Experience caring claims management with a trusted partner

At the heart of every workers’ compensation claim is an injured person. The manner in which the claims process is handled directly affects the health and timely recovery of that person, as well as the total costs incurred by the employer.

Our comprehensive approach harmoniously balances cost containment with claimant advocacy. By ensuring employees experience compassionate communication and quality care — in the right place, at the right time — we lower the overall cost of workers' compensation claims for employers.

Claims professionals focused on the best possible resolutions

While each step in the claims process is important, our experience in handling more than $9 billion in claims each year has taught us that specific decisions — or waypoints — along a journey can have an outsized impact on the outcome of a claim.

From the first report of injury to the successful closure of a claim, our highly trained claims professionals actively listen, empathize, and guide workers and employers through the workers' compensation claims process.

We refer to these professionals as Resolution Managers because of their leadership role in managing claims to the best possible resolution. We are committed to attracting, developing, retaining, and recognizing the finest in our industry.

Nevertheless, even the best leaders can benefit from navigational tools. As such, we equip our Resolution Managers with continuous advanced training and a suite of highly sophisticated decision-support tools.

Decisions based on proven data models

Our Waypoint Navigation System is a robust data analysis and predictive modeling tool built on our extensive claims experience and decades of historical data. It offers insights into the following:

  • Establishing accurate claim reserves
  • Determining litigation propensity
  • Identifying subrogation potential
  • Recognizing complex claims for early clinical intervention.

By collaborating with our clients to understand their unique needs and empowering our Resolution Managers to make informed decisions, we consistently deliver superior workers' compensation outcomes for employees and their employers.

Actionable information at your fingertips

Learn how our user-friendly mobile applications, and Luminos, the highest-ranked risk management information system (RMIS) in the industry, can help you track outcomes for more effective analysis, benchmarking, and ongoing program improvements.


Optimize clinical recovery and boost return to work with GBCARE™

The right care at the right time

GBCARE™, our medical management platform of solutions and integrated services, is engineered to provide the right level of clinical support at the right time. This assistance aids injured workers on their paths to recovery. Programs include:

In non-emergency situations, employees and their supervisors can directly speak with a GBCARE™ nurse 24 hours a day, 7 days a week, 365 days a year through a toll-free number.

During the call, the nurse obtains all relevant information and makes treatment recommendations and network provider referrals. With this program, clients can:

  • Avoid claims by channeling low-severity injuries to self-care
  • Direct injured workers to appropriate providers, including telemedicine, thus avoiding unnecessary ER utilization
  • Improve the employee experience with the option for a virtual nurse connection
  • Track key performance indicators with comprehensive reports spanning integrated solutions.

This early advocacy solution offers innovative risk assessment and targeted clinical support to an injured worker in the critical early days following a claim.

When a claim is reported, the loss details are reviewed for risk. Our team also reaches out via text message to the injured worker to help identify care needs and potential roadblocks to recovery.

Individuals identified as having a high-risk case are then assigned to Clinical Concierge, a limited engagement nurse who provides guidance, compassion, and clinical support with a whole-person approach.

Clinical Concierge will establish a care plan to address individual risk, including co-morbid and psychosocial barriers to recovery, and partners with high performing medical providers identified by Waypoint Provider Guidance.

Cases that would benefit from ongoing clinical oversight after the first 10 days of support are recommended to GBCARE™ Clinical Services for further case management.

Identifying the best providers to treat our injured workers is the foundation for ensuring optimal claims outcomes. Beyond cost savings, identifying the highest-performing providers sets up injured workers for a successful recovery.

Merging GBCARE's™ proprietary Treatment Quality Index (TQI) scoring with Outcome Based Network (OBN) designation, Provider Guidance prioritizes the highest-performing network providers focused on evidence-based medicine and optimal claims outcomes. This approach simplifies the process of identifying the best option when selecting a provider for a referral.

Criteria for identifying the best providers include:

  • Adherence to evidence-based-medicine protocols (TQI score)
  • Disability duration
  • Medical cost
  • Litigation
  • Total claim cost.

Clinical Guidance is the decision-support tool the GBCARE™ team uses to help identify injured workers who could benefit from clinical intervention.

Clinical Guidance delves into claim data, identifying hidden risk factors that could delay recovery and return to work. These risks include:

  • Injured worker profile and injury severity
  • Disability durations exceeding expectations
  • Care delivery that deviates from evidence-based medicine per our TQI scoring model.

By leveraging this tool in addition to their own experienced insights, the Clinical Guidance team recommends appropriate GBCARE™ clinical services, such as Field Case Management, or collaboration with a Return to Work Specialist.

Not all work injuries require clinical intervention to promote optimal recovery. However, GBCARE™ offers nurse case management solutions for high-risk claims, including Telephonic Case Management, Field Case Management, Catastrophic and Complex Case Management, and Return to Work Specialists.

Our nurses employ a goal-oriented approach to identifying barriers to recovery and return to work, promoting optimal outcomes on both a claim and program level.

The key areas of focus are:

  • Taking a holistic advocacy approach to each clinical assignment by partnering with injured workers and developing a customized care plan to support their individual needs
  • Leveraging innovative decision support tools to help identify injured worker risks, measure quality care, and provide insight into disability duration and recovery progress
  • Building on the foundation of our nurses' education with specialized training for Behavioral Health and Centers of Excellence.

Make Gallagher Bassett your partner for workers' compensation

Our customized workers' compensation claims solutions are designed to protect your organization and promote better clinical outcomes for your people. From streamlining claims management processes to advocating for exceptional patient care, Gallagher Bassett works alongside your team to meet the goals that matter most to you.


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