Choices Solution Center

Resolving Languishing Cases

Overview
Our nursing staff routinely sets up appointments for the inured workers. If left to the injured worker to do, they may put off being seen and stretch the time out between treatments or follow-up doctor's appointments. This can lead to delays in return to work and claims that are lasting longer than they should. We get them in and seen in a timely manner so there is no lapse in treatment and time delays.

All delays (delay in medical treatment, delay in return to work, delay in follow-up appointments or consultations) result in increased claims costs to the employer and carrier. Our goal is to remove or limit those delays. This happens with improved communication on the end of the nurse and excellent time management skills. We limit our nurses' caseloads (our nurses work less cases than any other company we know) so that they can be above the rest when it comes to managing the medical process, communicating and minimizing these delays.

Sometimes, resolving a languishing case just takes doing whatever is necessary, as the second case study example demonstrates.

Case Study Example #1
An injured worker was to return to work, but first the MD ordered a facet block injection for the injured worker for pain relief. The Choices nurse was able to get the injured worker in for treatment within 48 hours from date the MD ordered, enabling the injured worker to return to work within one week. This intervention saved lost days from work as it would typically take 2 to 4 weeks to get in and be treated.

Case Study Example #2
A claims examiner who had a languishing (long open) case was not able to close it due to a treating physician not providing a permanent and stationary (P&S) report. A Choices nurse was asked to do a "task assignment" (a one time request) to meet with the physician and obtain the P&S report. The nurse met with the MD who promised the P&S report in one week. The nurse returned to acquire the report at the promised time and the MD did not have report done - citing an excuse that her typist had quit and she had a pile of reports that needed typed. The nurse volunteered to type report while the MD dictated. The nurse left the office with P&S report in hand and signed that same day, and hand delivered to the carrier (claims examiner).

Result: The case was closed in less time.

Services we provide to TPAs, insurers and other claims professionals include:

  • Workers’ Compensation Case Reviews
  • Field & Telephonic Case Management
  • Catastrophic Case Management
  • Utilization Review
  • Task / Limited Assignments
  • Early Return-to-Work Assessments & Programs
  • Early Intervention Programs
  • Ergonomic Evaluations & Prevention
  • Job Descriptions & Analysis
  • In Service Training for Employers, Physicians and Treatment Teams
  • CEU Program for Nursing Staff

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