Practices

Sedgwick’s extensive insurance background uniquely positions the firm’s managed care attorneys to investigate, analyze, strategize and litigate healthcare disputes.  Drawing on the experience of attorneys from our healthcare and insurance practices, we have created a dedicated managed care defense team.  Our attorneys have a solid understanding of managed care programs and are well-versed in the legal liability issues associated with these programs.

Sedgwick’s extensive insurance background uniquely positions the firm’s managed care attorneys to investigate, analyze, strategize and litigate healthcare disputes.  Drawing on the experience of attorneys from our healthcare and insurance practices, we have created a dedicated managed care defense team.  Our attorneys have a solid understanding of managed care programs and are well-versed in the legal liability issues associated with these programs.

Sedgwick’s managed care practice is part of the firm’s Insurance Practices Group , a firmwide multidisciplinary collective of practice groups serving all facets of the insurance industry. Our clients cover the spectrum of the insurance industry and include some of the largest managed care insurers in the business.

Managed Care Litigation

Sedgwick has long held a reputation as one of the top trial law firms in the nation. Our lawyers have acted as regional counsel for major managed care providers in the United States and have defended multiple national class actions.  We have successfully defended liability issues involving utilization review, benefits and claims determinations, ERISA,   credentialing, peer review, privacy claims, breach of contract and alleged unlawful or fraudulent business practices in managed care cases.  We also advise our managed care clients on various aspects of their operations, including labor and employment policies and compliance with federal regulations.

Employee Benefits Disputes

Sedgwick applies our expertise as a trial firm to representation of individuals and employee benefit plans in ERISA fiduciary litigation.  Our attorneys represent employee benefit plans, plan fiduciaries and third party administrators and provide counseling, trial expertise and representation in administrative hearings. We have significant experience defending  managed care organizations and their insurers against claims made by benefit recipients. We have defended hundreds of benefit disputes and claims relating to ERISA, HIPAA and other federal legislation. Our lawyers routinely deal with state attorneys general offices and state departments of insurance.

We also represent employee benefit plans that are not governed by ERISA in state and federal courts. Our ability to explain complex concepts in understandable terms and our extensive experience in handling employee benefit cases enable us to obtain successful summary resolution of the vast majority of actions we defend. When summary resolution is not available, our trial expertise enables us to efficiently and effectively present both the technical and non-technical portions of claims.

HIPAA Compliance

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) initially impacted the healthcare industry by mandating the “portability” of health insurance for employees changing jobs, prohibiting discrimination based on health and easing pre-existing condition restrictions imposed by health plans.  HIPAA’s requirements expanded in 2002 with the promulgation of a comprehensive set of regulations—referred to generally as the Privacy Rule—addressing the confidentiality of “protected health information” created or maintained by managed care plans, health plan clearinghouses, or healthcare providers that transmit health information in electronic form.  

We partner with our clients to provide cost-effective HIPAA compliance.  Our team of experienced attorneys provides comprehensive risk assessment and gap analysis, HIPAA training as required by the Privacy Rule, and work plans tailored to the needs of hospitals, physicians, health plans and ERISA benefits plans.  We provide training and instruction materials to executive and administrative staffs leading to certification in the required Compliance Plan.  Business Associate Agreements, Notices of Privacy Procedures and other necessary forms are also provided by Sedgwick’s HIPAA attorneys. We coordinate overall compliance activities with security and information technology consultants.

Fraud and Abuse

Fraud and abuse investigations in the healthcare arena often involve both civil and criminal statutes. The firm’s experience in medical matters is key to evaluating and responding to government scrutiny.  In addition, Sedgwick’s nationally prominent civil litigators are joined by former criminal prosecutors to form a team that delivers superior legal counsel in preparing appropriate responses to federal and state inquiries.

We also provide clients with tools to manage the increasing risk of fraud and abuse investigations. Our attorneys conduct preventive audits of existing compliance programs and plan for internal investigations. Often future problems can be prevented at this level, at a considerable savings in both time and cost. Additionally, we constantly monitor changes in legislation and in court decisions to alert clients to new developments.

Insurance and Coverage

Sedgwick attorneys are experienced in managed care insurance coverage analysis, as well as in the substantive legal issues at play in the underlying claim asserted against the managed care provider. The firm’s extensive insurance background uniquely positions us to investigate, analyze, strategize and litigate managed care disputes.

For more than 20 years, Sedgwick has represented the interests of excess insurers within the context of a healthcare liability claims program. Through our management of more than 25,000 claims across the United States, we can efficiently and effectively identify the most advantageous strategy for guiding claims to resolution. Moreover, we have established relationships with medical experts throughout the country to better coordinate the defense of the claims we handle.

Our attorneys collaborate with many clients to draft insurance claims guidelines and policy language to underwrite the new world of managed care, which provides a major advantage when disputes arise. Our managed care attorneys frequently are selected to serve as monitoring counsel for insurers and insureds on matters involving medical malpractice, benefits disputes, directors and officers liability and professional liability.

Medical Malpractice

For over two decades, Sedgwick has defended hospitals and a variety of healthcare practitioners, including physicians, dentists, nurses, physical therapists and chiropractors, against claims of professional malpractice. Over the years, we have defended cases involving all aspects of medical care and treatment. Cases we have tried to verdict have involved serious injuries and sophisticated medical issues such as birth injuries, quadriplegia, surgical mishaps, bowel necrosis and wrongful death for a wide variety of reasons.

Technical Support

An extensive medical library supports the attorneys at Sedgwick. For rapid and efficient research, our attorneys have desktop access to Medline and the National Library of Medicine.  The firm periodically retains physicians, medical consultants and other healthcare practitioners to interpret and clarify issues from a medical point of view. Through these professional relationships, our attorneys become familiar with state-of-the-art medical techniques used for diagnosis and treatment. The experience our attorneys have in preparing and trying managed care cases, coupled with their medical backgrounds and ready access to medical information, allows for expeditious handling of complex cases.

Sedgwick’s extensive insurance background uniquely positions the firm’s managed care attorneys to investigate, analyze, strategize and litigate healthcare disputes.  Drawing on the experience of attorneys from our healthcare and insurance practices, we have created a dedicated managed care defense team.  Our attorneys have a solid understanding of managed care programs and are well-versed in the legal liability issues associated with these programs.

Sedgwick’s managed care practice is part of the firm’s Insurance Practices Group , a firmwide multidisciplinary collective of practice groups serving all facets of the insurance industry. Our clients cover the spectrum of the insurance industry and include some of the largest managed care insurers in the business.

Managed Care Litigation

Sedgwick has long held a reputation as one of the top trial law firms in the nation. Our lawyers have acted as regional counsel for major managed care providers in the United States and have defended multiple national class actions.  We have successfully defended liability issues involving utilization review, benefits and claims determinations, ERISA,   credentialing, peer review, privacy claims, breach of contract and alleged unlawful or fraudulent business practices in managed care cases.  We also advise our managed care clients on various aspects of their operations, including labor and employment policies and compliance with federal regulations.

Employee Benefits Disputes

Sedgwick applies our expertise as a trial firm to representation of individuals and employee benefit plans in ERISA fiduciary litigation.  Our attorneys represent employee benefit plans, plan fiduciaries and third party administrators and provide counseling, trial expertise and representation in administrative hearings. We have significant experience defending  managed care organizations and their insurers against claims made by benefit recipients. We have defended hundreds of benefit disputes and claims relating to ERISA, HIPAA and other federal legislation. Our lawyers routinely deal with state attorneys general offices and state departments of insurance.

We also represent employee benefit plans that are not governed by ERISA in state and federal courts. Our ability to explain complex concepts in understandable terms and our extensive experience in handling employee benefit cases enable us to obtain successful summary resolution of the vast majority of actions we defend. When summary resolution is not available, our trial expertise enables us to efficiently and effectively present both the technical and non-technical portions of claims.

HIPAA Compliance

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) initially impacted the healthcare industry by mandating the “portability” of health insurance for employees changing jobs, prohibiting discrimination based on health and easing pre-existing condition restrictions imposed by health plans.  HIPAA’s requirements expanded in 2002 with the promulgation of a comprehensive set of regulations—referred to generally as the Privacy Rule—addressing the confidentiality of “protected health information” created or maintained by managed care plans, health plan clearinghouses, or healthcare providers that transmit health information in electronic form.  

We partner with our clients to provide cost-effective HIPAA compliance.  Our team of experienced attorneys provides comprehensive risk assessment and gap analysis, HIPAA training as required by the Privacy Rule, and work plans tailored to the needs of hospitals, physicians, health plans and ERISA benefits plans.  We provide training and instruction materials to executive and administrative staffs leading to certification in the required Compliance Plan.  Business Associate Agreements, Notices of Privacy Procedures and other necessary forms are also provided by Sedgwick’s HIPAA attorneys. We coordinate overall compliance activities with security and information technology consultants.

Fraud and Abuse

Fraud and abuse investigations in the healthcare arena often involve both civil and criminal statutes. The firm’s experience in medical matters is key to evaluating and responding to government scrutiny.  In addition, Sedgwick’s nationally prominent civil litigators are joined by former criminal prosecutors to form a team that delivers superior legal counsel in preparing appropriate responses to federal and state inquiries.

We also provide clients with tools to manage the increasing risk of fraud and abuse investigations. Our attorneys conduct preventive audits of existing compliance programs and plan for internal investigations. Often future problems can be prevented at this level, at a considerable savings in both time and cost. Additionally, we constantly monitor changes in legislation and in court decisions to alert clients to new developments.

Insurance and Coverage

Sedgwick attorneys are experienced in managed care insurance coverage analysis, as well as in the substantive legal issues at play in the underlying claim asserted against the managed care provider. The firm’s extensive insurance background uniquely positions us to investigate, analyze, strategize and litigate managed care disputes.

For more than 20 years, Sedgwick has represented the interests of excess insurers within the context of a healthcare liability claims program. Through our management of more than 25,000 claims across the United States, we can efficiently and effectively identify the most advantageous strategy for guiding claims to resolution. Moreover, we have established relationships with medical experts throughout the country to better coordinate the defense of the claims we handle.

Our attorneys collaborate with many clients to draft insurance claims guidelines and policy language to underwrite the new world of managed care, which provides a major advantage when disputes arise. Our managed care attorneys frequently are selected to serve as monitoring counsel for insurers and insureds on matters involving medical malpractice, benefits disputes, directors and officers liability and professional liability.

Medical Malpractice

For over two decades, Sedgwick has defended hospitals and a variety of healthcare practitioners, including physicians, dentists, nurses, physical therapists and chiropractors, against claims of professional malpractice. Over the years, we have defended cases involving all aspects of medical care and treatment. Cases we have tried to verdict have involved serious injuries and sophisticated medical issues such as birth injuries, quadriplegia, surgical mishaps, bowel necrosis and wrongful death for a wide variety of reasons.

Technical Support

An extensive medical library supports the attorneys at Sedgwick. For rapid and efficient research, our attorneys have desktop access to Medline and the National Library of Medicine.  The firm periodically retains physicians, medical consultants and other healthcare practitioners to interpret and clarify issues from a medical point of view. Through these professional relationships, our attorneys become familiar with state-of-the-art medical techniques used for diagnosis and treatment. The experience our attorneys have in preparing and trying managed care cases, coupled with their medical backgrounds and ready access to medical information, allows for expeditious handling of complex cases.