DorlandHealth

What to do when encountering shipwrecked parties in the sea of workers’ compensation

A plant worker at a chemical manufacturer was involved in an explosion that killed a co-worker and caused partial and full thickness burns that covered 30 percent of his body, including parts of his torso, face and extremities. During a home visit following his discharge from the rehabilitation facility, he made a statement verging on the incredulous. “I have been with the company for over 25 years, never missed a day of work, and always came in when they called,” he said. “I willingly worked overtime when asked and I didn’t even get a Christmas card from them this year.”

According to this worker, his employer traditionally sent all of the employees a Christmas card every year. After his work accident, he became angry with his employer because he felt that he was forgotten.The man had become a casualty of the “out of sight, out of mind” syndrome that affected his company.

The employee’s words were shared with the corporate executives of his company during a claim review.The executives took the words to heart, as they were familiar with the high-profile accident and this particular employee. After a review of their loss-management program, it was evident that the employees who were off work due to a work-related injury had fallen through the cracks of their system. Contact and communication with the work-injured employees had been lost.The company executives subsequently

• Medical case managers should be familiar with the many benefits of timely and regular contact with an injured worker by the employer following an injury
• Continuous contact and communication with the employee can:
• Build the injured employee’s sense of belonging, self-confidence and overall wellbeing through a positive recovery experience.
• Enhance the employee’s physical and psychological recovery while preparing them to return to gainful productivity.
• Minimize the chances of the worker seeking legal counsel, which in turn can reduce the potential claim cost exposure.
• Control medical care costs by minimizing “care seeking” by the employee.
• Facilitate a successful return to work outcome that is a win-win situation for all.

When an accident happens, a phone call or a personal visit by the employer, especially if the worker is hospitalized, can go a long way to demonstrating that the company cares about the employee.This demonstration of concern and caring can help avoid the development of ill feelings, which can in turn morph into litigation. Employees often seek legal representation because they have questions and fears or are angry about their work injury. Often they don’t know what to expect from the system or whether they will have a job upon return.When the employee does not get answers to his questions, he feels he has been forgotten by his employer or claims representative, and believes that an attorney can provide answers. Employers who have a formalized return to work program that includes continuous communication requirements are the most successful, and typically have lower loss costs.

Medical case managers can play an instrumental role in the successful outcome of work injury cases by applying the Four C’s. Let’s examine how.

Communication

The case manager needs to determine what communication is occurring between all parties. The most crucial is that which (if any) occurs between the employee and the employer. The following is a list of duties necessary to gathering the needed information.

• Identify the “contact person” for the lost-time work injury.
• Offer to update the employer after each physician appointment.
• Obtain the fax number and offer to forward a copy of the work note.
• Determine whether the “contact person” is also the “decision maker” for return to work of the employee. If not, obtain the decision maker’s name/number- /title.
• Request and obtain the employee’s job description. Confirm whether the company will arrange modified duty for the worker while activity restrictions are in effect during the recovery process.
• Has the company provided the job description to this clinic/ physician before? Does this clinic/physician know the companycan offer a modified duty opportunity?
• Encourage the identified contact person or the worker’s supervisor to establish and maintain regular contact with the employee, whether it is by phone, in person or writing.
• Though the employer may have formalized communications in place, the employee also has a responsibility to keep in touch with his employer.

Coordination

As with communication, this factor is continuous to the case management plan as it evolves. As defined by the Commission for Case Manager Certification (CCMC), coordination is the process of organizing, securing, integrating and modifying the resources necessary to accomplish the goals set forth in the case management plan. The case manager is charged with the role of working collaboratively with the injured worker and family, physician, health services provider, employer, and payer and often an attorney. The case manager must gather all of the pertinent data, and then determine the case management actions needed to coordinate the necessary services. The process of coordinating is a dynamic, proactive and client-focused process. The case manager continually assesses the injured worker to identify the most suitable resources and works to offer the most effective expenditure of claims dollars for the case. This continual flow of written and verbal communications, along with the coordination of multiple resources, promotes the optimal allocation of available resources while maximizing the client’s health status and returnto- work outcome.

Creativity

This can be thought of as the process of bringing something into being. When providing case management services to work injury clients, flexibility and creativity are often characteristics that a case manager must possess in order to move the case management plan forward to a positive outcome and closure. The case manager is challenged to think outside the box, so to speak. On occasion, the employer, adjuster and attorney may need to “stretch” the rules and procedures. Some examples of case management creativity may include:

• Recommend a mid-week return to work day.
• Suggest the employer consider all departments and operations — even if they fall outside the union contract. Ask the employer to consider a temporary “non-union” position.
• Offer suggestions to the employer on ways to accommodate the employee’s restrictions. Refer them to the Job Accommodation Network (JAN) for ideas to consider for their setting.
• Encourage the employer to consider an alternate shift assignment than what the employee normally works.
• Suggest a progressive return to work plan, for example 4hr/day for 1 week; 6hr/day for 1 week; then 8hr/day.
• Confirm that the adjuster is willing to pay a disability benefit differential if the injured worker is brought back to work in a progressive schedule.
• Request the adjuster cover

Continuous

This is an application of the aforementioned roles. The case manager needs to continuously communicate, coordinate and think creatively until the injured worker achieves a full or maximal recovery for that injury and is able to resume occupational activities that are commensurate with their level of functioning. The case manager’s role is crucial to ensuring that the flow of communication, both written and verbal between all vested parties, remains steady, recurring and uninterrupted until the goals and objectives of the case management plan are met.

The creativity of medical case managers to achieve a successful outcome and return to work situation is boundless and limited only by the individual’s imagination. Engage your professional network; staff the case with your supervisor, co-workers and professional peers for ideas; identify community resources and what strategies worked well; plan to attend case management seminars to keep current, remain educated, demonstrate creativity, care, balance and commitment to all cases in order to serve your client’s best interests. When the Four C’s are applied, there will be no room for the “out of sight, out of mind” syndrome.