The following situation may require professional services and expertise:
- Following catastrophic injuries.
- When poor, inappropriate, or ineffective treatment is evident.
- When lack of medical progress is observed.
- When multiple medical problems exist but the physician is addressing only one.
- In cases where subjective complaints far outweigh objective findings.
- When a transfer of care to alternative physician, facility, nursing agency, or so on is desired.
- In cases where a pre-existing condition is complicating the disabling injury/illness.
- When a new injury/illness develops following the industrial injury.
- In cases where psychiatric/social problems are anticipated or present.
- When the ill/injured person is uncooperative/noncompliant.
- When the secondary gain or other factors affecting motivation are suspected.
- In cases where an injury or condition is uncommon/unusual.
- When discharge planning is needed.
- In cases where barriers to treatment exist.
- When additional information is needed (such as community resources, information on new procedures or treatment, equipment, etc.)
- When future employment evaluations are needed (including a Job Analysis or discussion with physician for determination of Return to Work status).
The phrase "Medical Case Management" is most commonly utilized when describing a strategy to manage complicated and intricate medical health care issues involving a work-related injury.
In 1992, the Certification for Insurance Rehabilitation Specialists Commission defined case management as "...A collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services to meet an individual's health care needs using community resources available to provide quality and cost-effective outcomes."
This definition is significant in that it describes a multidisciplinary and complex process that requires the cooperation and contribution of many participants in the health care delivery system to obtain a successful outcome.
The participants in a worker's compensation case involve the injured worker and their support system, the employer, the third party administrator, the physician, the physical therapist, the attorney, and vendors and/or suppliers to the health care system. With Medical Case Management, the objective is for all participants to work in harmony to accomplish the optimal outcome for the injured worker.
The goals of Medical Case Management are to coordinate quality health care, decrease fragmentation of health care during recovery, facilitate the return of the injured worker to his or her maximum level of functioning while reducing disability, unemployment and health care expenses.
We provide support and encouragement to the injured worker to follow the prescribed medical and rehabilitation treatment plan to facilitate maximum medical recovery (MMI) and an early return to work.
When performed well, the medical case coordinator can personalize an otherwise impersonal health care system to achieve optimal results which benefit everyone involved during the rehabilitation process.
Vocational Case Management is an integral component of the rehabilitation process to return an injured worker to suitable, gainful employment. This includes a complete evaluation of the rehabilitation potential of the claimant. Network Disability Management Services provides counseling for disability-related concerns. We provide access to the labor market and identify job placement opportunities through our job placement services.
Comprehensive, private vocational rehabilitation concentrates on attaining an employee's pre-injury wage and takes into consideration the worker's skills, aptitudes, interests and physical capability. Vocational Case Management is an appropriate option when a physician releases an individual for return-to-work or rules out a return-to-work with the same job and same employer.
The benefits of utilizing Vocational Case Management are numerous:
- Decreases claim dollars for both medical and vocational payments.
- Addresses consistently relevant medical and vocational issues.
- Identifies and solves problems associated with return-to-work in a timely fashion.
- Facilitates a positive working relationship between the injured worker, the employer, the third party administrator, the physician, and the attorney.
- Documents all case activity, including the intricate and objective details of medical issues, vocational goals, behavioral interactions, and financial aspects of the situation.
- Provides input for decision-making based upon specific recommendations.
- Encourages the injured worker to seek and obtain suitable work and offers support in that process.
- Proves employment options and permanent job opportunities are available.