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Medical Case Management

Workers' compensation medical 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 also for lost productivity. The medical case management specialist is usually the liaison between the injured worker, employer, claim representative, physician, and often the attorney representing the injured worker.

Novare On-Site Medical Case Management

On-site medical case management can provide a wealth of information that may be needed later if the case becomes complicated by the necessity for surgery, home care services, or job accommodations. On-site medical case management enables and facilitates integrated treatment plans that for difficult cases are the only way to achieve the combined objectives of quality care, return to work, and cost effectiveness.

Medical Case Management Coordination of Services

IME-Independent Medical Evaluation
Second Opinion
Peer Review
Functional Capacity Evaluation
On-site Medical Case Management: Limited or Full
Confirm assignment within 24 hours
Provide Initial Case Activity Form on all full medical case management assignments within 72 hours of referral
Contact injured person and physician within 48 hours
Contact employer within 72 hours

NOVARE RED FLAGS FOR MEDICAL 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 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 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
Unusual medical conditions

Toll Free: 866-532-1929
Phone: 985-845-4548
Fax: 985-845-9913

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