Pandemic prompts claims rethinkPosted On: May. 4, 2021 12:00 AM CST
The COVID-19 outbreak and the upheavals in work policies that followed sent claims professionals scrambling to maintain their operations.
From staying connected to keeping on top of evolving public health policies and crippling travel restrictions, insurers, adjusters, third-party administrators and others found themselves in unprecedented circumstances.
While many claims staff were already working remotely, companies had to shift nearly all their operations to all-remote for a sustained period and leaned heavily on technology to enable that transition.
Many of the changes in the use of technology are expected to remain in place after the pandemic subsides, but it remains unclear which changes will last as in-person claims assessments return, experts say.
“Our first priority was getting people working from home quickly,” said Pat Van Bakel, Toronto-based president, loss adjusting, North America, for Crawford & Co.
Adjusters and other claims professionals are often field-based, and many staff were already equipped with technology to work remotely, so the challenge was to make “desk positions” remote, 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 lead with technology,” said Dennis Tierney, national workers compensation claims leader in New York for Marsh LLC. For example, artificial intelligence and machine learning can be deployed to help 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 expedited adoption, said Jill Dalton, New York-based managing director of Aon’s U.S. property risk consulting group, who handles property claims for large commercial clients.
Mobile damage assessments, such as inspections carried out over video calls, are a good option, but for some large commercial claims “being there in person will always be best,” she said.
Sedgwick Claims Management Services Inc. used technology “to reimagine the best way to handle claims under the circumstances,” said Max Koonce, chief claims officer for the TPA in Fayetteville, Arkansas.
“We looked at how we could provide claims handling services to our clients to include telemedicine, virtual client and injured worker meetings,” as well as handle the complexities of getting medical care for workers during a pandemic, he said.
The realignment toward technology is notable, Mr. Van Bakel said. “Institutional change across the industry was not easy. Digital adoption rates were low, and we’ve seen massive improvements in those fundamentals in the last year.”
While in-person visits remain important, the technology is playing a growing role in claims, Mr. Van Bakel said.
“The expertise-led aspect of our business is always going to be more effective when we’re face to face with someone. There will be a much different use of technology as a sustainable part of the business model,” he said.
“Carriers have been adapting more and more to doing remote adjusting, and I think that trend is going to continue,” said Joseph Miele, an insurance coverage partner with Kaufman Dolowich & Voluck LLP in Fort Lauderdale, Florida.
During the pandemic, the expectation of how insurers are supposed to handle a claim has changed to include a greater reliance on connectivity and technology, such as remote inspections, Mr. Miele said. Whether this situation reverts to its pre-pandemic condition remains to be seen, he said.
In addition to connectivity, where systems were strained with thousands of employees online and many staff were unfamiliar with online communications systems, there were and continue to be informational challenges during the pandemic, sources said.
“Regulation and law changes have been a moving target,” even into this year, Marsh’s Mr. Tierney said, referring to various workers compensation presumption laws that require insurers and employers to cover first responders for COVID-19-related illnesses. “That definitely was a challenge. You had to keep up with each state, which industries, how long. Each state had its own twist to it.”
At Sedgwick, “information ranged from ongoing jurisdictional updates, restrictions and compliance measures to more routine information such as how to wear a mask properly. We also closely monitored and communicated provisions and changes around workers compensation presumptions,” Mr. Koonce said.
State regulations governing immunities from liability claims for health care workers also have evolved over time, with different states enacting legislation at different times, said Robert Blasio, managing director of Gallagher Bassett Specialty, a division of Gallagher Bassett Services Inc., who has clients in the health care field. “At the beginning, there was considerable concern from clients as to what their exposure was.”
“The hardest thing was making sure everybody understood which states you were allowed to travel into without having to quarantine. This required a lot more planning,” Ms. Dalton said. Such planning was difficult given the random nature of claims and the need for expediency in adjusting and settlements.
The abundance of legal and regulatory changes also translated to more advisory services, Mr. Tierney said. “The advisory that went on around COVID from a claims standpoint was at an all-time high.”