When workers are injured, medical case managers and disability managers need to operate like clockwork. The medical case manager's first responsibility is to be an advocate for the employee and his family.
As the worker is being treated, the medical case manager is at the hospital, talking with the family, answering questions and providing support. It is the medical case manager who also speaks with physicians and specialists and reviews medical records to determine the nature and the extent of the injury.
As a case management plan develops, the medical case manager determines if the victim needs extended hospitalization. Is major surgery required? Does the victim need a transfer to a specialized hospital? Is the prognosis for a full or partial recovery?
For their part, disability managers focus on insurance issues including making sure the right workers' comp carrier or third-party provider has been contacted. Other issues include making sure there are adequate financial reserves and that there is enough health coverage. Disability managers also deal with the long-term outcomes of the case.
The medical case manager and the disability manager must work with the medical team to track the victim's progress and to address rehabilitation and vocational service issues.
The same planning components essential to handling catastrophic cases also ease the pain for noncatastrophic workers' comp injuries.
When a person suffers a minor injury, the employee can benefit from a medical case manager's review. Similarly, the disability manager can use return to work strategies to help employees get back to work, either through modified duties in their regular department or through a temporary assignment elsewhere in the company.
When a catastrophic injury occurs, potentially costing millions of dollars in claims, sound planning pays off.
Accident victims benefit from a swift and efficient response that addresses the medical and vocational issues facing them. The medical community benefits because care and resources are more efficiently allocated. Employers gain as they can control their financial exposure.
May 1, 2005
Copyright 2005© LRP Publications