Choices Solution Center

Case Management Issues of Special Note

Physicians who are holding claims "hostage" because of Utilization Review.
Physicians who are having treatment orders denied by the UR process will sometimes refuse to address return to work or even deem the injured worker permanent and stationary because their requests were denied through the UR process. This ties up the claim and ends in delays in treatment, a delay in recovery, and ultimately, a delay in closing cases. Nurses can impact this process by working directly with all parties and improving communication (we excel in "Integrated Team Management"). They are great negotiators in all aspects of this process.

Public Police Officers and Firemen
Police officers and firemen receive special pay for when they are out on temporary disability. This fact has increased the amount of time that they will be off. It is called 4850 pay (a provision where they are paid there normal salary (tax free) for one year) Most of us who have an injury at work and are off work receive a reduced rate 2/3s of our normal pay. We currently work a lot of these cases for the cities and counties because of this and do an excellent job returning these types of workers to work through nurse intervention with the physician and the injured worker.

Language Barriers
An injured worker who cannot understand the claims process, speak a different language etc. will often get an attorney because they do not understand how to maneuver in the difficult workers' compensation arena. Having a nurse on those files can prevent litigation and save money.

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

6 Signs It’s Time
When is the right time to consider bringing in a nurse case manager? What difference can a nurse really make in speeding case closure?


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Food For Thought
Ask about Lunch & Learn seminars and training workshops in your office! Current topics presented at no cost by our subject matter experts. CEUs available.

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Case Closed Solutions Blog
The answer you’re seeking might be here! Find concise solutions to real-world challenges faced by claims professionals and employers.

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