Use of Medical Case Managers (Nurses) and Fees

Midland Claims Service, Inc. and Industrial Injury Claims® has for over a decade approached the use of nurses on workers' compensation claims as a common sense tool in the adjuster's tool box.  Unfortunately, the practice of retaining and working with medical case managers on less than catastrophic injury claims seems to be somewhat contrary to some in the industry.  We have been told a number of times that " practices dictate that using nurses is a waste of money, the adjuster should be in charge of the medical portion of the claim..."   Perhaps this is one of the topics that inspired us to file for our trademarked slogan Redefining Best Practices®.  At least in this area, we have proven conclusively, over the course of handling more than 22,000 WC claims in one of the most challenging jurisdictions in the United States, that tight coordination between the claims professional and the medical professional allows aggressive, appropriate and timely medical care to be provided to the injured person...which has resulted in a) faster and more complete healing, b) more satisfied injured workers, c) far less involvement of the legal profession and d) significant reduction in the overall cost of the WC program...including the TPA fees and MCM fees.  One of our clients has enjoyed a 46% annual reduction in their WC costs at a time when payroll and FTEs have increased. Another has an average cost per Indemnity claim nearly $50,000 (per claim) less than the predominant writer of WC in Montana...and has an average cost per Indemnity claim that is $2,000 LESS than their average cost per claim more than a decade ago.  These figures are not adjusted for inflation, and INCLUDE the impact of medical inflation, Indemnity wage loss and impairment benefit annual increases.

The link below is an article that we hope everyone in the industry will read.  We've produced for our clients the magnitude of savings results that the author refers to.  Saving money by trying to pass the financial risk of doing business to the TPA or medical case management company through insistence upon some type of flat rate, life of contract payment for service fees typically has an unintended consequence.  While a flat rate arrangement may save a bit on the single cost line, the loss cost increases typically is impacted by a factor of ten greater than the savings.  Attempting to justify using telephone nurses to fill in the gap is simply a wasted of money.  The face to face, jurisdictionally specific service that medical case managers bring to the process along with a proactive, holistic oriented adjuster is in our experience the most effective way to help legitimately injured workers AND minimize the overall cost of a workers' compensation program.