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Workers Comp Field Case Managers Now Even More Critical


Workers Comp Field Case Managers Post-Pandemic Critical Claims Component

Workers Comp field case managers, also known as rehab nurses have become even more critical in injured employees’ return to gainful employment and claims resolution.  Why? – Let us take a look.

I recommend reading one of my old articles on rehab nurses. That 10-year-old article has stood the test of time as most workers comp articles do even a decade later.

I wrote another article just last year on hiring Field Case Managers on workers comp files.  

pic of workers comp field case managers rehab nurses
(c) IMS Vintage Photos

Claims Review Shows Benefit of Using Workers Comp Field Case Managers

Some of J&L’s clients – larger employers, agencies, and especially self-insureds tasked us with doing full claims reviews looking at the files from a Risk Management view.

One area that we noticed a large group forming was the injured workers that refused or had hesitancy to return for in-person medical treatment.  I am including malingerers in the group – no differentiation.

The files that had a rehab nurse assigned returned to work more quickly even the claimants that were hesitant to return to their treating physicians.  Most of the Workers Comp Commissions sided with the injured workers that discontinued treatment during the pandemic.

Strikingly, the injured workers with a workers comp field case manager assigned rarely discontinued treatment or sought other avenues of treatment such as video appointments with the physician. The managers became motivators.

Claims Department Hesitancy To Hire Rehab Nurses

One of the most prevalent hesitancies was not the claimant hesitating or refusing medical treatment.  The workers comp claim departments seemed to hire rehab nurses only for the most severe injuries.  A non-serious injury can end up as a serious long-tail workers comp claim without the proper medical direction.

As I have pointed out in the prior two articles (see above links), the ROI of hiring a workers comp field case manager is $1 spent resulting in $8 of lowering the claims risk.   I have measured the ROI over the years.  The $8 to $1 ratio remains the same if the claims department hires the right rehab nurse.

Why So Critical Now?

The National Institutes of Health/CDC referred to a study that showed this eye-popping data. By June 30, 2020, 41% of adults in the United States (U.S.) reported delaying or avoiding medical care due to COVID-19 concerns ()

The 41% figure does not represent the data set for Workers Comp.  The number may be less and the pandemic may be over, but what percentage of workers comp patients are now seeking care?

A rehab nurse even on the smaller claims seems to be good Risk Management as the whole medical system recovers from a tidal wave of patients post-pandemic including injured workers. I am not saying that every lost time file should have a rehab nurse assigned to it.

Then again, even at an ROI of $3 to $1 spent, the savings and the injured worker benefit would seem to result in more field case managers on the claim files.



James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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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