Moore: The Value of Field Case Managers

Friday, May 7, 2021 | 0

Thursday was National Nurses Day. In celebration, I wanted to bring up a subject that I have seen overlooked in quite a few workers' comp files: field case managers.

James Moore

I like to call them rehab nurses. A field case manager does not have to be an RN or LPN, but most seem to have a nursing background.  

I have written a few articles on field case managers where I called them rehab nurses.  They are great risk management assets who greatly assist the employees in recovery. 

Field case managers are assigned by a workers' comp claims staff to better facilitate the medical treatment in a claim. The rehab nurses may also facilitate the return to work by an injured employee as a mediator (of sorts) among the claims department, employer and treating physician.    

One of the main benefits of hiring field case managers comes from attending physician appointments with the injured employee to help better understand the medical condition. 

Injured employees have often commented to me that the rehab nurse interpreted and distilled what their treating physician said to them. Having someone you can call if the injured employee becomes concerned about a medical condition is priceless.   

Promoting trust was studied heavily by the Workers Compensation Research Institute. Bogdan Savych’s studies name it as the more important component in returning to gainful employment. 

The field case managers may also assess the injured employee’s psychosocial factors.  No, they are not spies for the insurance carriers.  

One of the drawbacks that may concern some carriers is they are paid out of allocated loss adjustment expenses that are not charged to the employer’s experience modification unless under certain large deductible agreements. 

Self-insureds pay all the ALAE funds, so there is no difference in the charging rates. 

When performing loss-run and claim reviews on three different groups of claims, I noticed a hesitancy to hire field case managers by the adjusters even on what I would consider serious claims.  

Was it a lack of training or an attempt to save ALAE? I noticed that often the claims supervisor would instruct the adjuster to bring in a nurse. One some files, the adjusters would stop the rehab nurse services mid-file. 

Most of the time whenever I have performed a return on investment calculation on rehab nurses, the ROI came back as almost 3.5 to 1. For every $1 spent on field nurses, the file was reduced by $3.50. No, I never performed an exact study. This was a running tally in my head over the last 25 years.  

Bottom line: Field case managers save workers' comp funds if they are used properly on the correct files. 

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.