By Dr. Lynn Gordon, chief medical officer for global assistance, travel risk and claims management provider CEGA, a Charles Taylor Company.

Business travellers may worry about the threat of infectious diseases, new strains of infection, antibiotic resistance and even pandemics overseas.

Recently, dengue fever has been reported in France and Spain; yellow fever in Nigeria; measles in New Zealand; rabies in the USA; Ebola in the Democratic Republic of Congo. The list goes on.

Meanwhile, World Health Organisation (WHO) data shows there were an estimated 219 million cases of malaria in 90 countries in 2017, 36.9 million people living with HIV globally and approximately 5-15% of the population in the northern hemisphere affected by seasonal influenza.

WHO defines infectious diseases as those caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi. Many can be spread, directly or indirectly, from one person to another.

WHO sees evidence of an increase in many infectious diseases too, including some new ones, such as hepatitis C and SARS. And Public Health England says, “With the increased movement of people around the globe and urbanisation, the likelihood of coming into contact with new and emerging diseases has increased.”

Associations between climatic conditions and infectious diseases have also been identified, with malaria likely to be the vector-borne disease most sensitive to long-term climate change.

But, as corporate travellers increasingly embrace global destinations, how can they mitigate the risks of disease? The guidance below briefly explains.

Don’t dismiss travellers’ tummy

Travellers’ diarrhoea is common. Caused by viruses, bacteria or protozoa (tiny organisms that live as parasites), it can become a serious health threat, especially in undeveloped areas with unsophisticated medical care, and it’s vital to take the right precautions against it. Precautions include washing hands properly, checking that cooked food is piping hot and peeling raw fruit and vegetables yourself. If there’s a possibility that tap water is unsafe to drink, avoid ice in drinks and stick to bottled water, with unbroken seals. Be aware too that hygiene and sanitation standards may vary from country to country.

Get vaccinated

It’s important to be up-to-date with routine vaccinations such as measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, varicella (chickenpox), influenza and polio, before setting off abroad – wherever you go. You should also talk to a health professional about destination-specific vaccinations, at least six weeks before you set off. If you travel at short notice, it’s still worth talking to an expert about how to limit health risks abroad. But bear in mind that not all infectious diseases can be prevented by vaccines. Check the latest news from WHO on disease outbreaks: http://www.who.int/csr/don/en/. Also bear in mind that signs of disease may not manifest themselves until well after you return home.

Protect yourself

The risk of mosquito-borne diseases – such as malaria (the most common) dengue fever, Zika, Chikungunya and yellow fever can be reduced by insect repellent, bed nets and clothes that cover up arms and legs. Malaria tablets may also be called for (always check with a health specialist). Meanwhile, avoid contact with blood or bodily fluids, such as saliva, vomit, urine and faeces, or with tissues from someone who may have an infectious disease. The same goes for unknown animals. Although 99% of rabies cases are caused by dogs, the disease can also be spread by other animals such as bats, raccoons, foxes and cats, so it’s best to keep your distance.

Bear in mind too that contaminated food and water can transmit several infectious diseases beyond travellers’ tummy; not least cholera, hepatitis A, and typhoid.

Protect others

You can take some simple precautions to avoid spreading disease to others. This includes covering your mouth and nose when you cough or sneeze, throwing away used tissues and washing hands with hot water and soap after going to the bathroom or before preparing food. In the absence of soap and water, you can use hand sanitiser. It’s also important to have protected sex, to flush any vomit away in the toilet and to avoid sharing food or drink if you’re not well.

Think about the journey as well as the destination

As we travel more often, and further afield, avoiding disease involves anticipating and managing health risks associated not just with our destinations, but also with our journeys. A quick stop-off in South America, for instance, could expose a traveller to a risk (such as malaria) that may not be prevalent at his or her journey’s end. Make sure you get the right professional advice about all the risks you may be exposed to.

Make sure you have the right travel insurance – before you go

If you become ill overseas and are covered by travel insurance, your insurers won’t just pay the costs of any medical care and specialist transport, they will also make sure that you have access to the right care. And they will manage this care until you are returned home. Many travel insurers also offer bespoke travel risk management services that include advice about location-specific diseases and other threats.

Infectious diseases can be

• Foodborne

• Waterborne

• Vector-borne

• Transmitted by animals

• Sexually-transmitted

• Bloodborne

• Airborne

• Transmitted via soil

Source: World Health Organisation (WHO)

References

http://www.who.int/news-room/fact-sheets/detail/malaria

http://www.who.int/hiv/data/en/

http://www.euro.who.int/en/health-topics/communicable-diseases/influenza/data-and-statistics

http://www.who.int/globalchange/summary/en/index5.html

https://publichealthmatters.blog.gov.uk/2018/02/21/disease-detectives-keeping-track-of-new-and-emerging-infectious-diseases/

For information about CEGA’s travel risk management services contact This email address is being protected from spambots. You need JavaScript enabled to view it. or see https://www.cegagroup.com/what-we-offer

In this exclusive iPMI Magazine interview, Christopher Knight, CEO, iPMI Magazine sits down with Simon Cook, Head Of Technical Claims, CEGA Group, to discuss one of the leading risks in medical, healthcare and travel insurance markets globally: fraud.

Can you tell us a bit about yourself and your Special Investigations Unit?

Having worked in insurance fraud for over 14 years, I am passionate about the sector.

My career first began back in the 90’s, working for Eagle Star Direct/Zurich as a motor claims negotiator. I progressed to become a senior fraud investigator at TIG /Conversant Data and then joined CEGA in 2008 as Special Investigations Manager. My remit was to set up a new Special Investigations Unit (SIU) to help combat the ever-increasing threat of travel insurance fraud faced by our clients.

Today, this unit has grown to become a global provider of fraud detection and validation services for multi-sector claims; not least travel, household, health, personal accident and hospital benefits. Our specialist services benefit insurers by enabling dishonest claims to be declined: reducing insurers’ losses, while ensuring the fast payment of genuine claims. We also have a dedicated subrogation department to recover our clients’ costs from other sources, such as dual insurers, third parties and airlines.

Based in Chichester and Bournemouth, we work closely with our in-house medical, claims and travel units, and with a worldwide network of investigators, to carry out thousands of investigations a year. We are available as a stand-alone service - where clients manage their own claims and pass instructions to us - or as an integrated service, where we manage the end-to-end claims and assistance customer journey.

Until recently, I was also a director of the Insurance Fraud Investigators Group (IFIG): arranging conferences, speaker line-ups and social events.

You recently announced a partnership with Charles Taylor General Adjusting Services (CTGAS), a division of your parent company. What are the benefits of this?

Partnering with CTGAS in 2017 has enabled us to offer clients seamless loss-adjusting, fraud investigation and end-to-end claims validation services for all types of insurance - all over the world. This has created a range of new business opportunities; most notably in the the aviation, property, casualty and special risks sectors. It has also expanded CTGAS’ own service offering.

Would you like to share some of your other developments over the last two years?

We were delighted to be recognised in the 2018 British Claims Awards, with the Counter Fraud Award. Since then, we have continued to pursue an ambitious growth agenda and added to the team with both internal promotions of existing staff and external recruitment to add to our diverse skill set. We have also been pleased to see that we were responsible for over a third of the ABI’s reported annual travel insurance fraud savings in 2017 (the most recent ABI data available).

On the developmental front, we have been optimising internal fraud controls and processes for our insurer clients, as well as our own claims handlers; to ensure we are one step ahead of fraudsters.

We also constantly invest in our people and give them the opportunity for personal growth - supporting both our own team and CEGA’s wider customer-facing staff with training for professional investigator accreditations and CII exams.

How is fraud detection developing – particularly in the context of automated claims?

Some dishonest claimants may see automated claims as an easy target for fraud. But automation is playing an important part in detecting fraud too. For example, automated reporting systems can detect suspicious activity early in the claims cycle, such as subtle similarities between claims. Efficient data storage enables insurers to spot unusual patterns in or volumes of provider bills, while automated bill auditing enables case details to be scrutinised and cost or treatment discrepancies to be identified.

It’s important for fraud investigators to constantly enhance their processes, and to innovate. But prevention will always be the optimum solution to fraud, which is why insurers are implementing tighter controls at point of policy application, so that customers known to be associated with fraud can be refused cover.

What are the other key components of an effective insurance fraud detection strategy?

A robust Key Fraud Indicator (KFI) checklist, ideally supported by system-driven alerts, will help frontline claims handlers identify fraud at an early stage. Meanwhile, regular fraud awareness training and communication will help educate claims staff about new and existing fraud trends, drive the development of tailored front-end questioning techniques and ensure that genuine claimants are paid quickly.

In the case of medical claims, access to a multi-skilled medical team is crucial to identifying overtreatment or inflated costs in hospitals abroad. The team can talk to patients about their treatment and, where necessary, question the necessity of proposed medical procedures.

For all claims originating overseas, a global network of local investigators ‘on the ground’ is essential. They can visit hospitals, retail outlets and police stations, and interview witnesses (and more) to assess the validity of bills. Seeing an outlet at first hand will often expose a scam quickly, for instance when a shop or hospital doesn’t exist, medical records can’t be produced, or a loss report isn’t recognised by a local police station.

We’re fortunate that our parent company Charles Taylor’s presence in almost 120 locations worldwide gives us access to highly experienced international colleagues. They are able to carry out investigations on our behalf and complement our own extensive global network.

Can you give us some examples of outrageous fraudulent insurance claims?

Insurance fraud can range from adding a few extra items to a genuine claim (to cover the costs of a policy excess), to fabricating an armed robbery. But fraud is becoming increasingly sophisticated; often involving cunningly crafted scams, expertly executed and backed up with reams of supposed evidence.

To give you some examples: one policyholder claimed that he and his wife had received treatment for broken noses when they both fell down a flight of concrete steps abroad. Surprisingly, they had no other injuries. In fact, they had both sought treatment for cosmetic surgery and fabricated the circumstances of the incident to falsely claim these expenses.

This fraud was unearthed when our investigator visited the clinic where the couple claimed to have been treated. It quickly became evident that the clinic didn’t fit the description provided by the policyholder and that it had given the couple pre-cosmetic surgery advice, not essential medical treatment. More interestingly, there was a large caricature of a cosmetic surgery patient on its wall.

Then there was the man who stated that a small bridge had collapsed as he walked over it whilst on holiday, and that he had received extensive medical treatment for his injuries. Our overseas enquiries with locals established that they knew nothing about this alleged incident and that there was only one footbridge in the area, which had never collapsed. Further enquiries at the hospital revealed that the customer had never been admitted for treatment, although he had claimed over £5,000 for medical expenses.

If you’d like to find out more about our investigations, watch us in Series 11 of BBC 1’s Claimed and Shamed: the popular expose of insurance fraudsters. Shown later this year, it’s expected to attract over a million viewers and is a great chance to broadcast the message that fraudulent claims will be found out, wherever they originate in the world.

Claims management and assistance provider CEGA, a Charles Taylor company, has enhanced its insurance fraud investigation skills by appointing a high-calibre team leader to manage its new Special Investigations Unit in Bournemouth. The unit has been established to meet a growing demand for CEGA's global claims validation service and to complement its base in Chichester.

Matt Bowman, who takes on the new senior role, adds well over a decade of investigative expertise and intelligence analysis to CEGA's claims validation provision, which covers all areas of insurance claims validation, including insurance fraud and liability investigations on household, personal accident, travel and health claims. It is available as a stand-alone service.

Bowman, who will report into CEGA's Head of Technical Claims Simon Cook, spent 16 years at Zurich Financial Services prior to joining CEGA - over ten of which were dedicated to a variety of fraud investigation and intelligence roles. He was also selected to complete a 6-month secondment working alongside the Insurance Fraud Enforcement Department (IFED) at the City of London Police, and has worked across the insurance spectrum, not least in the motor, property, EL and PL sectors.

Simon Cook comments, "As our global client-base grows, investing in highly-skilled staff reinforces our ability to support insurers in the fight against insurance fraud, which in turn protects their bottom lines. We are delighted to welcome Matt to the team as a valuable addition to our claims validation service." 

CEGA, a Charles Taylor company, expands medical team to meet demand from travel and international health insurers.

Assistance, claims and travel risk management provider CEGA, a Charles Taylor company, has added two new doctors to its in-house medical team; enhancing its global provision for travel and international health insurers.

Dr Fiona Gillespie and Dr Chris Busuttil, emergency medicine consultants at Royal Sussex County Hospital and Queen Alexandra Hospital Portsmouth respectively, are the latest recruits to join CEGA's in-house medics.

CEGA's substantial team of doctors and nurses provide medical assistance and repatriation services to thousands of individuals every year (many in remote and offshore destinations) on behalf of travel and international health insurers. They also work closely with in-house cost containment and claims teams to validate medical bills from overseas hospitals.

CEGA's Chief Medical Officer Dr Lynn Gordon comments, "Extending our multi-skilled medical team reinforces our ability to support a growing number of global clients and their customers with the excellent service they expect.

"We ensure that all our doctors have experience of emergency or remote medicine and that many currently work in an NHS environment - demonstrating our commitment to provide the very best care to those in need, wherever they are in the world."

Read more news and press releases from CEGA on their iPMI Magazine company micro website, click here.  

Claims management and assistance provider CEGA, a Charles Taylor company, announces that two further members of its Special Investigations Unit have gained Level 3 Professional Investigator accreditations; strengthening its claims validation capabilities in the multi-sector insurance market.

Callum Bates and Martin Weekes are the latest staff to gain the accreditation at CEGA Special Investigations, which counts household, personal accident, travel and private health insurers among its clients and is available as a stand-alone claims validation service.

Committed to optimising fraud awareness amongst its entire travel claims and assistance operation, CEGA also encourages its wider customer-facing staff to gain the Professional Investigator accreditation, and runs company-wide fraud training that covers fraud trends, front-end questioning techniques and more.

CEGA's Head of Technical Claims Simon Cook, comments "Putting training and professional accreditations high on our company-wide developmental agenda means that our specialist fraud and front-end claims staff alike are fully able to support our insurer clients in the fight against fraud.

"The result is that we make significant contributions to the ABI's annual travel insurance fraud savings, protect insurers' bottom lines and treat all customers fairly."

To read more news and articles like this please visit the CEGA micro website on iPMI Magazine, click here.

About CEGA Group

CEGA, part of the Charles Taylor Group, is a world-class provider of global medical assistance, repatriation, travel risk management and claims services. We manage over 45,000 cases per year and have more than 40 years' experience of supporting a blue-chip client base that includes many leading banks, insurance companies, charities, NGOs and other global brands.

CEGA Special Investigations was established in 2008 and is available as a stand-alone service, serving both CEGA's clients and external organisations. Its capabilities cover all areas of insurance fraud investigation, including household, personal accident, travel and private health claims. Desktop investigations, cognitive interviews and overseas inquiries on the ground (thanks to a network of global investigators) are among the many techniques employed by CEGA, both to detect fraud and to establish liability.

The unit makes a substantial contribution to the UK's insurance fraud savings and works closely with Charles Taylor General Adjusting Services.

www.cegagroup.com

CEGA, a Charles Taylor company, attracts Millstream Underwriting to flexible online medical screening solution.

Global assistance, risk and claims management provider CEGA, a Charles Taylor company, has partnered with Millstream Underwriting to provide its new automated medical screening tool, Antidote, to Millstream's high-net-worth and other travel insurance customers.

Millstream Underwriting, part of the Nexus Group, specialises in tailoring accident and health insurance solutions for commercial and retail customers in the UK and beyond. 

Antidote has been developed by CEGA to further enhance its innovative and end-to-end travel risk management, assistance and claims solutions for global insurers. It provides agile and accurate risk profiling and simplifies travel insurance customers' medical assessment journeys.

Specifically, the tool allows customers to self-declare pre-existing medical conditions easily via logical question sets and is supported by intuitive technology that recognises a comprehensive range of medical conditions. CEGA is fully involved in its implementation; integrating it seamlessly with Millstream's existing systems.

CEGA's head of proposition development, Angela Smith, says, "We're delighted to be working collaboratively with Millstream to offer this flexible, unique and truly customer-focused service that draws on our 25 years' experience of medical screening.

"We expect Antidote to pave the way for enhanced policy renewals and sales; providing Millstream with measurable algorithmic outputs and consistency in underwriting outcomes. Crucially, it also offers ownership of customer data."

Tim Brangwyn, managing director of Millstream Underwriting, comments, "We chose Antidote for its ability to provide a simple, fast and customer-centric medical screening process; enabled by straightforward questions and easy, well-supported technology. Its versatility also allows us to meet the needs of our clients who need a more tailored screening solution.

"CEGA's professionalism, flexibility and alignment with Millstream's goals were key factors in establishing this important partnership."

Read more news and articles from CEGA, visit their micro website on iPMI Magazine, click here.

About CEGA

CEGA, part of the Charles Taylor Group, is a world-class provider of global medical assistance, repatriation, travel risk management and claims services. 

We manage over 45,000 cases per year and have more than 46 years' experience of supporting a blue-chip client base that includes many leading banks, insurance companies, charities, NGOs and other global brands. www.cegagroup.com

About Charles Taylor

Charles Taylor plc (www.ctplc.com) supports and enables the insurance market to meet the continually evolving challenges it faces.  We provide technical services to make the business of insurance work fundamentally better.  We have been providing insurance-related technical services and solutions since 1884 and today we employ around 3,100 staff in nearly 120 locations spread across more than 30 countries in the UK, the Americas, Asia Pacific, Europe the Middle East and Africa.

We are unique in our market in that our services support every stage of the insurance lifecycle and every aspect of the insurance operating model.  We develop and operate insurance vehicles on behalf of our clients, manage claims programmes and adjust losses. We handle legacy and run-off portfolios, provide a variety of specialist operational support services and offer solutions and support to drive insurance technology transformation.

Charles Taylor's breadth of services, technical skills and resources and global presence means the Group can manage and resolve virtually any insurance-related matter, wherever and whenever it occurs.

CEGA has appointed a new business development manager to meet the rising demand for private medical repatriations from travellers.

Nick Simon, who takes on the new role, will focus on the needs of ill or injured clients who require repatriation to their home country (wherever that may be) or a country that offers suitable medical care, but have no insurance, or find their policies do not cover them.  He brings significant experience of the travel sector to the job.

CEGA reports that the growing global demand for repatriations calls for a range of flexible solutions: from road, rail and sea journeys and scheduled flights with medical escorts, to intensive care bed-to-bed air ambulance transfers with full medical and security management, complex travel arrangements and hospital admission. It cites heart problems, long-term illness and complex fractures among the most common conditions to necessitate repatriation.

RELATED READING: International Medical Evacuation And Repatriation Strategies 2016

Nick Simon comments, "Individuals in need overseas are not always aware that they can access repatriation services directly, without insurance, nor that a repatriation involves very much more than a journey. My advice is to always seek the services of an experienced provider who has the best interests of the patient at heart.           

"A reputable supplier will fully assess a patient's needs, select and deploy the right transport and medical care to meet those needs and support them (and their families) from one hospital bed to another. Where needed, they will also provide integrated security assistance."

Muir Roberston, CEGA's managing director, concludes: "We draw on over forty years' experience, on in-house doctors, nurses and multilingual assistance staff and on a global network of hospitals, transport and security partners to provide the best patient care at the best cost.

"Testament to this is the fact that we were the first company in Europe to gain the Commercial Aviation Medical Escort Accreditation from EURAMI*: recognising our global expertise in end-to-end patient transfers."

 *European Aeromedical Institute

CEGA Group has implemented a fully automated workforce management system for its travel insurance claims and medical screening call handlers. The move supports CEGA's continued growth and optimises call volume forecasting and staff scheduling: benefiting travel insurers and policyholders alike.

The state-of-the-art system, Teleopti, enables call handlers to organise shifts quickly and remotely, and their managers to take full, automated, control of predicted call volumes and commensurate staffing levels - if necessary from a mobile device, in real-time.  All this helps to increase staff engagement, save time and ensure that call handler availability serves fluctuating call volumes.

Steve Marshall, head of claims and medical risk assessment at CEGA Group, comments, "Since using Teleopti, we have noticed improvements on many levels. Our ability to forecast call volumes accurately and use agent time efficiently and cost-effectively is outstanding.  Our service level agreements (SLAs) are now more stable than ever and our call abandonment rates have halved: maximising customer and client satisfaction.

"Looking to the future, we plan to use Teleopti to schedule staff dealing with claims correspondence via email and Web Chat: just another example of our proactive approach to providing the best customer service in today's changing global travel risk landscape."

Nick Smith, UK & Ireland business manager at Teleopti comments, "Our workforce management technology offers fast growth organisations such as CEGA the opportunity to create high-performing contact centres staffed with highly motivated agents.  Automation and real-time capabilities support smarter forecasting, yield tangible time and cost savings and help drive meaningful service improvements which means an improved employee and customer experience."

CEGA has been awarded a prestigious industry accolade for the worldwide patient transfer services it carries out on behalf of travel, personal accident and health insurers.

The global assistance, claims and risk management provider has become the first company in Europe to gain the Commercial Aviation Medical Escort Accreditation from EURAMI* as a standalone accolade.

"The very positive thing about CEGA is that it is a complete patient management provider, from first call, to case handling abroad, to bringing the patient back home," said the EURAMI report. It went on to say: "CEGA has a huge operations department that handles all medical cases, supports ongoing repatriations and tracks all flights. But it also has a safety department that works on daily threats all over the world: natural disasters, attacks, accidents and so on that may influence insured members or their own operations."

The provider underwent a full day's inspection and rigorous testing of its global patient transfer capabilities to achieve the accreditation: subjecting (amongst other areas) its business processes, operations personnel and safety, quality and medical management to close scrutiny. According to EURAMI, its quality management and safety regulations surpass those required by the accolade.

"This accreditation recognises CEGA's global expertise in end-to-end patient transfers, gained over its 40 years of service," concludes CEGA's Chief Medical Officer, Dr Tim Hammond. "It further reassures our clients that, day in, day out, we put patients in the most capable of hands - wherever they are in the world."

*The European Air Medical Institute. EURAMI's mission is to promote high quality aeromedical transfers throughout Europe and the world.