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Case Management – What Does The Term Mean In Workers Comp?

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Term Of the Day – Case Management

Case Management in the Workers Comp arena used to mean rehabilitation nurses or vocational experts that aid the injured employee in his/her medical care and return to work.

Picture of People Cross holding Hand Case Management In Workers Comp
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Case Management now seems to have become a buzzword that can actually mean anything from an adjusters to work to the medical bill review department.

This is from some older literature when case management meant health management in Workers Comp. Case Managers are usually RN’s, but not always. Their responsibilities are:
  • Assist employers in decreasing worker’s compensation and health care costs
  • Meet with the injured worker and the employer and complete a job evaluation
  • Coordinate injured workers’ return to work by acting as a liaison between the worker, the physician and the employer
  • Identify treatment plans, oversee medical care and monitor an injured worker’s progress
  • Keep the employer and the insurance company informed of pertinent progress, return-to-work status and treatment recommendations
  • Provide telephone case management as necessary
  • Serve as a source of information for the injured worker, the employer and the physician
  • Provide detailed reports for the employer and the insurance company and to the employee’s attorney, if represented.
Group Of Employee Case Management Standing
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A Vocational Case Manager is totally different. Their services include:

  • Coordination with the client, referral source, physician, employer, attorney and others with the ultimate goal being the client’s timely return to gainful employment.
  • Interviews and evaluates the client to determine the degree of disability, eligibility and feasibility of vocational rehabilitation services.
  • Determines suitable job goals consistent with the client’s interests, aptitudes and physical limitations.
  • This includes completing vocational evaluations, labor market surveys, job analysis, on-site job evaluations.
There are some case managers that are both a medical case manager and/or a vocational case manager. I have seen few, if any, that combine both disciplines.
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Table of Contents

James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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