Rehab Nurses As a Great Risk Management Technique

One of my long-standing Risk Management technique is the prudent use of medical and vocational rehab nurses (also known as case managers).  A great in-field rehab nurse can save thousands if not tens of thousands of reserves and payouts on a file.

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Our clients have actually sent in files that have reserves on them of over $200,000 (quite a large portion already paid) with no rehabilitation nurse assigned.  We had a group of 20 of them last year.The usual return on investment (ROI) has been 7 to 1 for the cases I have studied over the years.  That is not a bad investment – if used properly.

Many years back I actually worked for a carrier that did not allow nurse assignments “as the adjuster” could handle it.   In another insurance carrier position, I vehemently protested assigning a nurse to each file.   That, to me, is overuse of a good risk management technique.

I have always used these suggestions as a guide for assigning medical rehabilitation nurses (if you have any more suggestions, please comment):

1. Make sure the nurse is familiar with the surrounding territory and medical practitioners involved with the file.  Familiarity will save much time, aggravation, and $$.
2. Make sure that at the rehab nurse assignment time, the nurse receives ALL medical reports even if they are physical therapy notes, etc.  This will save you many headaches down the road such as having to dig through a file to find a note to send that was crucial last month.
   

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3. Similar to number one, make sure the driving times are no more than 1.5 hours each way. If a rehab nurse is sent three hours away, most companies do charge hourly and mileage.  You do not want to receive a massive rehab bill.  I still remember having to explain a $3,000 rehab  bill to an insured client.  That was not pretty.
4. There are triage rehab nurses for very serious claims.  A great triage nurse will enhance the medical control from the hospital to MMI.  Triage nurses are much more expensive than regular rehab nurses and worth it.
5. Listen to what your rehab nurse says as sometimes that info is not necessarily going to be in the report.  It may seem trivial at the moment.
6. Read the rehab reports – usually a summary section if you are overloaded.
7. Rehab nurses are not adjusters and vice-versa.
8. Plaintiff attorneys are starting to scour over the reports presently.  If you want to be on the same playing field as the attorney, you will have to read the report beyond the summary.
9. Some rehab nurses are better at certain things than others – almost goes without saying.
10. Along with #7, the claims staff needs to control the file.   The rehab nurse needs to be a team member, not the controlling factor except possibly for triage nurses.
11. Do not move any rehab nurse calls or reports to the bottom of your to-do list.  This can cost you dearly on the file.
    

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12. Breaking with my communication recommendations, I would say that phone calls may be the best way to communicate with rehab nurses.
13. There are certain legalities that come with rehab nurses that vary night-and-day state to state. If you are dealing with a multi-state claim, this may become complicated.
14. The cardinal sin – forgetting to have the rehab nurse cc:  the plaintiff attorney on all reports.  This can sour any later dealing with the plaintiff attorneys.  If you have an attorney on the file, then they should also be cc:’ed.
15. There are state-by-state peculiarities that may not agree with this list.  I was looking at more of a national scope.
16. I know all fifteen of these as at some time, I have broken all of them – and sometimes lived to regret it.
17. Bonus – the rehab nurse usually summarizes the medical reports – a real timesaver if you do not want to read every medical report.

I did not exactly cover vocational case managers.  The list would be very similar. This list was growing long enough.

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