Sedgwick Claims Management Services API

Known Gotchas

• ⚠ FMLA AND ADA INTERACTIVE PROCESS EMPLOYER LEGAL DUTY: Automated leave management integration with Sedgwick must preserve employer's non-delegable FMLA and ADA obligations; Sedgwick administers leave on employer's behalf but employer remains legally responsible for FMLA certification sufficiency, ADA interactive process, and adverse action review; automated leave denial without employer HR/legal review creates FMLA interference and ADA failure-to-accommodate liability
• ⚠ EMPLOYEE MEDICAL CONFIDENTIALITY IN ABSENCE DATA: Automated HR system integration with Sedgwick absence management must strictly control which HR data fields flow back to operational systems; employee disability leave reason and medical diagnosis must not be shared with supervisor or manager through automated HR system sync; ADA confidentiality obligations restrict medical information to HR, benefits, and safety roles only
• ⚠ WC CLAIM COMPENSABILITY ADJUSTER DETERMINATION: Automated WC claim intake and routing via Sedgwick must preserve adjuster compensability determination authority; automated claim acceptance or denial without adjuster review creates bad faith liability and state WC regulatory violation; automated FNOL routing to adjuster queue, not automated compensability decision
• ⚠ Multi-jurisdiction employer absence program complexity — automated absence management for employers with workers in multiple states must apply state-specific FMLA (California CFRA/CPFL, New York NY PFL, Washington PFML, others) concurrent leave tracking; automated leave management using federal FMLA only for states with more generous leave laws creates employee underpayment and leave law violation
• ⚠ Excess carrier attachment monitoring for large self-insured programs — automated Sedgwick claim monitoring for large deductible or self-insured retention programs must trigger excess carrier notification as aggregate losses approach attachment; automated excess notification delay creates potential excess coverage disclaimer; implement real-time aggregate vs attachment monitoring
• ⚠ Claim data authorized recipient scoping — Sedgwick API access must be scoped to authorized organizational recipients (risk management, HR benefits, safety); automated reporting distribution must enforce data governance policies restricting sensitive claim data; unauthorized claim data distribution creates HIPAA, ADA, and GINA confidentiality violations