Case Management Focus: 8 Tips for Return to Work

Sarasota, FL (WorkersCompensation.com) -- Case Managers are in place as liaisons between the injured worker, the employer, the treatment team, and the insurance company. The goal of a case manager's involvement is to coordinate medical care and find the resources to aid the injured worker in return to work.

To accomplish this, case managers much juggle multiple responsibilities and build relationships between the injured worker, the employer, the treatment team, and the adjuster. It is not an easy role, but when everything clicks, the injured worker wins, the employer wins, and the insurance company wins. In addition, we can assist injured workers with their injuries, limit lost time, contain medical costs, and avoid attorney involvement. Here are some tips I have found helpful in my career as a workers' compensation nurse case manager.

1. Answer the Question How Long am I going to Miss Work? When faced with an injury, most of us immediately look at the injury's impact on ourselves and their families. When an injury occurs, the injured worker is afraid and worried and wants to know what will happen to them. The injured worker is in a place where they are unfamiliar and have people working on them that they do not know and may not trust. Also, they are worried about how they and their families will make it if they can’t work for a period. Most people do not have a financial reserve in place for emergencies, and if they do, it will run out quickly, so returning to work is essential, even if the injured worker that it is in their best interest.

When I meet an injured worker, I let them know my role is to help to understand what is happening and that I am there to coordinate care so they can begin to heal and return to ‘gainful’ employment when ready. Gainful employment means returning to work within the restrictions that the doctor and the injured worker set because of restrictions from the injury. I informed the injured worker that I am their advocate and will work with him until they are medically stable and can return to work. I am available and encourage injured workers to call me anytime for questions or anything they are worried about. Over time this strategy helps me build trust as I show clients that I care about them and in place to break down barriers that can cause setbacks and delays in care.

2. Focus on Recovery. I stress to Injured Workers to focus on their Recovery and minimize distractions that take them from their goals.

3. Be Proactive. Get in front of challenges to offset any barriers or issues that might interfere with the plan of care. This may mean setting up transportation, expediting a diagnostic test, or making an appointment with a specialist. Doing these things helps avoid delays in care which will lengthen Injured Workers' ability to return to work.

4. Listen to Your Doctor and Other Team Members. I stress to the Injured Worker to ask questions of the physician involved in their care and the other team members, such as the therapist. Doing this empowers the injured worker to be an active team member, which gives them buy-in to the care plan. As an onsite case manager, I attend physician meetings with the client. If I can't participate in a meeting, I review with the Injured Worker what questions they want to discuss with the doctor and therapist on their appointment. I send a note to those involved, so we are all on the same page. I ensure the injured worker understands things, and if they don't, we review things again until they are clear. If the family is involved, I involve them because being injured impacts the injured worker and the family. Encouraging the Injured Worker to be active in his case vs. a passive observer helps them gain the control they have lost due to the injury.

5. Stay In Touch with the Employer. I encourage the injured worker to stay in contact with his employer and co-workers. I also encourage the employer to keep in touch with the injured worker so lines of communication are open and no hard feelings form due to the worker being off duty. Being isolated can make the injured worker feel abandoned by the people he works with.

6. Don't Go Back Before You're Ready. I ask if the injured worker is medically ready to return to work at each doctor's appointment. We don't want the worker to return to work too early, which could cause a re-injury. I also talk to the therapist to gain their insights.

I talk to the employer to see if they have light duty and, if so, what that would be so that I can check with the doctor on the next appointment. Return to work is up to the doctor, but everyone needs to be part of the decision. 

7. Ask for Accommodations/Work Restrictions. Depending on the injury and what the residual will be, I ask the doctor and the rehab team if there will need to be any accommodation necessary for the worker to return to work. If so, I communicate this with the employer, the adjustor, and the injured worker, so everyone is on the same page. 

8. Options to Return to Work. Depending on the injury, the type of work the injured worker did before the injury may not work for them now. Also, the work available from the original employer may need to meet the injured workers' capabilities. This would be a time to call in a Vocational Specialist to evaluate the injured worker and see what transferable skills they may have. Testing may have to be done as well as retraining. Calling in the vocational specialist adds another layer to the case but can be helpful if the injured worker cannot return to the original job.

Being proactive and keeping return to work in mind on a workers' compensation case is essential so that when the injured worker is ready to return to work, we will have options that everyone can buy in.

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