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Rehab Nurses Risk Management Technique – 16 1/2 Suggestions

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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.

Picture Of Rehab Nurses Risk Management Technique In Black And White Color
Wikimedia commons – Ministry of Information

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.

    Rehab Nurses Risk Management Technique Taking Blood Pressure Of Patient
    123RF
  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.

    Picture Of Nurses Risk Management Technique In Line
    Wikimedia commons – Vlastimil
  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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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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