Nurse Case Management in Workers' Compensation

Any time a work related injury notification is reported a case is opened on behalf of the injured employee.

It’s essential that the case is managed by an individual who can oversee the treatment process. This helps to ensure that everything is completed in the most efficient and effective way possible, to assist the injured worker in achieving an outcome that benefits both the worker and the employer/insurer.

This is where Nurse Case Management (NCM) can be particularly useful for lowering the cost of Workers' Compensation.

What is Nurse Case Management?

A Nurse Case Manager is a trained and experienced registered nurse who acts as an advocate and facilitator of care. Generally, this nurse will have wide-ranging experience in a variety of medical disciplines, such as home health care, medical management, or discharge planning.

The NCM can then use this knowledge to map out a road to recovery which will inform and support the injured employee to recover and return to work and life in an optimal amount of time.

This knowledge and experience also helps the patient make smooth transitions from one level of care to the next, minimising the risk of fragmented care, and increasing the odds of rapid recovery. They are also able to refer workers to immediate medical and treatment support as required, for example using virtual doctor services for the remote and regional workforce.

An NCM can begin managing the case at any point during the claim process, although they are increasingly being brought on right when a new claim is filed. Our experience has shown that early engagement, information and guidance, supports the worker self care and increasingly without the notification/claim escalating

Case Management via Telephone

Sometimes regulators or insurers prefer their NCM to function as a TCM, or a Telephone Case Manager. For this type of work, strong telephone and communication skills are required, as she/he uses telephone, fax or email as a primary means of connection with both care providers and the patient.

Telephone Case Managers can take on a larger workload than someone doing personalised intervention, since no time is spent travelling or meeting in person. They are often used for simpler cases which don't require a lot of face to face person to person interaction.

Personalised Intervention

The other style of Nurse Case Management is Personalised Intervention, which utilises the talents of an FCM, or a Field Case Manager. FCMs function as an on-sight nurse and advocate, and their skills are indispensable for more complicated or severe claims.

Field Case Managers rely less on phone or email, and uses in-person connections to communicate and build rapport. They do, however, tend to have a lighter workload than TCMs, because they spend more time travelling.

What are the Benefits of NCM?

No matter what approach the NCM is taking, a key requirement can be connection with the medical provider, employees and employer.

The purpose of this connection is to give the NCM a thorough understanding of what is happening with the claim, and to allow her/him to assist in formulating a recovery and RTW pathway plan that gets the employee back on the job as quickly as possible.

NCMs have become so indispensable in the process of workers' compensation that regulators and insurance providers are now bringing them in to claims right from the beginning, when in the past they may have only been brought in as needed.

But it is undeniable that Nurse Case Managers are consistently able to:

  • Empower workers and improve the customer experience
  • Prevent delays in patient recovery.
  • Omit unnecessary procedures from treatment plans.
  • Build rapport with patients and providers.
  • Increase insurance return on investment.
  • Bring down the cost of Workers' Compensation for employers.

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