Worker's Comp Case Management

  1. Hello to all CM's. I just joined this site because I am particularly interested in communicating with other CM's involved in worker's comp case management. I am an independent; however, I work with claims and claimants from a variety of states and would be interested in developing a network of other CM's to answer occasional questions regarding specific state laws/rules, doctors, etc. For example, I have now learned (the hard way) that if a claimant in Georgia refuses CM services, a CM cannot be involved in any aspect of the claim, and in TN, CM is mandated by law when claims costs reach $2500.
    Anyone else interested in communicating and developing a network within this network? And certainly, I would always be more than happy to share info regarding Texas!
    Thanks and hope to hear from you.
    Susan
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  2. 35 Comments

  3. by   LasVegasRN
    Susan, welcome aboard! That's exactly what this forum is for.

    Anything you need, just ask, and folks will come!
  4. by   DallasRN
    After reading the posts, it seems there are few WC CM's on this site, although several who have expressed interest. Are you independent or with a CM company?
  5. by   LasVegasRN
    Did some independent for a California based company, and have worked for workers comp company as Case Management Supervisor.
  6. by   hoolahan
    Hi Susan,

    I just started in the WC CM field, so I would be of little use to you right now. I am still figuring the basics out myself. I would love to become independent in time.

    I am wondering, how do you survive as an independent when so many of the big CM companies have such big PPO networks. You must do a lot of price negotiations? That si one of the obstacles I see now, as a newbie to the field, for going independent.

    Anyway, I am in NJ, and if you ever do have a question, I would be happy to find out what I can for you.
  7. by   DallasRN
    Hi there, Hoolahan. As I read through the posts, I noticed that you had just started working as a comp CM. And from your response, I assume you are working either directly for a carrier or for one of the CM companies.
    It is tough working as an independent. I've had to cut my billing rates to get my foot in the door in some cases, but I would rather do that and remain independent. That is part of the reason that I am interested in a forum for WC CM's - so that we can communicate with each other regarding issues specific to comp and at the same time, help each other bring credibility, reliability, and efficiency to our chosen areas of CM. I personally have strong feelings that the purchaser of CM services often gets more "bang for their buck" in the long run from an independent rather than the "cookie cutter" approach utilized by some of the big CM companies. From my own experience, I know that I will go that extra mile to respond to my own clients needs but when I worked for one of the big companies, I tended more towards the 8-5 mentality.
    As for your comment about being of little help because you are new...never discount yourself. We each bring with us experiences, both work and life, that can be shared and built upon. I like to think of forums/networking as brainstorming sessions...no single person may have the entire answer, but collectively, excellent decisions/resolutions can be found. The views and opinions of others sometimes prevents us from entering situations wearing blinders so to speak - so that we only see one view.
    That being said...it is early and I've got work to do. Later -
  8. by   LasVegasRN
    Ooooh, good post, Susan!
  9. by   ryaninmtv
    I am a case management supervisor with an MCO in Ohio. I too would love to go independent some day but with a wife, two kids, and one on the way, I am indeed a coward. I work probably 90% in WC, the other 10% in disability. I am looking forward to taking the CCM exam next year. In Ohio, we are a monopolistic state where employers are either in the state insurance fund or self-insured. The rates for CM are set (and paid for) by the BWC. I would be happy to offer my comments on the states in the great middle-west, where we do most of our work.
  10. by   Sharon
    DallasRN

    I usually spend my time on the occupational and disaster nursing boards. I would be happy to share information with you. My position responsibilities include integrated case management duties for mid-Atlantic area. I also am certified by the Maryland Board as a case manager and registered with the Workers Compensation both a prerequisite to do field or telephone case management with an Injured Maryland Worker. Though the bulk of my current work is DC, MD, VA, NJ, and PA, DE. I do still do work as a volunteer for small municipal law enforcement agencies (who always call at 1 am) and non-profit organizations in other localities throughout the US.
  11. by   DallasRN
    Thanks for writing. I must admit...I've been "away" for a while with major computer problems that just went on and on. Had tons of stuff to get caught up on, but now all is well.
    You peaked my curiosity with your comments about doing some volunteer work for law enforcement agencies. What exactly do you do? ...and with the other non-profit organizations throughout the US?

    While I'm here, let me ask for everyone's ideas and/or thoughts on this subject....
    How do you handle the situation when the IME/RME physician you have selected to examine a claimant provides you with one of the most horribly written (and in certain specific areas totally non-factual) reports you have ever received or read? In this case, I provided the IME doc with a medical summary/chronology of all records, copies of all records in perfect chrono order and a very explicit cover letter summarizing the case with specific questions to be addressed at the time of exam. Prior to the IME, I obtained TWO peer reviews - one with a very well-respected specialist in the same field as the IME and another in the specialty of the treating doctor. Both of these peer reviews blew holes completely through the prior treatment of the treating doc and also the recommended treatment plan. Quite honestly, after reading the IME report (that was 25 days late!) I had a hard time even believing he had examined the same claimant. And it was quite obvious he had not reviewed any of the records.
    Any comments on how this could/should be handled? I can't "make" him re-do the report, nor can I make the claimant return for re-exam. His report, as it stands now, will dramatically increase the claims cost.
    Thanks for any suggestions - Susan in Dallas
  12. by   LasVegasRN
    You can always send a letter with specific question to address those areas that were "unclear". There's no reason why you can't ask for an addendum. Usually, I word the letter in such a way:

    Dear Dr. Dumbass:

    Your time in evaluating this client is greatly appreciated. There are a few items we are hoping you can clarify in order to bring this case to resolution:

    1. [Your first carefully worded question] What the sam heck were you drinking when you wrote this report?

    2. [Your second carefully worded question, again, VERY carefully worded not to make it seem he didn't know what the heck he was doing] What color is the sky in your world?

    Your prompt reply to this matter is greatly appreciated. Thank you.

    Respectfully submitted,

    Super Great Case Manager Extraordinaire
  13. by   DallasRN
    and laughing....and laughing....I would love to send him that very carefully worded letter - verbatim!!

    I have frequently sent letters of clarification in the past, but honestly, this report is far beyond clarification. You may not be too far off course when you asked what he was drinking when he wrote it. The entire think is comprised of "she states" thus and such and there is not an iota of actual objective physical exam signs/symptoms in it. The claimant could have written that report. Now that I think of it, maybe she did!!

    Have you ever had any luck in petitioning your States Compensation Board for a new exam based on what appears to be lack of examination/evaluation? What makes this really bad is that I sincerely believe that the treatment she is receiving at present is, at best, completely worthless. The other side of that is that it may, in fact, be causing additional harm. What a mess - Susan
  14. by   Sharon
    DallasRN

    For the law enforcement and non profits that I volunteer my services, I do case management, performance issues and compliance with federal and state employment regulations and laws. This way I get more of my esoteric and humorous experiences.

    Las VegasRN did a great job with the letter. Another method I use is I call the back to school method. I contact a specialists whose written format has been useful in the past ideally a Professor of Medicine (if possible one of the current Board of Governor members of the creditaling body) and hire him to contact the IME/RME physician to clarify the questions. Then of course I do not use them again.

    By the way, I have found using a Professor of Medicine is more likely to document a need for additional testing including psychological. As a group they are more expensive so I reserve them for my cases that cause me constipation or diarrhea.

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