of absence.
Absence Reason	Reason for an intermittent absence.
Date Absence Reported	Date an intermittent absence was reported.
Absence Confirmation Number	Confirmation number assigned to an intermittent absence.

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.