Employee’s claims

The Employee’s claims page provides a list of an employee’s claims, notifications to you about their claims, and more. A message at the top of the page may also provide useful information.

To view this page, click the employee’s name from any of a number of pages, including:

This page is not available if the employee has no claims.

A navigation trail at the top of the page shows the page you visited from and the employee’s name. Return to the previous page by clicking its name.

A New Notifications Notifications alert icon icon displays the number of outstanding notifications, if any. Click the icon to view the Notifications tab.

To view a claim from here or any other page, click the claim number.

The following sections are available from this page:

Welcome Message

A message at the top of the screen, if shown, introduces you to features available in mySedgwick. It may also provide useful information related to your claims.

Employee’s claims

The primary section of this page consists of three areas:

A greeting with a list of important reminders for your awareness or action, if any exist, and quick links to common actions and features
The employee’s open claims and any claims closed within the last 24 months
Tabs listing any payments, new claims, notifications, return to work information, and off work dates for the employee

These sections are described in more detail below.

Sort what’s displayed in the claims list or Payments and Notifications tabs by clicking the Sort by option above a list and selecting the appropriate column. The arrow indicates the direction in which rows are sorted (ascending or descending); select the column again to change the orientation.

Greeting, Reminders, and Quick Links

The top of the Employee’s claims section includes a greeting and a list of important reminders, if any exist.

Screenshot of the top portion of the My claims portion of the screen

A list of quick links is also available, which vary by role. These may include:

Links to additional employer-provided resources may also be available.

Claim List

The middle portion of the My claims section provides a list of the employee’s open claims or those closed within the past 24 months. Future workers’ compensation and disability claims may also be shown.

Screenshot of the middle portion of the My claims section, depicting a list of claims, their status, additional details, and an Actions menu

To view details about a claim, click the claim number. Click the Actions menu icon to access additional features related to the claim.

If there are multiple claims, click Filter to access a search field to locate a claim by any displayed criteria. Sort what’s displayed in the claims list by clicking the Sort by option above a list and selecting the appropriate column. The arrow indicates the direction in which rows are sorted (ascending or descending); select the column again to change the orientation.

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

Claims
Feature	Description
Claim	Category of claim (e.g., Short Term Disability, Auto Liability, Workers’ Compensation, Accommodation Request) and the claim number. Click a claim number to open the Claim page for more information about the claim. Click beside a claim number to add that claim to your Watch List, or click to remove it.
Status	Current status of the claim (Open or Closed). For disability leave, and accommodation claims, the claim’s substatus is also displayed (e.g., Approved, Pending, Currently accommodated).
Detail	Display’s specific information based on the type of claim: Workers’ compensation: Claim’s Date of Loss Disability: Begin Date (i.e., the employee‘s first date absent or the claim’s date of loss) Leave: Begin Date (i.e., the date the leave began) and Leave Type (e.g., Employee Medical, Military Leave) Accommodation requests: Begin Date (i.e., the start date of the earliest accepted accommodation) and Request Type (e.g., At work or Leave of absence)
Actions	Click the Action icon to access various actions for the claim. The list below includes available actions; click an option’s name to view that feature’s help topic: Report return to work Upload documents View job functions Confirm job functions Review accommodations

Tabs

The last portion of the My claims section includes tabs providing more information about the employee’s claims. If the employee has no claims, thes tabs are not displayed.

Details of each tab are described below.

Payments Tab

This tab lists payments issued for the employee’s disability or workers’ compensation claims within the past 12 months. It is only displayed if allowed by your employer.

Sort what’s displayed in thePayments tab by clicking the Sort by option above a list and selecting the appropriate column. The arrow indicates the direction in which rows are sorted (ascending or descending); select the column again to change the orientation.

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 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	This section lists the mailing address to which the payment was issued (if applicable). It also displays the dates for which the payment applies.

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

New Claims Tab

This tab displays the employee’s new claims, including details about the last day worked, first day absent, or hours worked for each claim. From this section, you can confirm the information is accurate or, for disability and leave claims, update some of the information.

To view details about a claim, click the claim number.

If you have multiple claims, click Filter to access a search field to locate a claim by any displayed criteria.

Click Export Export icon to download a .xls file containing the list of new claims.

Sort what’s displayed by clicking the Sort by option above a list and selecting the appropriate column. The arrow indicates the direction in which rows are sorted (ascending or descending); select the column again to change the orientation.

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

New Claims
Feature	Description
Claim	Category of claim (e.g., Short Term Disability, Workers’ Compensation) and the claim number. Click a claim number to open the Claim page for more information about the claim. Click beside a claim number to add that claim to your Watch List, or click to remove it.
Name	Employee‘s name.
Detail	Display’s specific information based on the type of claim: Disability: First Day Absent (i.e., the employee‘s first date absent or the claim’s date of loss) and the Last Day Worked (i.e., the last day the employee worked). Workers’ compensation: Claim’s Date of Loss, Date Reported to Sedgwick, and Claim Reopened (if applicable). Leave: First Day Absent (i.e., the date the leave began) and Hours Worked in the last 12 months.
Confirm	Click to open a Confirmation window displaying the claim type, number, and claimant’s name. From this window, click Confirm to dismiss the new claim activity, removing it from the New Claims tab. Notification of your confirmation is sent to the claim’s examiner. For disability and leave claims, additional fields are displayed and an Edit button is available. Click Edit to update the claimant’s First Day Absent and Last Day Worked (disability) or Hours Worked (leave). You cannot confirm details of a future disability claim.

Notifications Tab

This tab lists any active notifications related to the employee’s claims. Depending on the status of a claim, you might be notified of changes to a claim’s status or benefits, an employee’s anticipated first date or absence or return to work date, and more.

Clicking Dismiss Dismiss button removes the notification from this tab. Completing a notification’s action also removes the notification.

By default, the list is sorted by the Date column. Sort what’s displayed by clicking the Date option above a list and selecting the appropriate column. The arrow indicates the direction in which rows are sorted (ascending or descending); select the column again to change the orientation.

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

Notifications
Feature	Description
Claim	Category of claim (e.g., Short Term Disability, Workers’ Compensation, Accommodation Request) and the claim number. Click a claim number to open the Claim page for more information about the claim. Click beside a claim number to add that claim to your Watch List, or click to remove it.
Name	Employee‘s name.
Message	Message informing you of important information about the specified claim.
Date	Date the message was received.
Dismiss	Click to remove the notification from this tab.

Return to Work Tab

This section displays unconfirmed return to work dates for the employee’s disability and leave of absence claims.

Click Confirm Confirm check mark button to confirm the date or update it.

Click Export Export icon to download a .xls file containing the list of return to work records.

By default, the list is sorted by the return to work date in the Detail column, in descending order. Sort what’s displayed by clicking the Detail option above a list and selecting the appropriate column. The arrow indicates the direction in which rows are sorted (ascending or descending); select the column again to change the orientation.

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

Return to Work
Feature	Description
Claim	Category of claim (e.g., Short Term Disability, Workers’ Compensation) and the claim number. Click a claim number to open the Claim page for more information about the claim. Click beside a claim number to add that claim to your Watch List, or click to remove it.
Name	Employee‘s name.
Return to Work	Date the employee is expected to return to work.
Confirm	Click to open the Return to Work page with the option to confirm the displayed date or enter a new return to work date. See Confirming a Return to Work Date on the Return to Work page’s help topic for details. Once confirmed, the claim is removed from the Return to Work tab. Unconfirmed claims are also removed from the list after 30 days.

Off Work Tab

This section displays the dates the employee will be absent.

Click Actions Three vertical dots (Actions menu icon) to report the employee’s return to work date. For workers’ compensation claims, you can also view the employee’s work restrictions.

Click Export Export icon to download a .xls file containing the list of off work employees.

By default, the list is sorted by the From date column. Sort what’s displayed by clicking the From option above a list and selecting the appropriate column. The arrow indicates the direction in which rows are sorted (ascending or descending); select the column again to change the orientation.

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

Off Work
Feature	Description
Claim	Category of claim (e.g., Short Term Disability, Workers’ Compensation) and the claim number. Click a claim number to open the Claim page for more information about the claim. Click beside a claim number to add that claim to your Watch List, or click to remove it.
Name	Employee‘s name.
From	Date the employee begins their off work period.
To	Date the employee ends their off work period.
Actions	Click the Action icon to access various actions for the claim. The list below includes possible actions; click an option’s name to view that feature’s help topic or additional details. Report return to work View restrictions

Accommodations Tab

The employee’s Accommodations tab provides the ability to toggle between Pending accommodations and View History. When selected, Pending displays a list of pending accommodations and job functions for your employee that are awaiting a business response. Click Actions Three vertical dots (Actions menu icon) to view a menu appears from which you can view previously approved job functions, approve pending job functions, or approve pending accommodations.

The View History toggle, when enabled, displays accommodation history details for the selected employee, showing decisions that were accepted, rejected, pending, or rescinded. The history details include the status, request type, accommodations periods, accommodation type, and more.

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

Accommodations
Feature	Description
Pending
Claim	Category of claim (i.e., Accommodation Request) and the claim number. Click a claim number to open the Accommodation request page for more information about the request. Click beside a claim number to add that claim to your Watch List, or click to remove it.
Name	Employee‘s name. Click the link to open the Employee’s Claims page (if the employee has claims).
Type	Type of accommodation request (e.g., Leave of Absence, Physical Accommodations) or job function status (e.g., Change In Job Function, Job Functions Approval).
Begin	Date the accommodation begins. Not displayed for job function approvals.
End	Date the accommodation ends. Not displayed for job function approvals.
Actions	Click the Actions icon to select from a list of options applicable to the accommodation or job functions. Possible options include: View Job Functions Approve Job Functions Approve Accommodations Clicking an option opens the Accommodation requests page and expands the relevant section.
View History
Claim	Category of claim (i.e., Accommodation Request) and the claim number. Click a claim number to open the Accommodation request page for more information about the request. Click beside a claim number to add that claim to your Watch List, or click to remove it.
Detail	Provides the information about each of the employee’s accommodation requests: Status: Current status of the request (Open or Closed) and its substatus (e.g., Pending business response, Under review, Currently accommodated). Request Type: Category of accommodation type (e.g., Leave of Absence). Type: Specific type of accommodation (e.g., Leave of Absence - Intermittent leave, Environmental Modification - Monitor size). Description: Description of the accommodations provided. Decision: Whether the accommodation is Accepted or Rejected. Decision Date: Date a decision was made. Begin: Period that accommodations were provided. Long Term: Indicates whether the accommodations were for an extended period.

Claims calendar

This section provides a calendar view of the employee’s time off work for all applicable claims. It also displays approved work accommodation periods, if applicable.

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 the employee‘s claims, 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. The information displayed varies by claim type. See a list of information available in this window.

Claims calendar Event popup

Field Description

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

Examiner Examiner assigned to an accommodation request.

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

Start Date Date a leave of absence begins.

End Date Date a leave of absence ends.

Benefits Begin Date benefits begin for a disability claim.

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

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

Claim Status Current status of the workers’ compensation claim (Open or Closed), the claim’s substatus (e.g., Accepted or Pending), and the reason for the substatus, if applicable.

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

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

Loa Specialist Leave of absence specialist assigned to your claim.

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

Date of Absence Date the leave of absence 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.

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

Current Work Status Employee‘s current work status for a disability or workers’ compensation claim.

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

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

Anticipated Return to Work Duty Role to which the injured employee is expected to return for a workers’ compensation claim.

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

Duration of Absence Length of a continuous leave of absence.

Begin Accommodation period’s begin date.

End Accommodation period’s end date.

Type Type and subtype of the accommodation (e.g., Work Schedule Change - Additional Breaks).

Long Term Indicates whether the accommodation request is a long term accommodation.

Claims calendar Event popup
Field	Description
Claim Number	Claim number to which the absence pertains. Click to open the Claim page.
Examiner	Examiner assigned to an accommodation request.
Claim Type	Category of claim (e.g., Short Term Disability, Continuous Leave).
Start Date	Date a leave of absence begins.
End Date	Date a leave of absence ends.
Benefits Begin	Date benefits begin for a disability claim.
Date of Injury	Date the injury or illness occurred that resulted in a workers’ compensation claim.
Status	Current status of the disability claim or accommodation request (Open or Closed) and the claim’s substatus (e.g., Approved, Pending, Under review).
Claim Status	Current status of the workers’ compensation claim (Open or Closed), the claim’s substatus (e.g., Accepted or Pending), and the reason for the substatus, if applicable.
Leave Status	Current status of the leave of absence claim (Open or Closed) and the claim’s substatus (e.g., Approved or Pending).
Absence Status	Status of the absence (e.g., Approved, Pending).
Loa Specialist	Leave of absence specialist assigned to your claim.
Leave Type	Type of leave of absence (e.g., Family Medical, Employee Medical).
Date of Absence	Date the leave of absence 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.
First Absence	Date of first absence from work for a disability claim.
Current Work Status	Employee‘s current work status for a disability or workers’ compensation claim.
Actual Return to Work Date	Date the employee returned to work.
Relationship	Employee‘s relationship to the individual for whom a leave of absence is taken (e.g., Self, Parent).
Anticipated Return to Work Duty	Role to which the injured employee is expected to return for a workers’ compensation claim.
Anticipated Return to Work Date	Date the employee anticipates returning to work.
Duration of Absence	Length of a continuous leave of absence.
Begin	Accommodation period’s begin date.
End	Accommodation period’s end date.
Type	Type and subtype of the accommodation (e.g., Work Schedule Change - Additional Breaks).
Long Term	Indicates whether the accommodation request is a long term accommodation.

Closed leave claims are not displayed on the calendar. Only open claims or disability and workers’ compensation claims closed within the past two years are included. If accommodation requests are available, only accepted requests are shown on the calendar.

Communication center

The Communication Center enables you to communicate directly with the examiner assigned to open claims.

Click View to open the Communication Center page and view or start conversations with the examiner.

Helpful resources

The Helpful Resources section provides links to various features of the Helpful resources page, such as the Learning Center, Links, and more. For more information, see the Helpful resources page topic.

Leave balance summary

This section, displayed if your employer enlists Sedgwick to manage open leave of absence claims, provides a graphical representation of the amount of time used, pending, and available for each leave policy for which the employee is eligible under the Family and Medical Leave Act, State Leave Laws, Military Leave, or other company leave policies.

See a list descriptions of this section’s features.

Leave balance summary
Feature	Description
Hours / Days / Weeks	Select the period increments by which to display the amount of leave used, pending, and available; options are Hours, Days, or Weeks.
Leave Policy (and maximum)	Displays leave of absence and eligibility information reported to date by or on behalf of the employee for consideration and protection under the Family Medical Leave Act, state leave laws, military leave, or other employer leave policies. Absences taken under a paid time off program, such as vacation and sick time, is not included. The maximum amount of time allowed per policy is displayed in parentheses beside each leave policy in hours, days, or weeks, as specified. Lifetime is displayed instead of a numeric value for lifetime policies such as the Uniformed Services Employment and Reemployment Rights Act (USERRA).
Used / Pending / Available Days	The amount of time used (purple), pending (blue), and available (green) for the policy, based on the period used to determine the maximum time allowed for the policy (hours, days, or weeks).