Medical Case Management encompasses a highly diverse range of services. For workers’ Compensation-related files, the medical Case Manager is assigned by the insurance company to assist in the medical rehabilitation process of claimants who have sustained work-related injuries and/or are suffering from a work-related illness.

The goal of the Medical Case Manager is to facilitate the optimum medical recovery of the claimant and their early return to work. This goal is achieved through a close liaison with all those involved in the rehabilitation process including the claimant, the treating physician, therapists, employer and the insurance carrier.

The primary focus of our Medical Case Managers is the claimant. In serving injured individuals our responsibilities may include some or all of the following:

Initial Evaluation Following Injury or Diagnosis of Illness

• Obtaining the claimant’s history of the injury or illness

• Reviewing/evaluating the treating physician’s treatment plan

• Obtaining the claimant’s medical history

•  Review of claimant’s employment history, hobbies and interests

•  Evaluate the injured individual’s financial status, ability to perform activities of daily living (ADL) and family support systems

Establishing a Comprehensive Care Plan

• A claimant profile which includes diagnosis, prognosis and outline of desired treatment

•  Identification and scheduling with appropriate medical specialists

•  Evaluation of the physicians’ treatment plan

• Schedule appointments for implementation/follow up of treatment plan.

• Identification/Evaluation of prescribed medications and therapy

• Description of any special needs involving medical equipment and assistance for their procurement through rental or purchase and delivery

• Evaluation of any Psycho-social, ADL, financial and other needs for the individual with appropriate follow up.

Attendance to Physician Appointments and/or Surgery

•  Ensuring transportation is available for the claimant to attend physician and/or surgery appointments

• Accompanying the claimant during their physician consultation

• Ensuring the physician is aware of any concerns the claimant may have

• Ensuring the claimant understands the physician's diagnosis of their injury/illness, and any instructions and recommendations regarding treatment

• Ensuring all concerns expressed by the claimant are addressed by the physician

• Evaluation of the appropriateness of the physician's recommendations and instructions, and follow through of any concerns

Assistance with Hospital/Surgery Admission and Discharge

•  Follow through of preoperative consultations, testing and evaluations

•  Follow-through with specialist consultation and treatment for any underlying disease or condition revealed through preoperative testing

•  Ensuring the claimant follows all preoperative instructions before surgery

•  Arranging when necessary, transportation to local or out-of-town surgery centers

•  Assistance with completion of surgery consent forms and other surgery/admission paperwork

•  Assistance with discharge procedures ensuring the claimant's understanding of postoperative instructions

•  Transportation home from surgery centers

•  Close and consistent postoperative monitoring, ensuring the claimant has home help and is progressing as expected

•  Ensuring prior to the claimant's discharge that any prescribed medications and/or adaptive equipment is available on their return home

Liaison with Therapists and Regular Attendance at Therapy Sessions

•  Follow-up with physical/occupational therapists to ensure claimants are attending sessions and adhering to recommended exercise and home therapy regimes.

•  Ensuring the claimant understands the therapy instructions and is comfortable with compliance

•  Evaluating the therapist's implementation of the treating physician's instructions and their involvement with the claimant

Emotional Support, Assistance with ADL and Education

•  Providing "hand-holding,” emotional support for the claimant and family, especially during the early and critical stages of medical rehabilitation and following catastrophic injury

• Answering health/treatment-related questions, ensuring the claimant understands their injury/illness and the treatment plan as prescribed by their treating physician

• Ensuring the claimant understands the correct use and dosage of prescribed medications

• Ensuring the claimant can perform or has assistance with activities of daily living (ADL)

• When necessary, procuring home health or homemaker services

• Educating and coaching the claimant regarding good nutrition, wound care and any other health issue

• Ensuring the claimant is aware that a Medical Case Manager is available at all times for consultation and assistance in times of need 

• Keeping the claimant motivated and on-track regarding treatment and return-to-work issues through consistent monitoring, contact and support

Reporting and Communication

•  Medical Case Managers keep the carrier and employer informed in a timely manner of all new and/or significant changes throughout the rehabilitation process

• Medical Case Managers concentrate on establishing effective rapport with all professionals involved in the claimant's rehabilitation process to facilitate continuity of treatment and optimum care

• A comprehensive monthly report is provided detailing the claimant's progress, physician/therapy visits and significant events - a copy is sent to the carrier, employer and attorney (if represented)

                 Benefits of Medical

Case Management

Quality Care

     Contemporary Medical treatment is complex, highly specialized and provided through a fragmented structure involving physicians, therapists, equipment providers and treatment centers. The medical Case Manager is in an unique position to observe and monitor the claimant’s response to treatment and report on any problems or concerns when treatment appears inappropriate and/or ineffective

Cost Effectiveness

Comprehensive Care Systems can impact the quality of care received by injured individuals and can significantly reduce costs. These costs benefits are revealed in hard and soft dollar savings.

Hard Dollar Savings come from the efficient utilization of medical services, equipment purchase and avoidance of litigation.

Soft Dollar savings are intangible but very real benefits accrue when:

• Claimants are kept on track with treatment and can return to work as soon as possible 

• All parties involved understand what is going on and are constantly informed of progress made.