"We're the Missing Piece in Your Employee Healthcare Puzzle"
What is Medical Case Management?
Medical Case Management is a Work Injury Management Company. We works directly with a network of trained medical professionals to oversee and streamline workplace injury claims from inception to resolution through return-to-work. The company manages the process working directly with the treating medical professionals to establish processes and protocols proven to reduce employer expenses related to claims and minimize lost-time.
Medical Case Management (MCM) is involved in its management from the point of incident to reduce recordables through its 24/7/365 telemedicine hotline manned by workers compensation physicians. If an incident becomes a claim MCM will immediately work with the employer and the Third Party Administrator (TPA) to gather appropriate diagnosis information from the treating physician and begin a timeline protocol and Injury Process Management (IPM).
The Injury Process Management 30-day Return-to-Work/Case Resolution meeting is a “fail-safe” to ensure all injury cases have action plans aimed at Return-to-Work or other case resolution. Participants may include the Work Injury Coordinator, Regional Review Nurse, Regional Medical Consultant, Claims Adjuster, Corporate Attorney, and Process Coordinator.
By having this meeting, consensus on case resolution strategies can be achieved through discussion and information sharing. Whether a case is resolved with a Return-to-Work, or stops lost time through a non-compliant resolution, the overall negative financial impact of that case will be reduced.
Every 30 days, this regularly scheduled meeting will be held. The cases to be discussed, and any policy or process issues that need to be discussed, will set the agenda.
- RTW/FFD Policies and Procedures
- Worker Selection (WorkSTEPS®)
- Medical Management
- Functional Job Descriptions
Injury Management Process
Claim Processing – TPA
- Employer claims handling instructions
Claims Handling – Regional Review Nurse (RRN)
- Process Manager, Not Case Manager
- Key Information
- Treatment Plan
- Estimate Current Function
- Estimated Return to Work Date (Full Duty)
- WorkSTEPS® FFD (if necessary)
Claims Handling – Regional Medical Consultant (RMC)
- Interact with medical providers when appropriate
- Timeline protocols – Employer process
- Second opinion
- Dispute resolution
Provider Management – RMC
Working with the employer and the claims handler, Medical Case Management uses statutory/regulatory solutions as prescribed by various workers’ compensation laws as a means of resolving claims/cases. This is also compatible with Medical Case Management’s functional information approach in self-insured and non-subscriber scenarios.
- Procuring an Independent Medical Exam or second option – with a Fitness for Duty assessment – to resolve disputes about diagnosis, treatment plan, or functional capabilities
- Procuring a Maximum Medical Improvement (Vocational Stability Point) determination to bring the claim to closure
- Procuring an Impairment Rating for settlement
As part of our full-service philosophy, Medical Case Management provides legal support to employers using its program. Medical Case Management’s legal staff is available to assist in the development of corporate policies and procedures covering Pre and Post-Offer Employment Testing, the Family Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA), ERISA plans, and other matters that may arise in the implementation of integrated services. Medical Case Management’s legal staff will interact with your corporate counsel, or outside counsel, as requested.
Specific case-resolution legal strategies can be formulated based on information gathered through the Injury Process Management system. Non-Compliance with treatment plans and functional evaluations will be documented. Declined restricted duty and return-to-work offers will also be documented, and will provide valuable information for legal intervention in the case of arbitration or law suits.
Long-term accommodations will be considered when an employee, based on functional status, cannot return to full duty. Accommodation is any change to the work environment, or the duties of a job, that permits an employee to productively return to his/her regular work assignment. This may include:
- Acquiring or modifying tools or equipment
- Exchanging or reassigning job duties with other employees within the same craft
- Modifying work schedules
If an employee, based on functional status, cannot return to full duty and cannot be accommodated, the employee will be terminated and vocational rehabilitation considered. This may include:
- Transferable skills evaluation for placement in another job
- Vocational assessment and/or training
The overall goal of the Return-to-Work policy, procedures, and team is to prevent the employee from becoming disabled, and to insure the employee returns to work at the most productive level for his/her functional capacity.
3019 Alvin Devane Blvd., Suite 150