When a worker becomes injured in a catastrophic situation, this injured worker typically may face a long recovery process. In addition to this, they may also be battling anger, depression and even opioid abuse. With an injury such as an ankle sprain, typically most workers return to work quickly, though 10-20 percent of these minor injuries result in a lifetime of pain and disability. Proper case management can provide mechanisms to prevent both catastrophic and minor claims from going off the rail.
According to Michael Coupland, a psychologist, rehabilitation counselor and network medical director with the Integrated Medical Case Solutions (IMCS) Group, “a large body of data suggests that both creeping catastrophic and ‘runaway’ catastrophic claims are characterized by complicated recoveries, higher costs and more medical complications when the patient presents with certain psychosocial risk factors.”
“Predictive modeling has advanced to the point that these factors can be identified and acted on earlier,” said Dr. Michael Choo of Paradigm Outcomes. Ultimately, this can assist in reducing the overall costs of Workers’ Compensation cases.
Benefits of Case Management
Claim managers play a critical role in putting the support mechanisms in place and will guide the injured workers through the recovery process. For example, claim managers will work with the physician’s office, help with referrals and ensure that the patient’s family is properly cared for.
In addition, Case managers provide chronic pain management care. With the opioids epidemic, an injured worker can struggle with getting off prescriptions which can trigger depression, anxiety and withdrawal. Non-pharmaceutical techniques such as cognitive therapies, biofeedback and hypnosis can help to manage injured workers’ pain.
If addiction issues occur, case managers have the ability to assist in providing intervention mechanisms to an injured worker. Nikki Wilson of Coventry Workers’ Comp Services said, “using data on providers, types of drugs, dosages and duration of a prescription, pharmacy benefits managers are in a unique position to identify trigger points where an intervention would benefit a claim.”
In conclusion, case management for catastrophic and minor workers compensation injuries is an important way to ensure that these claims are properly managed. Case management provides preventive mechanisms to provide injured workers with the proper guidance to mitigate and prevent from going off the rail.