Sedgwick Claims Management Services, Inc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Employee section. Enter your name, claim number, employee ID, and the dates for when your leave began and your expected return to work.
3. Sign and date the form in the designated areas to confirm your understanding that you cannot return without a release from your health care provider.
4. Next, provide this form to your Health Care Provider. They will need to complete their section by certifying your ability to return to work and indicating any restrictions or accommodations necessary.
5. Ensure that the Health Care Provider fills in their signature, date, and contact information before submitting the completed form.
6. Finally, fax a copy of the completed form to Sedgwick at 1-866-856-4862 as required by your supervisor.

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