Our team of nurse case managers can assist you in returning employees to the workplace healthy and productive. This in turn will help reduce your injury and disability related costs. Workers' compensation case management focuses on returning the injured worker to work as quickly as possible since the direct and indirect costs of a claim can be high for an employer. The employer is paying not only for the medical and wage replacement benefits, but for lost productivity. The nurse case manager acts as the liaison between the injured worker, employer, claim representative, healthcare providers, and often attorneys that may be involved as well. Case management can provide a wealth of information essential for for good claims management. Case management facilitates integrated treatment plans to achieve the combined objectives of quality care, return to work, and cost effectiveness. Coordination of Services IME-Independent Medical Evaluation Second Opinion Peer Review Functional Capacity Evaluation RED FLAGS FOR CASE MANAGEMENT INTERVENTION Relationship of accident to injury is unclear Medical guidelines indicate the treatment may be excessive Treatment plan is not clear or definitive Lost time over 30 days Indications exist for an Independent Medical Examination (IME) Multiple medical conditions with multiple diagnoses exist Treatment is unusual or excessive Multiple medical providers and ancillary services Possibility of pre-existing conditions Delay in return to work Medical and non-medical issues seem to complicate recovery Recovery is slow without medical indication Medical treatment does not correlate with accident, injury or disability facts Treating providers have failed to provide medical information or clarification despite requests Failure to follow the medical treatment plan Unwillingness to communicate by the claimant or physician Unusual medical conditions Suspicion of intervening incident Failure to move from light duty to transitional or full duty Catastrophic injuries