Field Case Managers – Workers Comp Claims Closed Faster and Happier

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Field Case Managers – Injured Employees Happier and Claims Closed Faster

This is National Nurses Day.  In celebration of the day, I wanted to bring up a subject that I have seen overlooked in quite a few Workers Comp files – Field Case Managers.  If you want to see nurses doing heroic duties, check out my articles on receiving my COVID-19 vaccination – amazing.

pic nursing students field case managers
(c) Wikimedia Commons – Vlastimil

One extremely overlooked area in Workers Compensation is Field Case Managers, or as I like to call them – Rehab Nurses.   A Field Case Manager does not have to be an RN or LPN, but most Field Case Managers seem to have a nurse background.  

I have written a few articles on field case managers where I called them rehab nurses.  They are a great risk management technique that also greatly assists the employees in their recovery.   

Field Case Managers / Rehab Nurse Definition and Duties

Field case managers are assigned by a Workers Comp claims staff to better facilitate the medical treatment in a Workers’ Comp claim.   The rehab nurses may also facilitate the return to work by an injured employee as a mediator (of sorts) between the claims department, employer, and treating physician.    

One of the main benefits of hiring field case managers comes from attending physician appointments with the injured employee to help them better understand their medical condition

Injured employees have often commented to me that the rehab nurse interpreted and distilled what their treating physician said to them. Having someone that you can call if the injured employee becomes concerned about their medical condition is priceless.   

Promoting trust was studied heavily by WCRI.  Dr. Savych’s studies name it as the more important component in returning to gainful employment. 

The field case managers may also assess the injured employee’s psychosocial factors.  No, they are not spies for the insurance carriers.  

One of the drawbacks that may concern some carriers is they are paid out of ALAE funds (Allocated Adjustment Expenses) which are not charged to the employer’s E-Mod unless they are under certain large deductible agreements. 

Self-insureds pay all the ALAE funds, so there is no difference in the charging rates. 

My Concern and the Numbers

Why am I writing this article besides Nurse’s Day?  When performing loss run and claim reviews on three different groups of claims, I noticed a hesitancy to hire field case managers by the adjusters even on what I would consider serious claims.  

Was it a lack of training or an attempt to save ALAE expenses? I noticed that often the claims supervisor would instruct the adjuster to bring in a nurse.  One some files, the adjusters would stop the rehab nurse services mid-file. 

Let us look at the numbers on using rehab nurses.  

Field Case Managers Return on Investment (ROI)

Most of the time whenever I have performed an ROI on rehab nurses, the ROI came back as almost 3.5 to 1.  For every $1 spent on field nurses, the file was reduced by $3.50.   No, I never performed an exact study.   This was a running tally in my head over the last 25+ years.  

Bottom Line – Field case managers save workers comp funds if they are used properly on the correct files. 

 

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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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