Gallagher Bassett’s Update on Claims Best Practices
Mar 16, 2020

Last week we reported on the decisive, enterprise level steps Gallagher Bassett has taken during the activation and engagement of our business continuity programs. This week we focus on Best Practice enhancements we instilled from the outset of the pandemic to ensure all matters are handled and reported appropriately.

The GB COVID-19 Task Force is providing ongoing technical oversight on individual claims and claims processes. Across the organization, we have implemented measures to aid our resolution managers in the administration, investigation, and adjudication of COVID-19 claims allegedly arising out workers' compensation (WC), general liability (GL), and defense base act (DBA) exposures. We are taking actions throughout the claim lifecycle to ensure timely and quality claims management involving COVID-19.

GB's intake process continues to operate seamlessly. There has been no disruption to this service and we are confident that this essential claims function will continue unabated. We have tested and confirmed business continuity plans, which are described below.

First, we have classified "essential" employees whose jobs are critically important to the continued core operation of claims intake and reporting. These essential personnel will be available and on-premises, consistent with the business continuity plan, during the pandemic. Further, our intake footprint has multiple locations geographically distanced - virtual staff, Charlotte, Atlanta, and Belize - so that in the event a pandemic becomes critical in any one location, we are able to shift call volumes to unaffected alternate sites.

In the event of unprecedented call volumes to our contact center, we will apply a recorded message to alert callers to file claims via email or fax options. In addition, our on-line reporting capabilities are universally available and can be supported by remote workers. We encourage all customers that utilize on-line solutions to remind their employees of available web-reporting options.

For all incoming losses coded and characterized as "Contagious Disease," we pose a conditional question to develop information whether the loss includes a potential exposure to Coronavirus/COVID-19.

PC 365
For those who use GBCARE Point of Injury Triage and Care Recommendation, or "PC 365," for claims intake, we have enhanced our scripts to identify potential exposure to COVID-19. The essential changes to the script include: identification of essential symptoms, description of the nature and duration of potential exposure, and questions to develop information on whether the exposure occurred in the work environment, consistent with the criteria set by the Centers for Disease Control and Prevention.

Our GBCARE nurses are also looking to identify potential high-risk conditions, such as respiratory conditions or heart disease. We've trained our nurses on appropriate responses to the reported exposure, including when to seek emergency care and how to access best-in-class medical care within their local community. Finally, as is the case with all PC 365 reported claims, we have ensured appropriate documentation and coding to support thorough investigation by our claims professionals.

Gallagher Bassett has made several changes to our core claims processing for matters involving potential coronavirus exposure. We highlight these changes below.

Claim Setup
We have updated our Best Practices to ensure all incoming reports related to coronavirus are screened and investigated, as necessary, with questions specific to the pandemic.  Our intake and claims teams have all been trained in these line-of-coverage-specific practices and we have been refining these as needed as the situation evolves.  For more information on our claim intake, setup and investigation practices for COVID-19 losses, please reach out to your account manager.”

Additionally, to accommodate the increased notification requirements for our client and carrier partners, we have established a unique Nature of Loss code to track all COVID-19 related claims. Presently, we are tracking and immediately reporting all incoming claims with potential exposure to COVID-19 to the respective clients and carriers.

The team has developed a new line of questioning for our resolution managers to use in the investigation of WC, GL, and DBA claims. The questions are designed to obtain the kind of information necessary to evaluate compensability of the claim and to concisely inform our clients of the nature and extent of the loss.

In addition to normal validation and investigative questions, we have added coronavirus-specific questions that seek to gain clarity on the nature and circumstances of exposure, the impact of that exposure on the claimant, and other pertinent information from medical providers and client contacts.

Compensability Determinations
While existing statutes provide some guidance on the applicability of communicable disease exposure on various coverages, this situation is unique.  As such we are working in close partnership with our carrier partners, clients, and regulatory bodies to determine approaches to compensability.

All claims must also be evaluated for coverage on a case-by-case basis, as jurisdictional differences may inform these compensability determinations. As such, we are compiling an aggregate list of jurisdictional directives related to claims adjudication.  Please stay tuned to The Network for these regulatory updates. You may also subscribe to The Network to receive additional notifications.

We will continue to share updates about our claims operational practices and actions taken as the situation unfolds. Thank you for trusting us as your risk and claims management partner.

We stand ready to serve and help.

Gallagher Bassett


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