As an employer assesses injured workers out on workers’ compensation and makes plans to offer modified jobs in line with a return-to-work (RTW) policy a referral to nurse case management may be appropriate under certain circumstances.
Reasons to Consider a Referral For Nurse Case Management
- Obtaina definitive diagnosis.
2. The causal relationship of treatment to injury is undetermined.
3. There is an illusion of sufficient medical care, but no resolution.
4. Long standing pre-existing conditions that prolong disability.
5. Complicated diagnoses.
6. Diagnosis without progress.
7. Two or more conditions related or unrelated to the work injury.
8. Claimant referred to multiple physicians for treatment.
9. Frequent emergency room visits by the claimant.
10. Need for coordination of services for timely conclusion.
11. Difficulty in obtaining medical reports from the health care provider(s).
12. To establish causal relationship between work injury and their current condition.
13. Prolonged treatment for a condition that may need surgery.
14. Conflicting reports.
15. Extended disability without apparent medical cause.
15. Prolonged medical care after the worker is able to return to work.
17. Documentation is insufficient to return a claimant to work or support their disability.
18. Jobs are inappropriate to sustain attendance at work for an injured worker.
19. Return to work made difficult due to unresolved medical conditions.
20. To prevent employer and employee misunderstandings regarding return to work guidelines and restrictions.
21. Employment started with a new company as medical disability continues.
22. Claimants suspected of working on the side as work comp benefits continue.
Long term an employer may experience significant cost savings by making use of a nurse case manager to monitor and report the health status of injured workers and suitability of return-to-work participation.
Victoria Powell is the President of VP Medical Consulting, LLC located in Central Arkansas. VP Medical Consulting is a nurse consulting firm providing services to employers, insurance companies, attorneys and the general public. Services include case management, life care planning, legal nurse consulting, ergonomics and patient advocacy. Ms. Powell holds specialty certifications in a variety of nursing specialties. She can be reached through the web at http://www.vp-medical.com by phone at 501-778-3378.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
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