'"Creating and implementing an effective case management program."

By R. Bruce Wright, CPCU

When we visit systems that have their Workers’ Compensation coverages with our program we often ask about their “Case Management" program. This article will offer an expanded explanation of what an effective case management program should contain, the potential benefits to you as an employer, some practical ideas you may want to try, and why each of the techniques is important to creating and implementing an effective case management program. But first, what do we mean by "Case Management?"

Case management is an umbrella term that refers to all of the efforts an employer makes to ensure that an injured worker receives both all the appropriate medical care and all indicated non-medical support needed to return to productive employment as quickly as possible. An effective case management plan includes access to effective and educated medical providers who understand (1) the treatment needed for typical utility related injuries, (2) the nature of the work your employees actually do and (3) the environment in which they do it. Case management programs also typically provide "light duty," or restricted duty work, to employees who have healed enough to do some tasks, but not enough to perform all of the duties of their regular jobs. Case management also includes having management follow up with the medical providers, the adjusters, and with the injured employee, while the employee is under treatment. Finally, case management works best when a communication plan is established in advance to facilitate the exchange of information among the employer, the chosen medical provider, and the claims adjuster. Let's take these elements one by one and see what they each really consist of.

Provide access to effective and educated medical providers.
In some states, as an employer you have the right under the state's workers' compensation laws to direct employees to a medical provider of your choosing for the treatment of any on-the-job injury. Other states do not give the employer this option and let the employee choose. Either way, you as the employer should identify and select a local medical facility to treat your injured employees. You should select a clinic that has experience and expertise with occupational health issues with access to rehabilitation and physical therapists who understand the needs of patients with traumatic injuries. If your state permits you to direct employees to the provider you select, the selection of a qualified provider will ensure that your workers will receive the best available care for their injuries. If your state does not permit you to direct employees to a facility, it still makes sense to do this homework and let your employees know that you have established a relationship with a provider who is an expert in the care of the particular injury types that they may be exposed to. Often an employee may not have a doctor in mind, or if even if he has a "family doctor" he may believe that using an expert provider who knows about the type of injuries that occur in the business would be a better choice. If you select a clinic that is conveniently located and user friendly, this will increase the chance that your employees will choose it rather than seek treatment elsewhere on their own. Another advantage to doing this is that you can establish an on-going relationship with your clinic and its staff. By using the same clinic to do your pre-employment physicals and other routine employment-related medical testing, you can develop a close working relationship with the clinic while giving your employees an opportunity to become comfortable with the clinic and its staff. Before deciding on a provider, you should visit the facility and make some observations of your own on how they treat their patients and what type of atmosphere their medical professionals promote. Once you choose a provider, you should meet with the clinic's management and/or the chief medical officer to make sure they know what your company does, what your employees' work actually consists of, and what the work environment is like. You will also want to discuss with them your Return to Work program to be sure that they fully understand the types of "light" or restricted duty jobs you have available. The more the doctors know about your early return to work plans and about the jobs that you have available for employees who recovering, the more likely that they will feel comfortable releasing a worker back to limited work duties within their restrictions.

Design a "light" or restricted duty plan.
A case management program includes a plan to offer restricted duty work to all employees who are recovering from an injury and who are well enough to work, but not well enough to return to their regular jobs. Obviously, if you are going to discuss this with your chosen medical provider, you have to decide what limited duty jobs you have or can make available before anyone is hurt! Planning is needed to ensure that the restricted duty jobs are valuable and productive, and not simply "make work" jobs. If you are going to have an employee come back to work at a restricted duty job, you want that job to have value to you and not be more trouble than it is worth. Equally important, injured employees who are given restricted duty jobs will quickly recognize if they are being given "real" work to do or just "busy work" to force them to be in the office. If the injured worker sees that you are serious about keeping him employed in some useful task, regardless of his limiting injuries, the response will to be far more positive than he thinks that you are trying to force him to report to work without having anything productive to do. The statistics are clear: In our program, a worker who returns to some form of productive work, even if it is limited in the duties he can perform, will heal in half the time of a worker who stays at home to heal. Many employers say "I can't afford to bring a skilled worker back at full wages to do general labor or office work, and I can't bring them back at a reduced wage." There is another option! In most jurisdictions you can bring a skilled worker back to a less skilled job, pay the worker only at the fair market rate for that job, and the adjuster will pay a pro-rated, reduced workers' compensation benefit to the worker. This way the worker is kept "whole" and you are not paying more for the job than it is really worth.

Provide for management follow-up.
A case management program requires regular follow-up by management with the injured worker, the medical care provider, and the adjuster. In a small system the person doing the follow-up may well be the GM while in a larger company a field superintendent may be the right person. Either way, keep in mind that the person calling the employee should be in that employee's direct chain of command. While having someone in HR or an office manager assigned to do this follow-up is better than not doing it at all, it will have far more impact if the person calling is in the worker's direct chain of command. The call is not merely an attempt to remind a worker that you know he is off work with a workers' compensation injury, but it is an opportunity to show workers that:

1. You know they are out with an injury
2. They are missed by the boss and co-workers
3. The company has an interest in their progress toward recovery
4. You would like to do whatever can be done to assist him in the recovery process
5. And, you have a light duty job for them as soon as they are able to handle it.

These messages mean the most when they come from a "boss." Of course, this is easy to say, but much harder to do. In order for this follow-up to work, you must be committed to the goals outlined above. If you are simply interested in "snooping" on the worker, that fact will come across in the conversation loud and clear, and workers are certainly bright enough to recognize when they are being hit with a snow job. So, if the injured employee is new, don't say how much everybody misses them. Instead, focus on how concerned you are that a new employee got hurt, how you want to have a chance to have them back soon, that you want to provide any additional training that might be needed, and that they will continue to have a chance to work with you and their coworkers. You may feel a little awkward the first time you try this, but that's normal. Like any new skill you try, the first time you try it, it will feel odd, but if you stick to it, you will become more comfortable with it. Remember, this is not only the best way to ensure that your employee gets back to some productive work, but also the best way for you to promote a full and prompt recovery. Remember, employees who come back to limited duty jobs heal in half the time of those who remain at home!

Follow-ups with the treating physician and the adjuster are also important. You should talk regularly to the doctors involved in treating your injured employees, both to learn from them the progress that they are making, and to let them know that you have a concern for your employees and have light duty work available for them to return to as soon as they are physically able to work within any restrictions that the doctors suggest. Contact with the adjuster allows you to find out how the insurance company thinks the case is progressing, gives the adjuster a chance to fill you in on plans to move the claim long, and lets you demonstrate that you are watching the progress of the case closely.

Create a comprehensive communication plan.
Although this is listed separately it is included in everything we've said so far, and is actually the first thing you need to think about. Right from the start, you should communicate your philosophy toward dealing with on-the-job injuries to all your employees. This should focus first on the goal of providing prompt, appropriate treatment for any injury, and you will want to let your workers know that you have done your homework, researched the local providers, and identified a medical care facility that specializes in occupational health issues. You should also let them know that you have restricted duty jobs available, jobs that need to be done but can be carried out by someone who is not fully physically fit enough to return to their regular work tasks. Let everyone know that if they are out as a result of an injury for any length of time, you will be in regular contact with them to see how they're doing, and to see what you can do to assist them in their recovery period. Your internal communication plan should also set out precisely who in your management structure will be responsible for contacting employees who are off work with an injury. Your entire management group should understand your case management plan, who is involved, how it works, what the purpose is, and when to activate the plan. They must be able to communicate to their direct employees, with conviction, what you have in mind. Your external communication with medical providers should cover the selection and education issues discussed above, including information about your limited duty jobs and your willingness to modify these jobs as needed to suit specific cases. This plan should also include contact with the assigned adjuster before you have any claims, if for no other reason than to introduce yourself and your company, and convey your interest in the process to the adjuster. You can also review any special requirements that you may have and make sure the adjuster knows who to contact at your company if they have any questions on a claim.

So, this is what case management is-- a plan to provide workers with the best appropriate medical care, to return them to work as quickly as possible, to a limited duty job as appropriate, to follow-up with injured workers, their doctors and the adjuster during the period when the worker is temporarily totally disabled and cannot work at all, and to have and use a communication plan for everyone involved, internally and externally. And, even after you have done this, you will still need to monitor the results and make adjustments as needed. You will need to regularly reinforce the program in training meetings, as well as provide information on the policy in your orientation program for new employees. Clearly, putting all this in place will take some effort, but since you know that the costs of your employees' injuries ultimately find their way into the cost of your insurance, it should be equally clear that if you can save half the cost of an injured worker's recovery time, your investment in case management should save you money in the end!