Pandemic prompts claims rethink | Business Insurance

The COVID-19 outbreak and subsequent labor policy upheaval caused claims professionals to scramble to keep their operations going.

From affiliation to advancing health policies to crippling travel restrictions, insurers, adjusters, third-party administrators, and others have found themselves in unprecedented circumstances.

While many claims handlers were already working remotely, companies had to move almost all of their activities to all-remote for an extended period of time and relied heavily on technology to make this transition possible.

Many of the changes in technology use are expected to persist after the pandemic ends, but it remains unclear what changes will be permanent after the return of personal injury assessments, experts say.

"Our first priority was getting people to work from home quickly," said Pat Van Bakel, president of Toronto, North America Loss Adjustment at Crawford & Co.

Adjusters and other claims professionals are often on-site, and many employees were already equipped with technology to work remotely. So the challenge was to remotely control "desk positions," he said.

Technology has played a key role in the claims process.

"Now more than ever, and the pandemic helped bring this out, you have to be a technology leader," said Dennis Tierney, New York director of National Compensation Claims at Marsh LLC. For example, artificial intelligence and machine learning can be used to pinpoint claims with the potential to escalate, he said.

Aon PLC was "in the process of getting some of these virtual processes going," and the pandemic accelerated adoption, said Jill Dalton, New York-based executive director of Aon's US real estate risk advisory group, which services real estate claims for large commercial clients.

Mobile damage assessments, such as B. Video call inspections are a good option, but it is always best to be there in person for some large commercial claims, she said.

Sedgwick Claims Management Services Inc. used technology to “redefine the best way to process claims in the circumstances,” said Max Koonce, TPA's chief claims officer in Fayetteville, Arkansas.

"We considered how we could provide claims handling services to our customers, including meetings with telemedicine, virtual customers and injured workers," as well as the complexities of providing medical care to workers during a pandemic, he said.

The realignment towards technology is remarkable, said Van Bakel. “The institutional change in the industry was not easy. Digital adoption rates have been low, and we've seen massive improvements in those basics over the past year. "

While face-to-face visits remain important, technology is playing an increasing role in claims events, Van Bakel said.

“The expertise-led aspect of our business becomes more and more effective when we face someone. The use of technology as a sustainable part of the business model will vary widely, ”he said.

"Carriers have increasingly adapted to remote fitting, and I think this trend will continue," said Joseph Miele, insurance coverage partner at Kaufman Dolowich & Voluck LLP in Fort Lauderdale, Florida.

During the pandemic, expectations of how insurers should handle a claim have shifted to create a greater reliance on connectivity and technology like remote inspections, Miele said. Whether this situation returns to its pre-pandemic state remains to be seen, he said.

In addition to connectivity, where systems were overloaded with thousands of employees online and many employees were unfamiliar with online communication systems, there have been and remain information challenges during the pandemic.

"Regulatory and legislative changes have been a moving target," said Marshs Tierney again this year, referring to various employee compensation presumption laws that require insurers and employers to cover first responders for COVID-19-related illnesses. “That was definitely a challenge. You had to keep up with every state, which industries and for how long. Each state had its own twist. "

At Sedgwick, “information ranged from ongoing jurisdictional updates, restrictions and compliance measures, to more routine information such as how to properly wear a mask. We have also closely monitored and communicated provisions and changes related to employee compensation assumptions, ”said Koonce.

Government regulations on liability immunity for health care workers have also evolved over time. Different states have laws in place at different times, said Robert Blasio, general manager of Gallagher Bassett Specialty, a division of Gallagher Bassett Services Inc. that has customers in the healthcare sector. "In the beginning, customers were very concerned about how high their engagement was."

“The hardest part was making sure everyone understood which states you could travel to without being quarantined. This took a lot more planning, ”said Ms. Dalton. Such planning was difficult given the random nature of the claims and the need for appropriate customization and billing.

The plethora of legal and regulatory changes also resulted in more advisory services, said Tierney. "Advice about COVID from the point of view of damage was at an all-time high."

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