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How Nurse Case Managers Add Value to WC Claims

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CM3: How Nurse Case Managers Add Value to Workers’ Compensation Claims

Workers Comp claims a nurse case managers and add value. Mary O’Donoghue, Vice President, Medical Services Helmsman Management Services

Picture of Nurse Case Managers Medical & Health Management
Wikipedia – Rosie.Andre

Stephanie Perilli, Senior Director, Medical & Health Management The Home Depot

November 12, 2015 8:30 a.m. – 9:45 a.m

Nurse Case Managers (NCM) have long been a recommended WC claims management technique as recommended by J&L often.  The right case managers can reduce the cost of claims greatly.

This is a chart that shows the value of a nurse case manager as a claim lengthens by comparing the claim costs with and without a nurse case manager.

There are instances where a NCM may not provide value such as an injured employee with no comorbidities and a great relationship with the employee<<I thought that was a great point of emphasis.

An employer-based study compared shoulder surgery claims with nurses to similar claims from 31 other companies that did not have a nurse assigned. Claims with a nurse assigned had 57% fewer disability days.   From my experience, this is a valid %. 

Home Depot uses nurses in these instances:

  1. Unique intervention based on assessed needs of our population
  2. Targeted case management strategy beyond catastrophic cases
  3. Clear and concise integration of all medical resources

That was a nice summary list.

Home Depot calculated they are experiencing a 12% reduction in claim payouts when an NCM is on the file.

This was a good presentation on Nurse Case Managers.  I have even seen larger reductions in claim values when a nurse is involved on the file.  The key is to know when and whether or not to assign a  NCM.

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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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