Sedgwick Claims Management Services

What they litigate

Disputed issues across the decisions this claims administrator is named in. Every row opens the decisions it counts.

Where they appear

• Van Nuys 142
• Los Angeles 71
• Oakland 67
• Marina del Rey 64
• Santa Ana 52
• Anaheim 36
• Pomona 28
• Long Beach 27
• San Francisco 26
• Riverside 25
• Sacramento 25
• Oxnard 22

How the appealed decisions came out

These are decisions that were appealed and published — the tail of a system that mostly settles. Most claims end in a compromise and release or a stipulation and never reach a panel, so nothing below describes how this claims administrator does its work. It describes how a set of appealed disputes came out.

• 313 for the defense
• 264 for the applicant
• 109 returned for more record

Counted over 655 appealed decisions. Not this claims administrator’s book of work. A decision that went one way on one issue and the other way on another is counted in both columns, so the figures add up to more than the total.

Decisions

Newest decisions this claims administrator is named in, each with the passage the panel turned on and a link to the official PDF.

• ADJ8545914 · 2026-08-28 · Marina Del Rey District OfficeApportionmentremanded

  Determinative passage · p.1on June 3, 2024. The workers’ compensation administrative law judge (WCJ) found that applicant, while employed by defendant as a Detention Services Officer during the period of October 1, 2009 to January 1, 2012, sustained injury arising out of and in the course of her employment (AOE/COE) to her right wrist, right hand, left knee, heart, lungs, psyche, headaches, and gastrointestinal system, resulting in 100% permanent disability. Defendant contends that the WCJ erred and acted in excess of her powers by failing to apply apportionment correctly pursuant to Labor Code sections 4663 and 4664. 2 Furthermore, defendant 1F

  The Appeals Board found that the medical evidence was insufficient to apportion disability with reasonable medical probability due to intertwined injuries and deferred permanent disability and apportionment for further factual determination.

  Official decision · page 1 →
• ADJ13613836 · 2026-08-18 · Salinas District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.7(Rodarte) (2004) 119 Cal.App.4th 998 [69 Cal.Comp.Cases 579].) Moreover, based on our review of the evidentiary record, including the PQME reports of Dr. Lockwood, we observe that Dr. Lockwood’s opinions are grounded not only in the reported history of the injury, but also comprehensive physical examinations of applicant, and thorough review of extensive medical records, numbering more than 2,500 pages. Ultimately, even after review of records pertaining to applicant’s prior injuries with Earthbound Farms, Dr. Lockwood continued to find injury AOE/COE. Defendant contends that Dr. Lockwood relied primarily upon applicant’s inaccurate depiction of her job duties, but in his March 19, 2022 report, Dr. Lockwood noted review of applicant’s actual job description. (Exhibit A1, p. 2.) Thus, despite being given the opportunity to reverse his opinions, he continually opted to find injury. Ultimately, in reviewing Dr. Lockwood’s reports, we find his opinions to be well-reasoned and not based upon surmise, speculation, conjecture, or guess. We thus conclude that Dr. Lockwood’s opinions constitute substantial medical evidence on the issue of injury AOE/COE to the cervical spine, lumbar spine, bilateral shoulders, and bilateral wrists. We also find, for the

  The WCAB found Dr. Lockwood’s opinions to be well-reasoned, based on comprehensive physical exams and extensive medical records review, constituting substantial medical evidence supporting injury AOE/COE. Applicant’s claim was found compensable for the cervical spine, lumbar spine, bilateral shoulders, and bilateral wrists.

  Official decision · page 7 →
• ADJ18573103 · 2026-08-17 · Oakland District OfficeTemporary disabilityapplicant prevailed

  Determinative passage · p.8II. We will affirm the WCJ’s finding that applicant was totally temporarily disabled from January 9, 2026 going forward. Temporary disability indemnity is compensation for temporary impairment in earning ability caused by the industrial injury which is reasonably expected to be cured or materially improved with proper medical treatment or over time. (Lab. Code, §§ 4453 and 4653; see Chavira v. Workers’ Comp. Appeals Bd. (1991) 235 Cal.App.3d 463, 473 [56 Cal.Comp.Cases 631].) We adopt and incorporate the WCJ’s report on this issue as follows: THE FINDINGS OF FACT AND AWARD OF TTD FROM JANUARY 9, 2026 AND ONGOING WAS SUPPORTED BY THE RECORD AND NOT IN ERROR

  The WCAB found that the applicant was totally temporarily disabled from January 9, 2026, ongoing, based on the credible opinion of PTP Dr. Kamdar and applicant's testimony, rejecting the stale opinions of AMEs Dr. Levy and Dr. Woodcox regarding permanent and stationary status. The delay in payment was not unreasonable due to genuine medical doubt, so the 25% penalty under section 5814 was rescinded, but a 10% increase on delayed payments was awarded under section 4650(d). Attorney fees under section 5813 were rescinded and replaced with a 15% fee on delayed payments.

  Official decision · page 8 →
• ADJ16563992 · 2026-08-17 · Oakland District OfficeJurisdiction / venueapplicant prevailed

  Determinative passage · p.5Thus, we conclude that the parties were provided with the notice of transmission required by section 5909(b)(1) because service of the Report in compliance with section 5909(b)(2) provided them with actual notice as to the commencement of the 60-day period on June 18, 2026. II. Turning to the merits, we will first consider applicant’s contention that the WCJ proceeded to trial in her absence. In our en banc decision in Perez v. Chicago Dogs (2025) 90 Cal.Comp.Cases 830 (Appeals Board en banc) (Chicago Dogs), we stated that: In conducting our preliminary review, we observe that in addition to our constitutional mandate to accomplish substantial justice, the following fundamental legal principles must guide us:

  The WCAB found that the WCJ proceeded to trial without applicant present, denied a virtual appearance request improperly, and showed bias and unqualified opinions, violating due process. The WCJ was disqualified and the decision rescinded to ensure a fair hearing.

  Official decision · page 5 →
• ADJ9213906 · 2026-08-11 · Van Nuys District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.8(Cal. Code Regs., tit. 8, § 10786(e) and (f).) Here, there is no evidence in the record that defendant objected to cost petitioner’s invoices or issued any EORs. At time of trial, defendant offered no exhibit evidence or witness testimony about its timely compliant objections or EORs in response to cost petitioner’s invoices. Accordingly, under section 4622(a), defendant has waived their objections to cost petitioner’s invoices, and they owe the bills, penalties of 10 percent, and 7 percent per annum interest. Furthermore, the WCJ’s order of payment per fee schedule is incorrect. Specifically, under WCAB Rule 10786(f), the fee schedule applies when defendant has sent EORs. We also note that the order to bill review is also not appropriate given that defendant failed to submit evidence that it issued timely compliant objections or EORs. (Lab.

  Defendant failed to issue timely and compliant objections or Explanations of Review (EORs) to cost petitioner's invoices as required by Labor Code section 4622(a) and WCAB Rule 10786(e), resulting in waiver of objections and entitlement to payment, penalties, and interest for cost petitioner.

  Official decision · page 8 →
• ADJ14149688 · 2026-07-27 · San Francisco District OfficeMedical treatment / UR / IMRremanded

  Determinative passage · p.12Chen’s opinion that all treatment rendered after the March 6, 2021 surveillance is nonindustrial, and that there is no need for future medical care for the neck and back. We emphasize the point made by the WCJ that this opinion amounts to impermissible apportionment of medical treatment. If the need for medical treatment is partially caused by an applicant’s industrial injury, an employer must pay all the injured worker’s reasonable medical expenses. (Granado v. Workers’ Comp. Appeals Bd. (1968) 69 Cal.2d 399, [33 Cal.Comp.Cases 647].) An injured worker is entitled to medical care for a non-industrial condition that must be treated in order to cure or relieve the effects of an industrial injury. (Bolton, supra, 34 Cal.3d 159.) Dr. Chen does not indicate any medical basis for cutting off industrial liability for medical treatment that he opined was warranted up to the point of the March 2021 surveillance. Likewise, his opinion still states that the injuries are 100% industrial. He is consistent that the industrial motor vehicle accident caused injury to the cervical and lumbar spines. There is no evidence anywhere in the record of an intervening event that would sever causation for ongoing care. Moreover, the spine is listed in diagnoses from the beginning of the medical record. Again, the opinion is not supported, is contradictory, and is not substantial.

  The QME's opinion cutting off medical care after March 6, 2021 was found to be an impermissible apportionment and not supported by substantial evidence, leading to remand for further development.

  Official decision · page 12 →
• ADJ13153374 · 2026-07-21 · Santa Ana District OfficeJurisdiction / venueapplicant prevailed

  Determinative passage · p.10We are therefore authorized to exercise jurisdiction over his claims by sections 3600.5, subdivision (a) and/or 5305. 3 Accordingly, we will rescind the Findings of Fact and substitute a new order finding that applicant was hired in California for purposes of California workers’ compensation law and is eligible to bring both his specific and cumulative injury claims in this forum. For the foregoing reasons, IT IS ORDERED, as the Decision After Reconsideration of the Workers’ Compensation Appeals Board, that the May 12, 2021 Joint Findings of Fact is RESCINDED, and the following order SUBSTITUTED therefore:

  The WCAB found that the applicant was hired in California for purposes of California workers’ compensation law based on binding precedent in Gandy, which holds that hire by a California-based team equates to hire in California, despite the contract being signed outside California. This established subject matter jurisdiction over the claims.

  Official decision · page 10 →
• ADJ21567804 · 2026-07-20 · Pomona District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.7Here, the report is not signed by anyone other than the nurse practitioner. Applicant provided unrebutted testimony that no physician other than the nurse practitioner and a physician

  The nurse practitioner's report was not signed by a physician and thus invalid as a release from care; a nurse practitioner cannot be designated as a primary treating physician under Labor Code section 3209.10; therefore, the applicant is entitled to designate a new primary treating physician and continue medical treatment.

  Official decision · page 7 →
• ADJ292246 · 2026-07-01 · San Francisco District OfficeJurisdiction / venuedefendant prevailed

  Determinative passage · p.4Under California's workers' compensation system, questions relating to the medical necessity of a treatment requested by a physician are decided through a compulsory UR process. Section 4610 requires that employers establish a UR process and once a treating physician submits an RFA to an employer, the employer must either approve the treatment request or dispute the treatment request and submit the matter for review by a UR physician who then must determine, based on "medical necessity," whether to approve, modify, or deny the requested treatment. (§ 4610; State Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230, 241.)

  The WCAB concluded that the request for a motorized wheelchair is a new and different treatment subject to utilization review, so the WCAB lacks jurisdiction to decide its medical necessity at this time.

  Official decision · page 4 →
• ADJ15211632 · 2026-06-25 · San Diego District OfficeMedical treatment / UR / IMRapplicant prevailed

  Determinative passage · p.1Applicant seeks reconsideration of the April 14, 2026 Findings and Order (F&O), wherein the workers' compensation administrative law judge (WCJ) found that a prior utilization review (UR) decision denying authorization for a requested treatment barred a subsequent request for authorization (RFA) for the same treatment submitted on December 4, 2025. The WCJ further determined that the UR decision issued on December 8, 2025 regarding authorization for a wheelchair accessible hotel room was untimely but that the requested services were not medically necessary.

  The Appeals Board found that the WCJ erred in concluding the prior UR decision barred the subsequent request and that the December 8, 2025 UR decision was untimely but the requested treatment was medically necessary, warranting reconsideration.

  Official decision · page 1 →
• ADJ10896001 · 2026-06-18 · Oxnard District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.14Here, a careful review of the medical reporting in this matter reveals that the apportionment opinions provided by both PQME Dr. Brooks and PQME Dr. Tirmizi fail to meet this rigorous evidentiary standard. The apportionment analysis proffered by PQME Dr. Brooks regarding applicant's thoracic and lumbar spine relies upon generalized factors rather than a precise medical explanation of causation. PQME Dr. Brooks assigned 75% nonindustrial apportionment to both spinal regions, attributing this allocation to applicant's mild degenerative MRI findings, his 16 years of previous employment in the construction industry, his participation in sports activities, and his limited 60-day tenure with defendant. PQME Dr. Brooks justified this determination by concluding that a single specific injury likely did not cause the total impairment and positing that applicant likely would have developed 75% of the impairment even absent the October 28, 2016 injury. This rationale is fundamentally speculative. The mere fact that a medical report assigns approximate percentages of industrial and nonindustrial causation does not make the report reliable medical evidence by itself. By relying on applicant's prior work history and sports activities

  The apportionment opinions by PQME Dr. Brooks and Dr. Tirmizi lacked sufficient medical explanation and were speculative, so no apportionment was found. The permanent disability was found to be 27%.

  Official decision · page 14 →
• ADJ931866 · 2026-06-15 · San Bernardino District OfficePermanent total disabilityremanded

  Determinative passage · p.1Defendant seeks reconsideration of the Findings, Award, and Order issued on March 16, 2026. The workers' compensation administrative law judge (WCJ) found, in relevant part, that applicant sustained an injury to the lumbar spine, right shoulder, right wrist, ribs, thoracic spine, head, teeth, jaw (clenching), nose, right clavicle, left lung, sexual dysfunction, bowel dysfunction, urinary dysfunction, sleep, hearing, nervous system, psyche and esophagus (upper GI); and that applicant's injury caused permanent total disability of 100%.

  The Appeals Board found that the vocational expert's opinion on permanent total disability was not supported by substantial medical evidence, particularly regarding work restrictions and pain condition. The Board granted reconsideration to further develop the record and review the merits of the petition.

  Official decision · page 1 →

Also recorded as

The same claims administrator is printed several ways across the decisions, and all of them were counted as one. These are the twelve commonest of 58.

• SEDGWICK CLAIMS MANAGEMENT SERVICES
• SEDGWICK CMS
• SEDGWICK
• SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.
• Sedgwick Claims Management Services
• Sedgwick
• Sedgwick Claims Management Services, Inc.
• Sedgwick CMS
• SEDGWICK CLAIMS MANAGEMENT
• Sedgwick Claims Management
• SEDGWICK RIVERSIDE
• SEDGWICK CMS, INC.

Is this your company and something here is wrong? Tell us and we will fix it. Every figure on this page is a count of released decisions this claims administrator is named in, and the decisions themselves are listed above with the passage each turned on.