NWCDC 2018: How to Navigate and Manage Catastrophic Claims

Las Vegas, NV (WorkersCompensation.com) – Michael Choo MD, CMO, Paradigm; and Kevin Confetti, Deputy Chief Risk Officer, University of California, talked catastrophic claims at one of the final NWCDC sessions Friday.

Confetti said part of his philosophy is getting employees the benefits they need, “…Nothing more, nothing less.”

When discussing the catastrophic claims process, he stressed the importance of experts. “…When I have a pipe leaking in my house, I would rather use a plumber,” instead of getting help from someone that doesn’t specialize in those skills.

Considering the system UC refers to when a catastrophic claim surfaces, Sedgwick sits in the middle, and Paradigm, Optum, ProCare, Medval, MedRisk and Genex surround the center as some of the moving pieces that support in the process. Each element plays a part in supporting the employer and employee toward a recovery plan. 

Confetti provided the crowd with anecdotes involving injured workers and navigating their process through catastrophic claims.

A 59-year-old machine shop superintendent was pinned to the ground by a crane in a terrible accident that left him with an abdomen injury and leg amputation below the knee. Confetti said his team worked to get this man back to what was most important, with a prosthetic option to sail again, and another prosthetic option to ride his bike again. These options helped to get the injured worker back to what he loved the most, which in turn, got him back to work. Confetti asserted this aided in making the claim process easier. 

Dr. Choo took the stage next to talk the “secret sauce” elements behind what it takes to deal with catastrophic cases, including inviting the help of experts.

The major challenges of catastrophic injuries include: a high rate of uncertainties in the variations of care, and medical volatility, per Dr. Choo. Also, chronic conditions can come with permanent alterations of the body and self-image.

Dr. Choo also emphasized the psychosocial effect these injuries can have on workers. Issues can include, “fear avoidance, catastrophizing, lack of coping skills, a sense of injustice, and depression.” 

A holistic approach, including a bio-psycho-social model, along with a medical expert team and insight-driven analytics are key to positive medical outcomes, he said. 

Also worth utilizing for maximum functional outcomes: clinical insight from data-driven analytics, data-driven provider quality training, and medical/health innovations.

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