What is Case Management in Workers’ Compensation

By July 6, 2020 No Comments
Close-up of a medical worker with laptop
The main goal of workers’ comp case management companies is to assist injured worker claims and allow them to return to their jobs in good health and full capacity. Workers’ compensation case management companies coordinate and actively supervise an injured employee’s care by identifying the appropriate providers and facilities and ensuring that high-quality care is delivered in a timely and cost-effective manner.

Case managers are responsible for the following tasks:
1. assessing the needs of an injured worker

  1. planning their care, specifically treatments and other procedures
  2. communicating with the injured employee’s healthcare providers
  3. coordinating with employers and support system
  4. keeping payers up to date on details and progress
  5. implementing post-procedure and post-discharge care
  6. evaluating the injured employee’s well-being, and quality and cost efficiency of care
  7. helping injured worker understand their condition and treatment details
  8. working with employers to facilitate any changes or modifications in the job description and workplace environment to allow the employee to return to work

Case managers, who are most frequently registered nurses or licensed practical nurses or physicians, act as a liaison or intermediary between the injured employee, employers, insurance carriers, health care providers and clinicians to ensure that the patient gets the appropriate and cost-effective medical services that they need.

When should workers compensation injury claims be forwarded to a case manager?

  1. There are multiple healthcare providers, clinicians and physicians involved.
  2. The injured worker has a history of previous injuries and illnesses.
  3. The injured worker is required to return to work soon despite still not being physically capable to do so.
  4. The injury involves major body parts that limits movement and functional abilities and capacities.
  5. If the injured worker lives alone and does not have a support system for post-discharge care.
  6. A catastrophic event occurred on-location at the workplace which resulted in massive accidents and severe injuries

Many injured employees who have been referred to a workers’ compensation case management company are back to work within three months. This is because case managers are able expedite the process and make sure that everything goes smoothly and according to care plan while making sure that the patient’s needs are met. According to Business Insurance, case management helps to reduce the duration and cost of workers compensation claims by guiding the injured workers’ medical treatment and monitoring the efforts for the injured worker to return to work right away.
By involving case managers in workers comp injury claims, injured workers and employees will greatly benefit for the following reasons: faster and more streamlined process, comprehensive access to care, improved care quality and better outcomes for recovery. The employers and insurance carriers can also benefit from better communication between partiers and lower costs in the long run.

As one of the top workers’ comp case management companies, Novare is committed to providing cost-effective and efficient ways to help employees achieve maximum medical improvement and get back to work right away through medical case management and vocational case management. Our staff of experienced industry professionals will deliver personalized representation and efficient, cost-conscious services with an emphasis on optimum medical outcomes.

Let us handle your worker’s comp needs. Give us a call today at 866 532 2929!