people 1979261 640

Can Case Managers and Adjusters Work Together?

people 1979261 640
                               Case Managers are involved in numerous issues and barriers while following a workers’ compensation case. As an RN Case Manager, they are bound by their duties to remain objective with all involved in the case. First, they are a licensed Registered Nurse, then a communicator and coordinator for the injured worker, the family members, claims adjuster, the physician, the employer, the providers such as Physical and Occupational therapists and the attorney representing the injured worker. The Case Manager is pulled in many directions but must remain objective. I would like to demonstrate the impact I made with one case while I was one of two case managers who provided case management for a large employer in East Tennessee. The claims adjuster forwarded every workers’ compensation initial report of injury and appropriate records to me at the very beginning of the case (usually the day of injury or asap, within days. If the injury seemed minor, I would continue to review the case and if no case management intervention was necessary the case was closed in approximately 30 days. If anything changed with the case the adjuster would notify me and I would continue to provide support and discussion with the adjuster and others involved in the case. With the injury report in hand, I was able to immediately contact the injured worker and meet them at their initial MD appointment. This provided the opportunity to form an initial case management plan with the goal to facilitate an appropriate and timely return to work. In my experiences, this case is an example of what early case management intervention and team effort can provide. I received the referral and reviewed the initial report of injury. This injured worker reported the injury occurred while working at another job site. He stated the injury occurred as he turned around and hit his eye on a filing cabinet and this caused the eye infection. At that point there was the possibility an enucleation (removal) of the eye with costly facial reconstruction would be necessary. After I reviewed the information provided, I called the adjuster. I did not think this type of injury/infection was caused by hitting his eye on a filing cabinet. I suggested the adjuster request his medical records from his primary care MD. When the adjuster reviewed the patient’s medical records she determined the employee was diagnosed and treated for the eye infection prior to the injury claim. The claims adjuster denied the claim which avoided significant costs in surgical procedures and facial reconstruction. Working together is so important in workers’ compensation!

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