Telephonic Case Management

As Workers’ Compensation costs continue to escalate, decision-makers with bottom line accountability are seeking more powerful methods of controlling claims costs. Employers know all too well the costly effects of work injuries, from the escalating medical costs to lost productivity.

Employers and Insurance Companies alike are realizing that work place injuries must be managed and controlled from the point of injury until return to work is achieved and the injury is resolved. Early involvement of a registered nurse in the initial assessment and management of the injury helps to facilitate a medically appropriate discharge from care by the physician and accelerates a return to work thereby achieving rapid case closure.

In the past, when an injury occurred the adjuster was responsible for adjusting the claim and controlling the medicals on the file. One might say that the adjuster was considered the “train engineer” of the claim. If the injury was considered a catastrophic, immediate referral was made to an outside nurse case manager to coordinate the medical aspects of the file. If the injury was not serious, a referral was usually not made to the nurse until after three months or sometimes longer. In this instance, the nurse would be considered the “caboose” of the claim.