Tips on Maintaining Control of Catastrophic Workplace Injury Claims

By Denise Johnson | July 13, 2017

Catastrophic injuries impact the severity and complexity of workers’ compensation claims. In a two part Inside Workers’ Comp podcast series, Genex’ Laney Bond discussed how catastrophic workplace injuries can derail claims.

Bond, national catastrophic program manager for Genex, outlined four ways catastrophic injuries differ from other workplace injuries:

  1. Witnessing and dealing with a catastrophic injury will impact daily workplace operations.
  2. Financial impact to the employer and insurer.
  3. Accountability to government agencies, like the Occupational Safety and Health Administration.
  4. Separating pre-existing injuries and co-morbidities.

Common issues that cause a catastrophic claim to go off track include poor communication among those handling the claim.

“For instance, when there’s an attorney involved, and they’re restricting case management communication directly with the injured worker, that can really delay and minimize the impact the case manager can have,” Bond said.

A case manager can help facilitate communications between medical providers and the insurer, she added.

Another issue that can derail a claim is when inappropriate medical care is provided or when medical care is delayed.

“There are times where there is delayed care right at the onset of the injury,” Bond said. “There can be an issue with ground transport. There’s also issues with delays in medical care that carry on throughout the claim. For instance, when you have a lack of approval or of a provider providing a guarantee letter of payment before they’ll start treatment. These things can be mitigated if we keep the communications flowing more smoothly.”

Bond offered three tips to maintain control of catastrophic claims. The first is to maintain good and consistent communication among “the injured worker and their family, doctors, hospital staff, employers, carriers, attorneys, and any other party that may be involved, like a TPA.”

In addition, it’s important that appropriate medical care not be delayed in these types of cases.

Lastly, lag time in engaging catastrophic case management can hinder return to work and maximum medical improvement. Both, she said, are “best achieved when catastrophic case management is assigned within the first 30 days following a catastrophic injury” adding that “These outcomes decline dramatically when there’s a lag time of 60 days and become actually negligible by the time we hit 90 days.”

Catastrophic case managers offer unique benefits to injury management, Bond said.

“They have keen assessment and analytical skills necessary to provide early intervention on complications. They also have instant knowledge regarding the chain of communication in these hospital settings and know how to access essential medical information and records,” said Bond.

Because they must report to multiple parties, including attorneys, insurance personnel and employers, they are adept at providing medical information in an easy to understand way.

Bond said they can tie in all the various providers and treatments, identifying and removing barriers to recovery.

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