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How and When to Use Workers’ Comp Case Management

Having a straightforward workers’ compensation process is vital for maintaining positive relationships with your employees. Injured employees will know what to do in the event of a work-related injury and your HR team will ensure they get the support they need.

But from claiming workers’ comp in the first place to navigating the return to work (RTW) process, dealing with a work-related injury can be a daunting process for employers and employees alike. Assigning a case manager or using a cloud-based case management system can streamline the claims process, ensure regulatory compliance, and allow injured workers to return to work as soon as they’re medically able.

Here’s what you need to know about workers’ comp case management, including when to use it, and how to process workers’ compensation claims with HR automation.

What Is Workers’ Comp Case Management?

Workers’ compensation insurance is a type of insurance policy that covers health care costs and lost wages if an employee is injured in the course of their work. The specific coverage limits of your workers’ compensation policy will depend on your insurance carrier and the rules and regulations in your state.

Workers’ compensation case management is a way of navigating the claims process from beginning to end by assigning a case manager to each injured employee, rather than having different members of your HR team responsible for different parts of the process. A case manager works with the employee to ensure they receive suitable medical treatment and to facilitate a timely return to work.

Case managers aren’t just responsible for filling out paperwork. Often, case managers are registered nurses or other qualified medical professionals, and play a direct role in shaping the employee’s treatment plan.

Case Manager Roles and Responsibilities

The role of a case manager will vary depending on the severity of the case. Telephonic case managers perform their job remotely, while field case managers and catastrophic case managers may be involved in on-site incident investigations and meet with the injured employee face-to-face.

In general, it’s the case manager’s job to facilitate communication between all parties, including the injured worker, their employer and medical providers, and the insurance company’s claims adjuster. This includes:

  • Informing the employee about their options
  • Updating the insurance company about the care plan
  • Overseeing referrals for physical therapy or medical services
  • Ensuring care is provided in a timely and cost-effective manner
  • Navigating the return to work and ADA interactive process

Employers can outsource the work to a case management services provider or use a case management software solution to perform the work in-house.

Either way, it’s important to ensure that the case manager has the appropriate level of training and experience. More complex cases may call for a nurse case manager or a Certified Case Manager (CCM) with medical case management experience.

Benefits of Workers’ Comp Case Management

Case manager showing a document to an employee

As an employer, it’s your responsibility to document workplace incidents, report injuries to the appropriate state or federal body, and file a workers’ compensation claim. After that, many employers may be unsure how best to support an injured employee.

Having a standardized case management process in place can benefit both parties in three key ways.

Faster Recovery

The amount of time it takes for an employee to recover from an injury will depend on its severity as well as the quality of their medical care. Incomplete paperwork, mismatched expectations, and poor coordination between health care providers can all delay or impede medical improvements.

Effective case management can result in a faster recovery process by ensuring that employees receive appropriate treatment, attend their medical appointments, and understand their rights and responsibilities under employment law.

Employees who return to work faster typically have better health outcomes due to the increased opportunities for socialization and emotional support.

Improved Compliance

Workers’ compensation doesn’t exist in isolation, and in some cases, employees may also be entitled to short- or long-term disability insurance, or a leave of absence under the Family and Medical Leave Act (FMLA) or state leave laws.

Employers may also need to provide reasonable accommodation under the Americans with Disabilities Act (ADA). Requiring employees to be “fully healed” before returning to work is a violation of the ADA, so proactively offering a modified work assignment can provide a pathway back to an employee’s previous role.

Lower Costs

Hiring a case manager or developing an in-house case management process can be expensive, but it pays off in the long run. According to the National Safety Council, the average cost of a workers’ compensation claim in 2019-2020 was $41,353 and as much as $85,311 for those involving a motor vehicle accident.

By streamlining the workers’ compensation process, you can help employees recover faster and receive more efficient, cost-effective medical care. This benefits employees financially too because they can begin receiving their full salary again instead of the partial wage replacement they receive under workers’ comp.

When to Assign a Workers’ Comp Case Manager

Minor workplace injuries that don’t require ongoing medical treatment may not call for a dedicated case manager. But there are some situations in which medical management can make all the difference between a successful outcome and a drawn-out process that leads to chronic health issues or litigation.

Here are three situations that may require additional oversight from a case manager:

  • Serious injuries: Serious injuries, such as burns, eye injuries, and brain injuries, should always be assigned to a case manager. Not only do these cases require urgent medical attention, but they may trigger accident investigations and are more likely to result in long-term medical leave or disability claims.
  • Complex cases: Injuries that are not especially serious but that involve multiple health care providers may also benefit from ongoing case management. A case manager can streamline communication between doctors, physical therapists, and other health care professionals.
  • Extended absences: If an employee refuses to engage in the return to work process or is seeking out unproven medical treatments, a case manager may need to intervene. While you should never rush an employee into returning to work before they’re medically ready, you can conduct a utilization review to ensure they’re following an evidence-based treatment plan.

Other situations that may require a case manager are those in which the employee has made workers’ compensation claims before and those in which mental health plays a contributing factor. A case manager can identify any obstacles that are getting in the way of returning to work, including fears about workplace safety and reinjury.

Streamline Workers’ Comp Claims With Automation

Workers comp case management: senior woman talking to a case manager

Workers’ compensation case management involves educating injured employees about their options, facilitating communication between employers, health care professionals, and insurance companies, and coordinating the return to work process.

A case manager could be a registered nurse or a third-party service provider, but they could also be a member of your in-house HR team.

When handling workers’ comp case management in-house, it’s important to use claims management software that’s up to the job. Pulpstream is a no-code HR management platform that can handle workers’ compensation claims from beginning to end.

Use Pulpstream to document workplace incidents, manage correspondence with claims adjusters, and track workers’ compensation trends over time. Plus, with HR automation, you can reduce or eliminate manual tasks so that your case managers have more time to spend interacting with employees face-to-face.

Request a demo today and see how Pulpstream can streamline workers’ comp case management and improve HR compliance.