Need (yet another) illustration of what happens when a state establishes a consequence-free environment for workers’ comp claims administrators?

There is currently no way for California providers to obtain reimbursement for treating employees of the fast-food chain Del Taco in cases where Gallagher Bassett is the claims administrator.

As a franchise, different Del Taco employers utilize different claims administrators. Effective April 16, 2024, Gallagher Bassett took over Del Taco claims previously administered by CorVel. However, Gallagher Bassett now denies bills for Del Taco employees, including those submitted on and after April 16.

Gallagher Bassett denies these bills on the grounds that they cannot identify the patient as covered by Gallagher Bassett. As of May 20, 2024, Gallagher Bassett reports that they do not have the necessary claims data to process bills for Del Taco employees.

While switching Third-Party Administrators (TPAs) is not unusual, this payment chaos is not an isolated occurrence for Gallagher Bassett.

Provider Warning: A significant California employer is failing to reimburse providers for treating its employees. We expect little by way of consequences, and providers should proceed accordingly.

Del Taco: Leaving Providers Without Pay

DaisyCollect was first alerted to the problem when Gallagher Bassett denied payment for the treatment of an injured Del Taco employee. Previously, CorVel had paid for the same employee’s treatment.

As the screenshot from the daisyBill application shows below, Gallagher Bassett claimed the patient could not “be identified as our insured” to justify the payment denial. The e-bill was sent on May 1, 2024, well after Gallagher Bassett's effective date of April 16 to assume responsibility for paying Del Taco bills.

When daisyBill contacted Gallagher Bassett on May 20, representatives confirmed they could not locate Del Taco employees’ claims data, leaving the TPA unable to process the bills.

As of this writing, Gallagher Bassett continues to deny bills for Del Taco’s injured workers, leaving providers no way to be reimbursed. We can only wait for Gallagher Bassett to locate the claims data and resolve the problem.

Theoretically, Gallagher Bassett should owe penalty and interest payments for any bills that are ultimately paid untimely—but bear in mind that in California, penalties and interest are “self-executing” consequences that the claims administrator is entrusted to impose upon themselves (try to read that without laughing).

In as complex an industry as workers’ comp, the occasional glitches and errors are inevitable. Unfortunately, accountability is not inevitable; it is non-existent.  

daisyBill will keep readers updated on the latest developments.

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