Tips to Expedite Care for the Injured Worker

Case Management Focus

Nurse Case managers working in the area of workers’ compensation face many challenges. Over the next few weeks, I am going to outline a few of them with tips to help you address them. 

Here is the first Challenge: Reducing delays in medical treatment and return to work guidelines. 

Often, injured workers face long wait times for approvals on medical procedures, therapy, or specialist visits, which can prolong recovery and increase costs for all parties involved. Nurse Case managers can step in by streamlining communication between healthcare providers, insurance adjusters, and employers, ensuring that necessary treatments are authorized promptly. How do you do this? 

First if you are an onsite case manager attend the appointment with the doctor, so you hear firsthand what the plan of care is and how the injured worker received the information. Is the injured worker on board with the plan of care? If so, that is the first step. If they are not on board, ask why? What are they worried about? If the doctor is ordering therapy and the injured worker does not have transportation this could be a barrier. Let them know you can arrange for transportation to take them to and from the appointment. 

Another common problem is that the injured worker is in a lot of pain and cannot see how they can participate in therapy. Ask the doctor if he/she will order pain medication and when is the best time to take it. Sometimes taking the medication before the therapy is helpful or after therapy.  The therapist may also have insight into this so make sure monitor the patient in therapy to ensure they are moving forward.  The important thing is that you address barriers that hold the injured worker back from progressing and work to resolve them. The injured worker and all members of the healthcare team will benefit from your work. 

Starting therapy in a timely manner is also another barrier that can arise. Ask the doctor where he recommends the injured worker go for therapy. If they have a preference, they can help you get an appointment in a timely manner. If the doctor does not have a specific place in mind, think about where you have had good success in the past. Ask your colleagues and the adjustor. This is why networking is so important. Knowing the places, the doctors and others who care for workers’ compensation patients is important to make sure your patient gets the care they need when they need it. 

Next, let the claims adjustor know right way what the plan of care is, and ask her to authorize the plan so the patient can get started. This will move the process along. Ask the providers to let you know if there is a delay in the processs so it does not hold things up. 

If you are a telephonic nurse, a case manager expediting things can be more of a challenge. Many doctors working in the area of workers’ compensation have staff that you can get information from since you can’t attend the appointment. Try to get your patients into those offices and build a relationship with the person working in this area. Having contact on the inside is very helpful in getting questions and information in a timely manner. 

As the goal of the nurse case manager is to return the injured worker to gainful employment, ask the doctor at the appointment if the injured worker can go back to work. This might not be possible on the first or second visit, but planting the seed is important. If you can get the injured workers’ job description and provide it to the doctor, that is a huge step so the doctor can keep this in mind as the case progresses. Also, talk to the employer to see what they have in terms of light duty. Next talk to the injured worker about the benefits of going back to work. Many people working today is just making it on their salaries. A work comp injury can put extra pressure on the worker as well as their family when their income is reduced. In most states if the worker can go back to work, even at light duty, they will receive full pay. 

By taking a proactive approach, case managers can minimize unnecessary delays, improve outcomes for injured workers, and reduce the financial strain on employers and insurance providers. I hope this post will help you with your clients. 

If you have a challenge you are facing in your practice, please email me and I can address it in a future post. You can email me at allewellyn48@gmail.com 

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