Event/Multiple Claims Occurrence
Abrams, Chief Operating Officer
12/21/2017; New 08/20/2013
11/14/2016; New 08/20/13
I. POLICY PURPOSE
purpose of this policy is to ensure crisis events are properly identified, and
to ensure consistent injury management:
BWC using crisis event teams; and,
collaboration between BWC and the Managed Care Organizations (MCOs).
policy applies to all BWC and MCO staff.
a claim in which there is a serious injury resulting in limited mobility and/or
cognition related to the allowed conditions in the claim and that severely
limits the ability of the injured worker (IW) to perform activities of daily
an incident resulting in:
1. At least two workers
being severely injured or hospitalized; and,
2. The nature of the
event could involve death claims, long-term treatment, the inability to return
to work and psychological issues.
3. Examples of a crisis
a. Natural disasters;
c. Workplace violence;
A. General Policy
It is the policy of BWC to evaluate reports of potential multiple claim occurrences
and to determine if the event meets the criteria set forth in the crisis event
definition in this policy.
B. Crisis Event Teams
1. When BWC has
categorized an event, it is the policy of BWC to proactively assist the IWs and
facilitate injury management services through the crisis event teams. The
regional core crisis event teams and the claims offices and/or claim types they
service are as follows:
a. Columbus team:
v. Self-insured bankrupt employers;
vi. Out of state IWs;
vii. Special Claims/COEMP;
viii. Out of state employer claims; and,
ix. Death claims.
b. Dayton team:
iii. Lima; and
c. Youngstown team:
iii. Cleveland; and
iv. Garfield Heights.
2. BWC will not utilize a
crisis event team for claims managed by a self-insuring employer.
3. The regional core crisis
event teams will be responsible for managing claims throughout the initial
Requirements: BWC staff shall refer to the Standard Claim File Documentation
and Altered Documents policy and procedure for claim-note requirements and
shall follow any other specific instructions included in this procedure.
B. Crisis Event Team
Members and Responsibilities: Claims Services Division shall maintain regional
crisis event teams whose members participate in staffing as needed and consist
of the following:
1. An injury management
supervisor (IMS) who:
a. Is the team lead;
b. Oversees the efforts of
the team through the closure of the crisis event;
c. Assigns a work item to
the crisis event team members;
d. Coordinates the
transfer of claims to the responsible regional claims service specialist (CSS)
as needed; and
e. Coordinates completion
of the initial crisis management summary document.
information to claims director (CD) for dissemination to senior staff.
2. A claims service
specialist (CSS) who:
a. Creates the Multiple
Claims Occurrence event in the Multiple Claim Occurrence window in the claims
b. Ensures the information
remains current by updating the claims management system according to staffing
c. Manages all aspects of
the injury in accordance with all applicable policies and procedures.
3. A medical service
specialist (MSS) who acts as a primary resource for medical issues regarding
4. A BWC catastrophic
nurse advocate (CNA) who is the primary resource for issues regarding
5. An employer management
supervisor (EMS) who:
a. Decides in what
capacity employer services needs to be involved; and,
b. Notifies the Safety
Violation Investigation unit (SVIU) or the Public Employment Risk Reduction
Program unit (PERRP) when a fatality is part of the crisis event.
6. An MCO catastrophic
claim program coordinator (MCO CAT Coordinator) who:
a. Is the point of contact
for the responsible regional crisis event team;
b. Obtains medical
documentation for his/her respective employer(s); and,
information within the MCO as needed.
7. A survivor benefits
coordinator (SBC) who:
a. Manages death claims
that result from the crisis event; and,
b. Makes the initial
confirmation and notification contact to the employer(s).
C. Reporting an event
1. Upon becoming aware of
a potential crisis event, BWC staff or MCO staff shall report the incident by
sending an email to email@example.com.
2. Staff shall title the
email “Potential Crisis Event” and note the location of the event in the
subject line of the email (e.g., Potential Crisis Event – Dayton).
3. BWC staff shall include
all known information on the initial crisis management summary document and
attach the document to the email.
4. MCO staff shall include
all known information in the body of the email (e.g., location of event,
employer(s) involved, number of injured workers (IWs), and extent of injuries).
D. Establishing the
responsible crisis event team
1. The IMS of the region identified
in the subject line of the email shall direct a member of the regional crisis
event team (generally the CSS) to enter the available event information into
the Multiple Claims Occurrence window in the claims management system.
2. The IMS shall then
either, within one business day:
a. Coordinate an initial
staffing with the responsible regional crisis event members, notifying the
appropriate MCO CAT coordinator(s) of the event and staffing via email and
phone call; or
b. If the event involves
multiple regions, staff with the IMS and Claims Directors of each involved
region to determine the responsible crisis event team; and,
i. Notify the responsible
crisis event team members;
ii. Notify appropriate MCO
CAT coordinator(s); and,
iii. Notify the appropriate
E. Crisis event
1. If, after the initial
staffing, BWC has determined that the event does not meet the definition of a
crisis event as defined by this policy, a member of the responsible regional
crisis event team shall:
a. Enter a staffing note;
b. Update the multiple
claim occurrence window in the claims management system; and
c. Reassign the claim to
the appropriate regional service office and CSS who shall then process the
claim(s) in accordance with the Initial Claim Determination or Occupational
Disease Claims policy and procedure in the appropriate claims office.
2. If, after the initial
staffing, BWC has determined that the event does meet the definition of a
crisis event as defined by this policy:
a. All claims related to
the event, even if previously filed, shall be reassigned to the regional
multiple claims occurrence CSS;
b. The multiple claims
occurrence window in the claims management system shall be updated by the CSS;
c. A crisis event action
plan created by the IMS; and
d. Each claim associated
with the event is processed in accordance with the Initial Claim
Determination policy and procedure.
F. The action plan
1. A designee of the
responsible regional event team shall create an action plan by using the
template located on the Crisis Event policy page on COR.
2. Claims staff shall
document each action step and utilize the action plan to capture work items and
outcomes associated with claims occurring from an event.
3. Staff shall close an
action plan when the team agrees that all major claim and employer issues have
4. Claims remain assigned
to the crisis event office throughout the life of the claim.
5. The closure of a CAT
event action plan results in closure of the multiple claims occurrence event.
6. Upon closure of the CAT
event action plan, involved claims shall be processed in accordance with all
applicable policies and procedures.