OUTLINE

Introduction

Once a work-related injury or illness occurs, returning the injured worker back to work (if possible) can be a challenge. Workers’ Compensation is a government-mandated program that provides benefits to someone injured or who becomes ill while at work or from the result of the job. Whether you’re an experienced case manager or new to the profession, administration of Workers’ Compensation is not often taught or understood by medical professionals. When an injured worker becomes your patient, would you know how to maneuver through the system to achieve the best injury or illness outcome(s)?

Determining outcomes in Workers’ Compensation case management comes down to knowing the rules in your state, the employer you work for and the appropriate medical treatment of the injured worker. 

Acknowledgements

Anne Llewellyn

Chapter 1

Frequently used abbreviations/terms : (IW, EOR, POR, AOR, RTW, MCO, DME, TT, PTD, claims adjuster, WC, malingering, magnifying symptoms, compensable vs non-compensable claims, state-funded vs self-insured programs, TBI, SCI)

Incidences of worker related injuries

Common injuries: (LBP, sprains/strains, etc.)

Other injuries/diseases: (lung diseases; asbestosis, pneumoconiosis, work related exposures)

Factors that influence work related injuries

Chapter 2

Role of the employer

Role of the provider

Role of the attorney

Role of the claim’s payor

Role of the state BWC

Role of the claims adjuster

Role of the Managed Care Organization

Role of the Case Manager

Role of Catastrophic Case Manager

Coordination of care

Chapter 3

Hearing

Appeals

Independent medical examination

Chapter 4

RTW strategies

RTW barriers

RTW with restrictions

Rehabilitation/work hardening/work conditioning

Chapter 5

TT awards of disability

Temporary vs Permanent Disability

PTD (outcome of this award, percentage of disability exams, how PP is awarded)

Chapter 6

Case studies (start with the injury, where IW was assessed-ER/urgent care, hospital/physician’s office) how injury is reported, where to send injury report, take the process step by step

Case management interventions

Impact of multi state licensure

Chapter 7

Catastrophic Injuries

Catastrophic case studies (traumatic brain injuries, spinal cord injuries, burns, heart attacks)

COVID 

Home/vehicle modifications

Conclusion

Case management is an important tool in the workers’ compensation industry. Being able to show the value we bring to the injured worker, their family, the employer, and other key stakeholders requires continuing education, clinical knowledge, communication, and negotiation skills. 

Resources

References