To fill out a Sedgwick claim form, start by getting the right form for your specific claim type from the mySedgwick portal or your HR department, then complete three sections: your own statement describing the condition and work limitations, an Attending Physician’s Statement signed by your doctor, and an employer verification of your job and earnings. Submit the completed package through mysedgwick.com, by fax, or by certified mail, and keep copies of everything.
Sedgwick is a third-party administrator that handles workers’ compensation, short-term disability, and FMLA requests for many large employers. The forms and the exact fields differ by claim type and by employer, but the filing process below works the same way across them.
Get the Right Form First
The fastest route to the correct forms is the mySedgwick portal at mysedgwick.com, where you log in with credentials from your employer and download documents matched to your plan and claim type.1Sedgwick. Help with My Claim If you can’t get into the portal, your HR or benefits department keeps copies, and Sedgwick’s toll-free line at (866) 647-7610 can send forms by mail or email.
Which form you need depends on the claim. Workers’ compensation uses state-specific injury report forms. Disability claims usually require an employee statement plus an Attending Physician’s Statement. FMLA leave uses Department of Labor certification forms: Form WH-380-E for your own serious health condition and Form WH-380-F for a family member’s.2U.S. Department of Labor. FMLA Forms
Don’t substitute a generic form you found through a search. Sedgwick’s packets are tailored to your employer’s plan, and the wrong version can bounce the claim before anyone reads it.
What to Gather Before You Start Writing
Missing information is the single biggest reason a claim sits in limbo while Sedgwick sends follow-up requests. Pull all of this together before you open the form:
- Your employee ID number, job title, department, and supervisor’s name.
- For a workplace injury: the exact date, time, and location, and a plain description of what happened. For disability: the date symptoms began or the date your doctor took you off work.
- Full name, specialty, office address, phone, and fax for every provider who has treated the condition. Sedgwick will contact them for records.
- Copies of diagnostic results, specialist reports, treatment notes, and imaging related to the condition. Under HIPAA, your provider can charge only a reasonable, cost-based fee for copies you request.3eCFR. 45 CFR 164.524 – Access of Individuals to Protected Health Information
- A recent pay stub, your job description, and any incident report your employer has already filed.
You don’t need to look up ICD-10 diagnosis codes. Your doctor supplies those on the medical section. What you do need is a clear, consistent account of what happened and how it affects your ability to do your job, written in your own words rather than medical language.
Filling Out the Three Sections
Most Sedgwick claim packages have three parts that go to three different people. Each one has to line up with the others.
Your Statement
Describe the injury, illness, or condition in plain language. Focus on when it started, what caused it, and how it limits your ability to do your job. Be concrete about physical restrictions. “I cannot lift more than five pounds with my right arm” is far more useful than “I have a shoulder injury.”
Check that every date you write matches your medical records. Discrepancies between your account and the clinical notes are one of the fastest ways to trigger an investigation or a request for an Independent Medical Examination.4PubMed Central. Ethics and Legalities Associated with Independent Medical Evaluations
Attending Physician’s Statement
Your doctor completes this part. It asks for a diagnosis, a treatment plan, the expected duration of disability, and specific functional limitations. A licensed physician must sign it. In federal workers’ compensation cases, reports from nurse practitioners or physician assistants don’t count unless a physician countersigns.5U.S. Department of Labor. Office of Workers’ Compensation Programs Attending Physician’s Report
Hand this form to your doctor as early as possible and follow up before your filing deadline. Physician offices routinely sit on these for weeks if no one pushes.
Employer Verification
Your HR or payroll department fills in your earnings, job duties, and employment status. Tell them you’re filing the moment you know. Some employers complete this part automatically when the claim is reported through their internal system. Others wait for you to deliver the form in person. Don’t assume it’s been handled. Confirm it.
If You Can’t File It Yourself
If you’re too ill or injured to manage the claim, you can appoint someone (a family member, attorney, or union representative) to act on your behalf. Under federal ERISA rules, your employer’s benefit plan cannot stop you from choosing your own representative.6U.S. Department of Labor. Information Letter 02-27-2019 Put the designation in writing and say whether the representative is handling the initial claim, an appeal, or both. Once designated, Sedgwick should direct correspondence to that person unless you say otherwise. In urgent care situations, a healthcare professional familiar with your condition can act as your representative without going through the plan’s standard authorization process.
Submitting the Completed Package
You have three options:
- Upload PDFs or JPEGs through the mySedgwick portal. This is the fastest route and gives you an electronic timestamp, which is useful proof you met a deadline.1Sedgwick. Help with My Claim
- Fax to the number in your claim instructions. These numbers are often unique to specific benefit centers, so use the one on your paperwork rather than a general Sedgwick number. Keep the confirmation sheet.
- Mail to the regional processing address in your packet. Use certified mail with return receipt. Expect several extra days of processing.
Whichever method you use, copy everything before it leaves your hands. Every page of every form, plus the supporting documents. If a claims examiner later says a document never arrived, your copies are the only backup you have.
Filing Deadlines
There is no single deadline that applies to every Sedgwick claim. The window depends on the benefit type and, for workers’ compensation, state law.
- Workers’ compensation: most states require notice to your employer within 30 to 60 days of the injury, with the formal claim deadline often one to two years from the date of injury. Waiting is still a bad idea because evidence and medical links fade.
- Short-term disability: the deadline sits in your employer’s plan document, called the Summary Plan Description. ERISA does not set a single federal deadline for initial disability claims, so read the SPD or ask HR.
- FMLA: give at least 30 days’ notice for foreseeable leave. For unforeseeable events, notify your employer as soon as practicable, which the Department of Labor generally reads as the same day or the next business day.7U.S. Department of Labor. Family and Medical Leave (FMLA)
Missing any of these is one of the top reasons Sedgwick denies claims outright. File sooner rather than later. You can supplement with additional medical records after the initial submission.
After You Submit
Log back into mySedgwick to track status. Sedgwick assigns a claim number that you’ll use on everything going forward, so write it down somewhere you can find it. A claims examiner is your point of contact for benefit eligibility, payment schedules, and missing-document requests. The initial acknowledgment letter arrives by mail or email and lists anything else Sedgwick needs.
For disability claims governed by ERISA, the plan has 45 days from receipt to issue a decision. If circumstances beyond its control require more time, it can take up to two additional 30-day extensions, bringing the maximum to 105 days, but it must notify you in writing before each extension expires, explain why, and tell you when to expect the decision.8eCFR. 29 CFR 2560.503-1 – Claims Procedure If Sedgwick blows past those windows without sending a written extension notice, raise it with HR or an attorney.
Keep a log of every call, email, and letter. Who you spoke with, the date, what was said. If the claim turns into a dispute, that log is your most valuable asset.
If the Claim Comes Back Denied
A denial letter has to explain the specific reasons for the decision and describe your appeal rights. Read it before you do anything else. The two most common reasons Sedgwick denies claims are insufficient medical documentation and missed deadlines, and both are often fixable on appeal.
For ERISA disability denials, you have 180 days from the denial letter to appeal. That deadline is strict, and missing it almost always ends the claim. Submit through a method that leaves proof: certified mail, email with delivery confirmation, or a timestamped portal upload. Use the appeal to fix what was wrong with the original filing. If the denial cited gaps in medical evidence, get updated records from your doctor that speak directly to those gaps, and include a written statement explaining why you disagree. Sedgwick must decide the appeal within 45 days, with one possible 45-day extension for special circumstances.8eCFR. 29 CFR 2560.503-1 – Claims Procedure
Workers’ compensation appeal routes depend on whether your claim is federal or state. Federal cases can go to the Employees’ Compensation Appeals Board within 180 days of the final OWCP decision, though the Board reviews only the existing record and will not accept new evidence. New records belong in a reconsideration request to OWCP instead.9U.S. Department of Labor. Processing an Appeal State workers’ comp appeals follow each state’s own procedures and deadlines, which vary widely. Check with your state’s workers’ compensation board. If you believe you have a strong claim, an attorney who handles ERISA or workers’ comp cases is worth a call; many offer free initial consultations.