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.
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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