Mitigating Issues that Arise in Workers’ Compensation Cases with a Nurse Case Manager

Case Management Focus

In this article, I want to discuss the challenges that can arise in a workers' compensation claim and how they can be recognized and addressed by having a nurse case manager on the case. 

Many workers in the United States have concerns about the workers' compensation system. While the system provides critical support for employees injured or made sick by their jobs, many find significant challenges that can derail a case if not addressed. 

Reports indicate that the workers’ compensation system often fails to provide adequate benefits, leaving injured workers vulnerable to financial hardship. Additionally, employers contribute only a small portion of the overall costs associated with workplace injuries, shifting a significant portion of the burden onto workers, their families, and taxpayer-supported programs. There is a growing frustration over the difficulty of accessing full benefits, with some states imposing restrictions that make it harder for workers to receive compensation. 

Calls for reform have been increasing, as many believe the system needs to be updated to protect employees better and ensure fair compensation for workplace injuries.

So, how are payers and employers addressing these issues? Some are taking their concerns to their State Legislature to address the problems by updating the laws and rules that govern the workers' compensation system. 

Yet, others are turning to NCMs, who play a crucial role in helping injured workers navigate the workers' compensation system and have realistic expectations as they work through it. NCMs act as a bridge between the injured employee, healthcare providers, the employer, and the insurance company, ensuring that medical care is coordinated correctly, the worker receives appropriate treatment, and that the worker's compensation rules in their State are administered according to the law. They build trust with the injured workers so they feel save to bring issues to them before they balloon into major problems. 

Here are some ways the NCM can change the system for the better:

• Scheduling medical appointments and ensuring timely care.
• Coordinating with treating physicians to monitor recovery progress.
• Communicating work restrictions to facilitate a safe return to work.
• Providing updates to the insurance company while maintaining confidentiality and ensuring compliance with relevant regulations.
• Helping reduce lost time by streamlining the claims process.
• Working with the Claims Adjustor to ensure issues with payments and other benefits are addressed when they arise. 
• Working with the treating physician and the healthcare team to reach maximum medical improvement and a safe return to work for the injured worker. 

Next, let's examine the value of having a nurse case manager involved in a workers' compensation claim from the outset. Studies show that while there are costs associated with nurse case management services, the benefits ultimately outweigh the costs. Having a proactive nurse case manager actively involved can lead to significant long-term savings. Here are some ways to demonstrate the value of utilizing nurse case managers early in a worker's compensation claim. 

• Faster Recovery – The Nurse Case Manager helps ensure that injured workers receive timely and appropriate medical care, thereby reducing delays in treatment.
• Lower Litigation Rates – Workers who have a nurse case manager guiding them through the process are less likely to sue their employer.
• Improved Communication – NCMs act as a liaison between the worker, employer, insurance company, and healthcare providers, ensuring everyone is on the same page.
• Cost Savings – According to a recent Mitchell Case Management Services annual report, engaging a nurse case manager can save an average of $6,100 per claim in medical and indemnity costs, resulting in an 8:1 return on investment (ROI).
• Better Compliance – Workers are more likely to follow treatment plans when a nurse case manager is involved, as they feel they have an advocate on their side. This leads to a faster and more effective recovery.

I hope you and your teams will use this article in helping to convince clients the importance of using a nurse case manager as part of your services. 

If you are a manager of nurse case managers, share this article with your team to let them know the value they bring by being part of the team! It is important to know your are making a difference! 

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