Policy and Procedure Name:
Crisis Event-Multiple Claims Occurrence
Ann M. Shannon, Chief of Claims Policy and Support
Policy # CP-03-05, effective 05/06/2019
Previous versions of this policy are available upon
Table of Contents
I. POLICY PURPOSE
A. General Policy
B. Crisis Event Teams
A. Standard Claim File Documentation
B. Crisis Event Teams
C. Reporting an Event
D. Crisis Event
E. The Action Plan
The 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).
This policy applies to all BWC and MCO staff.
Claim: 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 living.
An incident resulting in:
A. At least
two workers being severely injured or hospitalized; and
nature of the event could involve death claims, long-term treatment, the
inability to return to work and psychological issues.
of a crisis event include:
1. It is the
policy of BWC to evaluate reports of potential multiple claim occurrences, and
determine if the event meets the criteria set forth in the crisis event
definition in this policy.
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:
vi. Out of state
vii. Special Claims/COEMP;
viii. Out of state employer claims;
ix. Death claims.
iii. Lima; and
3. BWC will
not utilize a crisis event team for claims managed by a self-insuring employer.
4. The regional
core crisis event teams will be responsible for managing claims throughout the
initial determination process.
1. BWC staff
shall refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
follow any other specific instructions for claim notes and documentation
included in this procedure.
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:
a. An injury
management supervisor (IMS) who:
the team lead;
the efforts of the team through the closure of the crisis event;
iii. Assigns a
work item to the crisis event team members;
iv. Coordinates the
transfer of claims to the responsible regional claims service specialist (CSS)
completion of the initial crisis management summary document; and
information to claims director (CD) for dissemination to senior staff.
b. A claims
service specialist (CSS) who:
the Multiple Claims Occurrence event in the Multiple Claim Occurrence window in
the claims management system;
the information remains current by updating the claims management system
according to staffing outcomes; and
all aspects of the injury in accordance with all applicable policies and
medical service specialist (MSS) who acts as a primary resource for medical
issues regarding non-catastrophic claims.
d. A BWC
catastrophic nurse advocate (CNA) who is the primary resource for issues
regarding catastrophic claims.
employer management supervisor (EMS) who:
in what capacity employer services needs to be involved; and
the Safety Violation Investigation unit (SVIU) or the Public Employment Risk
Reduction Program unit (PERRP) when a fatality is part of the crisis event.
MCO catastrophic claim program coordinator (MCO CAT Coordinator) who:
the point of contact for the responsible regional crisis event team;
medical documentation for his/her respective employer(s); and,
information within the MCO as needed.
g. A survivor
benefits coordinator (SBC) who:
death claims that result from the crisis event; and,
the initial confirmation and notification contact to the employer(s).
the responsible crisis event team
a. 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
b. The IMS
shall then either, within one business day:
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
the event involves multiple regions, staff with the IMS and Claims Directors of
each involved region to determine the responsible crisis event team; and
a) Notify the
responsible crisis event team members;
appropriate MCO CAT coordinator(s); and,
c) Notify the
appropriate BWC CNAs.
becoming aware of a potential crisis event, BWC staff or MCO staff shall report
the incident by sending an email to BWC CAT Event-Notification mailbox.
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
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
b. Update the
multiple claim occurrence window in the claims management system; and
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
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 assigned to the
regional multiple claim occurrence CSS;
the claims are filed in the Central Claims office, the Medical Claims
Specialist (MCS) shall staff with their supervisor;
Medical Claims Specialist Supervisor will determine where the claims should be
multiple claims occurrence window in the claims management system shall be
updated by the CSS;
crisis event action plan shall be created by the IMS; and
d. Each claim
associated with the event is processed in accordance with the Initial Claim
Determination policy and procedure.
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.
staff shall document each action step and utilize the action plan to capture
work items and outcomes associated with claims occurring from an event.
shall close an action plan when the team agrees that all major claim and
employer issues have been addressed.
remain assigned to the crisis event office throughout the life of the claim.
closure of a CAT event action plan results in closure of the multiple claims
closure of the CAT event action plan, involved claims shall be processed in
accordance with all applicable policies and procedures.