Paradigm Catastrophic Care Management CEO Kevin Turner recently shared, with Michael Stack of AMAXX’s Workers’ Comp Training Center, his 30-plus years of extensive knowledge and experience with strategies for handling catastrophic care claims. In the training session, “Highly Effective Strategies to Manage Catastrophic Workers’ Comp Claims,” the two industry experts went into depth on the very high stakes, both emotional and financial, that this relatively small group of high costs of claims represents.
From defining catastrophic claims to developing and implementing a care plan, Kevin emphasized the importance of personalized care throughout the process. These cases have an enormous psychological component, not just for the injured workers, but for their families. Successfully managing these challenging cases often means addressing psychological concerns, along with coordinating the highly specialized medical care catastrophically injured workers require.
Clearly defining catastrophic claims
In defining a catastrophic claim, Kevin stressed that a catastrophic loss can mean different things for different organizations. What a company defines as a catastrophic loss can vary greatly, depending on the specific profession and the size of the organization. However, when discussing catastrophic care management in workers’ compensation, Kevin explained the defining factors for the types of cases that a medical management company such as Paradigm handles.
While costs can vary, the average catastrophic claim is typically $1.35 million in medical costs and, as mentioned above, these cases have an enormous impact on the lives of injured workers and their families. Additionally, these injuries can disrupt daily workplace operations and even the lives of co-workers and the broader community.
Kevin further defined catastrophic injuries as being so rare, so traumatic, and so expensive, they require not only a highly specialized system of care, but a very specific mindset when developing and implementing a care plan. Catastrophic injuries typically fall under the following diagnoses:
- Multiple trauma
- Severe burns
- Traumatic brain injuries
- Spinal cord injuries
- Amputations
Establishing catastrophic care management plans
Kevin and Michael then transitioned to the primary focus of the course, which was how to successfully build a care plan for these injuries. According to Kevin, there are six main priorities that a catastrophic care management team should focus on while handling these cases:
- Establishing rapport and trust at the time of the injury
- Conducting a detailed, long-term investigation
- Establishing a medical and support team that is right for the case
- Constantly communicating with the injured worker and the family
- Developing an effective plan for ongoing treatment and transitioning to home and a potential return to work
- Holding weekly claims roundtables with stakeholders to build a long-term action plan
Since the injured worker is often incapacitated, especially at the outset of the case, successful catastrophic care management depends on establishing genuine rapport and trust with the family. According to Kevin, one of the biggest hurdles to successful care is poor communication, which is why staying in touch throughout the process should be fundamental.
Delayed and improper medical treatment is another danger that catastrophically injured workers face, so care management teams need to conduct exhaustive investigations and have the clinical support and resources needed to act properly. Often, this involves taking a biopsychosocial approach to care that includes the psychological impact on the worker, as well as the family.
Implementing the care plan
Finally, in the third part of the program, Kevin and Michael discussed many of the important aspects that go into implementing the care plan from a results-oriented standpoint. Kevin stressed that, due to the rarity of these types of cases, many organizations and payers aren’t prepared to handle all of the intricacies that go with catastrophic workers’ compensation case management. Working with a specialized care management organization can often mean the difference between a positive outcome and returning to work versus a longer-term case with a far higher-risk exposure. In the end, both experts agreed that having a plan and the right team in place before the unthinkable occurs can make a substantial difference in the lives of injured workers, their families, their employers, and their communities.
Paradigm is committed to guaranteed outcome-focused results for the most challenging catastrophic workplace injuries. We invite you to learn more about the incredible work our team does every day and the powerful impact of the Paradigm Systematic Care ManagementSM model.
Register for the replay of the Amaxx training session featuring Kevin Turner via the Paradigm registration link. You will receive a user specific password via email in order to login and access the replay at no cost to you.
Improve Medical Case Management in Workers’ Comp Claims
