Gallagher Bassett Services

A review of Mr*** file show that his file is being overseen by the *** Worker's Compensation Board. According to documentation in the file, he has signed the needed paperwork for his PPI settlement, and that information was forwarded on to the State of Indiana's Board for approval
on 04/03/2017. We cannot issue settlement until the paperwork has been approved. It can take 30-days for the Form to be reviewed, signed and returned. The branch manager, *** ***, called Mr*** on 05/10/to advise that all paperwork has been submitted to the State of Indiana, and that receipt of the approved paperwork should be received any day now. He has advised he will follow up with him again on Friday, 05/12/with the assigned Resolution Manager, *** ***, to advise whether the paperwork has been received and to address any other issues

This injury was not reported to Gallagher Bassett until 03/03/2017. At the time it was reported, Ms*** was represented by an attorney and we received the letter of representation. Gallagher Bassett maintained contact regularly with Ms***’s attorney until 09/21/2017,
when her attorney’s office advised that they no longer represented her for injury. Gallagher Bassett then maintained communication with Ms*** via phone and via e-mail on a monthly basis to advise her that the investigation was ongoing and what was needed from her to complete the investigation. The item that was most needed to make a full determination was the medical treatment that Ms*** advised she had sought. The medical providers were slow to respond to our requests, and when the records were received, they did not clearly identify a causal connection between Ms***’s alleged incident and her treatment. Ms*** was advised via e-mail and phone of these findings and assisted on securing the needed medical information. The medical information needed was not received until March, 2018, at which time a review of that information was made. Based on the liability assessment, as well as the submitted investigation material, an offer was extended to her telephonically and via e-mail on 3/14/2018. Negotiations have been continuing directly with Ms*** with additional correspondence taking place on 3/23/2018, 3/30/as well as most recently on 4/4/

Gallagher Bassett received Ms***’s worker’s compensation claim on 03/05/2018. In the State of Virginia, per the statute, we have days to make a decision on whether a claim is accepted or denied. For that reason, Mr*** contacted Ms*** on 03/06/to begin his claim
investigation. At the time of the initial call, Mr*** did advise Ms*** he would need some items to make that compensability decision, which included her statement and her medical records for the treatment received prior to the claim being reported to Gallagher Bassett. He secured her statement, and on 03/07/2018, made an additional call to Ms*** to confirm the information on the initial treating physician as there was some clarification needed on where she sought treatment in order to request the records. The request for the records was made on 03/07/On 03/08/2018, Mr*** was notified by Ms***’s employer that she had requested a visit with Urgent Care, at which time, authorization for the one time visit was provided. Upon the completion of that treatment, Ms*** requested approval for an orthopedist. Ms*** was notified that because the investigation into her file was not complete, approval for that visit could not come from Gallagher Bassett until a compensability decision was madeGallagher Bassett received Ms***’s initial medical records on 03/09/2018. Based on having all the information at hand, a compensability decision was made and issued on 03/12/2018, and Ms*** was advised that her claim was being denied and that a denial letter was being issued. Mr*** kept Ms***, as well as an individual who reported to be her husband, as well as a woman who reported to be her daughter, apprised of all steps and what was needed for him to make a decision. He advised why Gallagher Bassett could not approve the required treatment, but did not say she could not seek care. A decision was made on the claim well within the days allowed per the statute, and was done with the understanding that Ms*** needed to have an answer to make the best decisions she could in regards to her care