Interested stakeholders seeking to reduce workers’ compensation case should consider using a nurse case management program. There are many benefits to these programs, which include the ease of implementing them within a program. They can drive injured employee engagement, which will reduce litigation (and the costs associated with litigation), and provide better satisfaction. When done correctly, they can also help build relationships and improve morale.
What is Nurse Case Management?
A nurse case manager is typically a registered nurse (RN), or someone holding a similar designation that helps direct medical care for an injured employee on behalf of the insurance carrier. They perform a variety of roles during the open claims process. Common roles include the following:
- Assess the employee’s condition following a work injury. This can include recommending medical care following a work injury, or directing the employee to a specialist;
- Prepare health care plans to assist in getting an employee back to work. This can include a review of the employee’s transferable job skills, understanding what work is available, and making suggestions on job duty modifications;
- Educate the injured employee about their options. This typically includes attending the employee’s medical appointments, and making additional recommendations consistent with the medical evidence; and
- Serve as a conduit between the employee, the treating physician, and insurance carrier – ensure there is an open line of communication between all parties.
An effective nurse case manager is responsible for a number of roles. The ultimate goal is to help reduce unnecessary costs, or delay in the claims process.
Benefits of Nurse Case Management to Reduce Costs
There are many benefits to implementing a nurse case management program. Nurses and other health care professionals serving in this capacity often employed by the insurance carrier. In other instances, they work for a service provider under contract with the claim team. Benefits to using a nurse case manager include:
- Litigation Rates: Studies demonstrate lower litigation rates of claims involving nurse case managers. This is likely because employees have a better understanding of their medical options, the workers’ compensation process, and increased lines of communication.
- Claim Management Engagement: Given the role of a nurse case manager, there is an increase in engagement between all parties. An effective nurse case manager should serve as a conduit and ensure information is being shared between all interested stakeholders. When this occurs, morale increases as there is a greater sense of trust.
- Effective Return to Work: Lower litigation rates and increased engagement drive a quick return to work. A nurse case manager will understand the limitations an employee has, and work with the employer on modifying job duties, or develop creative opportunities. The role as a conduit again comes in helpful to help facilitate communication between all parties, and stakeholders.
The costs associated with a nurse case manager are often offset when done right. They offer many benefits to claim management teams in reducing workers’ compensation cases.
Avoid Common Objections to Nurse Case Management
It is important to remember that injured employees can reject the involvement of a nurse case manager in most jurisdictions. In fact, some attorneys who represent injured employees specifically instruct their clients to not cooperate. It is important to recognize this barrier by being proactive to avoid objections.
- Honesty and Integrity: Attorneys who oppose the involvement of a nurse case manager likely had a bad experience in the past where someone was merely acting as a “spy” for the insurance carrier. This objection can be avoided by requiring nurse case managers to act in an ethical manner. The first interaction with the injured employee needs to set the proper tone; and
- Factual Communications: Nurse case managers should always communicate in a factual manner. Their reports should be accurate and avoid providing opinion – only recommendations founded in objective medical evidence.
Nurse case managers must recognize their important role, and work hard to maintain a high level of professionalism. When done correctly, it can avoid many of the common objections employees and their attorneys may have to their involvement.
Nurse case managers play an important role in the claims process when parties are seeking to reduce workers’ compensation costs. They offer a number of benefits to all parties, and can reduce litigation, and promote an effective return to work. They can also serve as a conduit that communicates empathy and direction to all parties, including the injured employee.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is the founder & lead trainer of Amaxx Workers’ Comp Training Center, which offers the Certified Master of Workers’ Compensation national designation.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.