Return to Work: A Key Role for Workers Compensation Case Managers
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 is to coordinate medical care and find resources to help injured workers return to work.
To accomplish this, case managers must juggle multiple responsibilities and build relationships between the injured worker, the employer, the treatment team, and the adjustor. 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 help injured workers with their injuries while attempting to limit lost time, control medical costs, and avoid the need for attorney involvement. Here are some tips that I have found useful in my career as a workers’ compensation nurse case manager.
- Answer the question, “How long am I going to miss work?” Most of us, when faced with an injury, immediately look at the impact of the injury on ourselves and our families. When an injury occurs, injured workers are afraid, worried, and uncertain about what is going to happen to them. Injured workers have people working with them that they do not know and may not trust them. They are likely worried about how they and their families will make it if they can’t immediately return to work. Most people do not have adequate financial reserves in place for emergencies, so return to work is important even if the injured worker does not realize it initially. When I meet injured workers, I let them know that my role is to help them understand what is happening and to coordinate care so they can begin to heal and return to ‘gainful’ employment when appropriate. Gainful employment means returning to work within the restrictions that the doctor assigned because of the injury. I make clear to injured workers that I am their advocate and that I plan to will work with them until they are medically stable and able to return to work. I encourage injured workers to call me at any time for questions or for anything that they are worried about. Over time, as I show clients that I care about them and try to break down barriers that delay their recovery, I eventually earn their trust.
- Focus on Recovery: I stress that injured workers should focus on their recovery. My goal is to be proactive and offset any barriers or issues that might interfere with the plan of care. This may mean setting up transportation, expediting a diagnostic test or an appointment with a specialist. Doing these things helps avoid delays in care that frustrate a timely to return to work.
- Listen to Your Doctor and Other Team Members: I encourage injured workers to ask their physicians and medical teams questions. Doing so empowers injured workers to be active members of the team, which gives them buy-in to the plan of care. As an onsite case manager, I usually attend physician meetings with clients. If I can’t attend a meeting, I review the questions my clients want to discuss with their doctors and therapists during appointments. I send a note to those involved so we are all on the same page. I make sure injured workers understand their treatment plans, and if they don’t, we review things util they are clear. Encouraging injured workers to be active in their recovery helps them gain the control they have lost due to the injury. If family members are involved, I also reach out to them since their buy-in and support are essential.
- Stay In Touch with the Employer: I encourage injured workers to stay in contact with their employers and co-workers. Being isolated can make injured workers feel abandoned. I also encourage the employer to stay in touch with the injured worker, so lines of communication are open, and no hard feelings develop.
- Safety First: At each doctor’s appointment I ask the physician if the injured worker is medically able to return to work. I also talk to the therapist to gain additional insight. We don’t want injured workers to return to work too early as that could cause a re-injury. I talk to employers to see if they have light-duty opportunities. If so, I relay that to the doctor to see if the light duty assignment is medically appropriate. Return to work is up to the doctor but everyone needs to be part of the decision.
- 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 needed 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.
- Options to return to work: Depending on the injury, the type of work the injured worker did prior to the injury may not work for them now. The work available from the employer may not meet the injured workers’ current capabilities. This would be a time to call in a vocational specialist to evaluate the injured worker to see what type of 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 injured workers cannot return to their original job.
Taking initiative, building trust and consensus, and keeping return-to-work in mind at the forefront of considerations will help generate options that everyone can support.
I hope this article gives you some tips and reinforces your return-to-work efforts for your clients. Share your return-to-work strategies with me so I can add them to the list in a future article.
Anne Llewellyn, MS, BHSA, RN, CRRN, CMGT-BC, BCPA, FCM,
is a registered nurse with 40 + years of experience in critical care, risk management, case management, patient advocacy, healthcare publications, and training and development. Anne is a leader in case management and patient advocacy. Today, Anne works as an Independent Nurse Advocate to assist people on their healthcare journeys.
Anne speaks and writes frequently on topics for consumers, caregivers, and all healthcare team members so that together, we can improve each person's health and healthcare experience. Follow her in her weekly Blog, Nurses Advocate, where she shares stories and events to help people be better prepared when they enter the healthcare system. You can find Anne here at www.nursesadvocates.com. You can reach Anne by email at allewellyn48@gmail.com.
DISCLAIMER
Views expressed in the REWARD Report are solely those of the authors and may not reflect the official policy or position of the Tennessee Bureau of Workers’ Compensation, the Tennessee Court of Workers’ Compensation Claims, the Tennessee Workers’ Compensation Appeals Board, or any other public, private, or nonprofit organization. Information contained in the REWARD Report is for educational purposes only.
R.E.W.A.R.D. PROGRAM: RETURN EMPLOYEES TO WORK AND REDUCE DISABILITIES
R.E.W.A.R.D. PROGRAM: RETURN EMPLOYEES TO WORK AND REDUCE DISABILITIES
A skilled case manager understands that the best possible outcome for the injured worker is to get the appropriate treatment to recover and to set the expectation of returning to work in some capacity as soon as the injury occurs. To read more about the role of case managers in return-to-work, download the REWARD Toolkit (tn.gov).
MEET WITH LIKE-MINDED EMPLOYERS
The REWARD Employer Support Network is an ever-growing group of Tennessee employers who are interested in (or are already) running great return-to-work programs. The next meeting is scheduled for Tuesday, October 10th at 1:00 Central Time. Register here to join the return-to-work conversation facilitated by Theresa Dunn RN, Occupational Nurse with Trane Technologies.