Choices Solution Center

Workers' Comp Case Warning Signs
(or, When to Consider a Nurse Case Manager)

When a case shows one or more of these signs, intervention by a nurse case manager should be considered:

1. Catastrophic Injury (head injury, broken bones, motor vehicle accident, etc.)
2. Surgical case (setting up recovery from the beginning)
3. Primary treator is a chiropractor
4. Over-treatment by physician
5. Injured worker is treating with a physician who is known to be uncooperative and/or tends to prescribe too many medications. Or does not provide proper medical documentation in a timely manner
6. Minor strain is over 30 days old and not resolving
7. Injured worker has had multiple claims in the past
8. Injured worker has other medical conditions which could effect outcome of work related injury
9. Injured worker is changing doctors repeatedly
10. Physician is not reporting, communicating or cooperating with examiner
11. Psych/Stress claim
12. Physician is "holding the claim hostage" until he gets what he wants
13. Progress is not being made by injured worker
14. Case is open too long and not moving forward
15. Physicians who will not address light duty (they won't address what the injured worker "can do" - will only say what they can't do) and employer has modified duty/light duty program
16. Injured workers who speak a language other than English, or who have anything that makes understanding the workers' compensation system difficult. Without help, many will hire attorneys when all they needed was a nurse to assist
17. Suspect injury may not be industrial related