Chicago Eyes Overhaul of City’s Workers’ Compensation Program with Help from Gallagher

Chicago Mayor Lori E. Lightfoot said the city will partner with Gallagher Bassett, a public sector claims administrator, as well as Gallagher Global Brokerage Risk Program Administrators, to overhaul the city’s workers’ compensation program after an independent audit found system reforms are needed.

Lightfoot said the reforms will be designed to improve services for injured workers and to help prevent fraud, waste and abuse in the administration of claims.

The city also hopes these changes will drive down claim costs, improve closure rates and generate significant annual savings.

In 2018 alone, the workers’ compensation program cost the city more than $93 million.

The audit revealed that the Chicago’s workers’ compensation program had widespread deficiencies, driven by the lack of training for administrators, fraud controls, and clear policies needed to enforce consistency in investigations and claim administration.

As recommended by the audit, Mayor Lightfoot directed the city to partner with a third party to implement changes to improve claim handling and outcomes for claimants; introduce controls and oversight that do not currently exist; and ensure a timelier response and better service for employees.

“The findings of this audit revealed what we already suspected: that the city’s workers’ compensation program was undermanaged and lacked proper protocols — which poses a disservice to our injured city employees as well as taxpayers,” Lightfoot said in a media release.

She added that the city is “taking action to make this program more accountable and are making changes to bring the program in line with best practices, just like other municipalities across the nation have done.”

Gallagher Bassett’s team of claims adjusters will work with the city to implement best practices claim handling practices and procedures aligned with best practices; adopt new technology to expedite claims review and control medical costs and improve outcomes for injured employees; create a process for handling legacy claims with a goal of clearing the backlog, and implement a “return to work” program to increase closure rates.

Gallagher Bassett will also work to ensure proper training for city staff who remain involved in handling claims.

Gallagher’s Risk Program Administration (RPA) division will assist the city with overall program administration.

The city’s Department of Law, Comptroller’s Office and the Office of the Inspector General (OIG) engaged the firm of Grant Thornton in 2019 to conduct an independent audit of the city’s workers’ compensation program. In its audit, Grant Thornton conducted a review of over 100 claims handled in 2017 and 2018, dozens of interviews, and a review of procedures and protocols in conjunction with best practices used in similar programs.

The audit found that the program did not meet industry best practices, had an inadequately trained workforce, and lacked controls to identify fraud, waste and abuse.

The city will begin to transition claims management and processing later this year. The workers’ compensation program will remain at the Department of Finance for the interim, where it was transferred from the Committee on Finance in April of this year.

As part of the management transition, outstanding claims will be transferred in a phased approach to ensure claims are not delayed or adversely impacted by the transition.

Source: Chicago Mayor’s Office