How to File a Claim with Sedgwick

How to File a Claim...

To file a claim you will need to have your physician name, address, telephone number and fax information when you call Sedgwick, Inc. There are two ways to file a claim:

  • Telephone – You may call Sedgwick CMS, Inc. at (800) 845-7739 Monday through Friday from 6:00 a.m. to 4:45 p.m. Pacific Standard Time. You will be mailed the forms that need to be completed.
  • Internet – Go to Sedgwick's website, www.vpaweb.com. Select “File a Claim” from the menu. You will be asked a series of questions, such as: for who you work, in what state you work, under which plan you are filing. After you have answered these questions, you will be given access to the online claim form to complete. When the form has been completed and submitted, you will be presented with a confirmation page that includes instructions on your next steps (e.g. call your doctor, call your supervisor, complete the forms, etc.)

Sedgwick Eligibility and Other Information

Eligibility:

Class 1:  All members represented by RSA Public Safety Unit.

Class 2:  All members represented by Laborer’s International Employees of California (LIUNA) and Service Employees International Union (SEIU) except the Supervisory Unit will be classified as Class 2.

               

STD Benefit Amount:

Class 1:  The plan shall pay 55% of the member's salary up to a weekly maximum benefit of $249.70.

Class 2:  The plan shall pay 60% of the member's salary up to a weekly maximum benefit of $461.54.

Note: Approved SEIU disability claims filed with a date of disability prior to January 1, 2013 will be paid at the Class 1 STD benefit amount.

When a disability begins in the middle of a pay period, the daily amount payable will be one-seventh (1/7) of the weekly amount.

 

Waiting Period:

A waiting period is the number of days you must be consecutively disabled before benefits will be paid under the plan. Benefits will begin on whichever day is the earliest of:

  • The eight (8th) day of disability;
  • The first (1st) day of hospital confinement; or
  • The first (1st) day of treatment in a surgical clinic or a surgical unit provided you are continuously disabled for at least eight (8) days.







    If you are continuously disabled for more than 21 days during any one period of disability, any waiting period previously applied is waived.

When to File a Claim – You should initiate your claim for benefits as soon as you are hospitalized or when you believe your disability will last eight (8) days or more.  To avoid payment delay, you should file your claim as soon as possible, and within 120 days from the date of disability or as soon thereafter as reasonably possible. 

Deadline to File a Claim – No claims will be accepted after one year from the end of the 120 day claim filing period.  Claims not filed in a timely manner will be denied and benefits will not be paid.  These time limits will not apply during any period when you lacked the legal capacity to file a claim.

Resources: Summary Plan Document

File a new claim form: https://www.vpaweb.com/Intake/newclaim.aspx

 

Downloadable forms: http://www.vpaweb.com/Employee/ssl/EmployeeDownLoadForms.aspx