How Increased Case Complexity and Consumer Duty Obligations Are Transforming Accident and Health Claims Management

As insurance policies and claims become more complex, Gallagher Bassett, the leading claims management provider, has transformed how its Accident and Health division triages new claims.

Victoria Lee, the division's head of Claims, has seen significant change over a decade in the industry. Her team has quadrupled in size, reflecting growing volumes of claims and the demand for nimble, personalised service. Recently, the team's approach to service has shifted to meet the needs of an increasingly challenging sector.

"With new regulations, such as the Consumer Duty Act, and heightened customer scrutiny, claims resolution is becoming more technically challenging," said Victoria. "In response, we have created dedicated technical referral roles to support our front-line claims handlers. These are our most experienced managers, who quickly identify and triage urgent or sensitive claims to specialist handlers. We have also deepened our ongoing training in areas prone to change, including policy wording, recoveries, subrogation, and industry reforms."

Developments such as the Financial Conduct Authority's renewed focus on customers' best interests, the explosion of generative AI tool availability, and overall higher service expectations are compounding to drive operational change across the industry. Victoria has implemented measures to ensure her team is at the forefront of this change.

"In the face of these challenges, Gallagher Bassett's Accident and Health division set the goal of improving claims outcomes and customer satisfaction. We have moved away from rigid call targets and instead are concentrating on case ownership, encouraging our handlers to proactively contact customers, personalise their communications, and offer direct dial access. The feedback we have received so far from customers and clients is overwhelmingly positive, even as claims volumes continue to grow," said Victoria.

"The role of the third-party administrator is fundamentally changing, so we must adapt accordingly. As consumers adopt generative AI to interpret dense policy documents and prepare for claims, process transparency is at an all-time high. With empowered customers, the customised service Gallagher Bassett provides has perhaps never been more critical, ultimately requiring a more nuanced, regularly reviewed approach.

"These trends will continue to shape our industry. Gallagher Bassett's culture and dedication guarantee we will continue to respond."

Learn more about Gallagher Bassett's claims handling.