Case Management in Workers Comp
By Jim Miller, Certified Rehabilitation Counselor
My philosophy of case management in workers comp.
Conclusion: Treat people like you would like to be treated.
My 20 years of experience costs you no more on your file than another mgr. with far less experience.
There are always RTW issues for any lost time case. My focus is getting these workers back to work, and placed at MMI in that order. MMI is going to happen regardless of the case. RTW may not.
What type of case manager is assigned?
Discussion of different types of case managers and their role in working with the injured worker.
How to work with your case manager and your insurer to choose the best option.
(Communication is the Key) Case managers are not actively practicing nurses, clinicians, or caregivers, and they do not diagnose, prescribe a medication, nor detail the course of treatment. They do offer their expertise and observations to suggest alternatives in a case, various options that might be available, and also issues with employers that need to be addressed.
What is their role, and why do I need them?
Normally, it is the adjuster who determines whether or not a case manager will be utilized on a workers comp claim, but the employer can and should request a case manager if they feel the employee or the case would benefit. They can help to clarify the issues and remove the barriers to get the case moving.
You are the customer, and you can and should make your preference known with regard to the case manager that you would like to work your cases.
What we are looking for with regard to treatment plan and ultimate goals to case resolution.
Discuss managed care goals, reasonable outcomes, treatment guidelines, etc. (People don’t always fit into the “average” treatment guidelines.)
Things that employers can do to help reduce and manage their workers comp cases.
Discuss strategies to help employers with all of their work comp files, and especially lost time claims.
Examples of forms & documents that make workers comp cases start out right & end up right.
· List of local medical providers made up for your injured workers. (Worker gets to choose, you can help)
· Note faxed to the MD that your company does have a light duty RTW program if they can help with the RTW capacities that the injured worker must follow.
· Offer of RTW options made to the medical provider via fax before recheck appointments.
· Job descriptions showing the physical demands required (PD) for both the workers regular job, and light
· duty alternatives.
Discussion of early return to work programs for employers that save money. Recent study medical providers were asked what percentage of workers were taken off of work due to the work related injury alone. Answer: 10%
ERTW Programs:
Simply put, they make a difference.
· Lower overall costs. (Wage loss is less, treatment is less, communication is better)
· Better outcome. (Breaks the disability mentality in lost time cases)
· Less legal involvement. (No legal issues on the ADA or workers comp front)