The Latest and Greatest! Case Management Strategies: The Latest and Greatest!

Duties of the Adjuster Determine Compensability Facilitate/Coordinate Medical Treatment Control the Cost Establish goals for Recovery, Return to Work and Resolution

Strategies Employer Involvement Employee Involvement Medical Management Nurse Case Management Return to Work Programs Surveillance Vocational Rehabilitation

Employer Involvement Establish a good working relationship with the Employer Keep the Employer involved at every stage Encourage Employer to communicate, document, and notify carrier of any changes or development throughout the Recovery and RTW process Develop a RTW Program

Employee Involvement Keep Lines of Communication Open Communicate goals and Expectations Establish Goals for Return to Work Contact Employee regularly throughout the Recovery Process Build and Establish Trust

Medical Management Physician Choice Forms Medical Release 2nd Opinions EME’s Communication DME Provider Bill Review / Network Provider PBM MSA / Annuity

Nurse Case Management Catastrophic Injury Brain Injuries Accidents involving multiple injuries Out of State Injuries Select Physicians

Return to Work Program Physician Selection Modified Duty Restriction on Activities Restriction on Time Worked Establish Policies Inform New Hires at Orientation Complete job description for each job

Effective Comparison Two 60 bed facilities Facility A – Not Committed to their RTW Program Facility B – Fully committed to their RTW Program

Facility A Facility B Summary: 2008-2016 Total Premium 1,006,601.00 Losses 440,592.18 Dividends 41,501.29 Lift/Equipment 42,501.82 Summary: 2008-2016 Total Premium 688,428.00 Losses 65,842.00 Dividends 244,648.54 Lift/Equipment 28,496.62

Surveillance Activity Other Employment Background Check Social Media

Vocational Rehabilitation Job Analysis Labor Market Survey Job Placement Assistant Transferable Skills Analysis Job Retraining Coordination of On the Job Training

Conclusion