Tips for workers’ compensation case management

Case managers provide value across many healthcare settings and specialties. In particular, their interpersonal and communication skills can prove invaluable in the area of workers’ compensation, according to CMSA Today.

The transition from clinical case management to specialty areas such as workers’ compensation can bring new and unique challenges. CMSA Today offers the following tips for case managers making this leap:

• You’ll likely make regular contact with the insurance or claims adjustor who will be an expert in state-specific workers’ compensation laws and rules. The case manager should anticipate that he or she may work with patients (known as injured workers) from various states and should become well versed in these state laws. The case manager must also ensure he or she is licensed to practices in each state he or she sees injured workers from.
• Complications that arise must be linked back to the injury that occurred on the job. If the patient presents with a condition unrelated to the injury and is treated for it, the workers’ compensation adjustor may deny it.
• Unlike with commercial insurance, the injured worker does not incur out-of-pocket costs for his or her injury related to workers’ compensation.
• Clinical case management is typically done over the phone, but workers’ compensation case managers are expected to attend all appointments for the injured worker. Use this as an opportunity to ask questions and expand your knowledge.
• Ask the provider about the injured worker’s ability to return to work at every appointment. The goal of workers’ compensation case management is to return the injured worker to his or her job.
• Build a rapport with the injured worker so you can understand his or her issues and be an advocate.
• Workers’ compensation cases can be lengthy and complex, so be sure to keep thorough documentation.

For additional information on workers’ compensation, see CMSA Today.