Workers’ compensation case management is used by many states to coordinate an injured employee’s healthcare and rehabilitation needs, with the goal of a full recovery and return to work. Case managers may schedule appointments and provide information, but involvement varies by state and may be mandatory for employers or insurance companies. Medical case managers are often registered nurses, and eligibility requirements vary by state.
Many states use some form of workers’ compensation case management to maximize the chances of an injured employee returning to work. This type of medical case management works to coordinate the injured employee’s health care and rehabilitation needs, with the ultimate goal of a full recovery and return to work for the employee. Among other things, the workers compensation case management system aims to ensure that an injured employee reasonably receives all necessary medical care related to his injury, so that he can make a full recovery.
Some examples of the functions a case manager may perform are scheduling appointments with physical therapists or specialists, locating convenient facilities where the worker can undergo medical tests or procedures, and providing information to the injured worker about his or her doctors or treatment. While some injured workers may welcome the assistance of a case manager, other workers may wish to handle their own workers’ case. An injured worker, however, typically does not have a choice whether to be involved in the workers’ compensation case management system. Rather, state workers’ compensation case handling laws and insurance company practices and preferences may affect whether an injured worker has the help of a case manager and how closely the case manager will be involved in the case.
The role of case management in a workers compensation system can differ from state to state, and state law generally prescribes the extent to which case management is required in a given workers compensation case. In some states, for example, employers must use medical case management for outstanding workers’ compensation claims to receive benefits. In other states, employers or their insurance companies may hire medical case managers to handle their workers’ compensation cases, but it’s not mandatory. Some insurance companies may even employ their own medical case managers on a perpetual basis to handle workers’ compensation claims. As a result, medical case managers usually disclose their employment or employment relationship with the insurance company to the injured worker at the outset of the case.
The eligibility requirements to be a medical case manager also vary from state to state. Some states require medical case managers to be licensed or registered under state law if they want to work within the workers’ comp system. The medical case managers in a worker’s case management system are often registered nurses.
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