The Importance of Professional Injury Management in Workers' Compensation

When an employee becomes sick or injured on the job, ensuring they receive prompt and appropriate treatment is crucial. A medical case manager facilitates this care, guiding both the employee and employer through New York's Medical Treatment Guidelines and supporting a safe return to work.

But who handles the administrative complexities—like accurately completing forms and meeting strict deadlines? Who schedules hearings and determines the employer's representation? Who collaborates with adjusters on complex cases to ensure reserves and treatments align with regulations?

This comprehensive process is known as injury management. Unlike medical case management, which is led by registered nurses focusing on the employee's health, injury management is managed by claims experts. They handle the behind-the-scenes administration and coordination needed to successfully resolve a claim from start to finish.

In this article, we'll explore:

The unique role injury managers play
Key trends and considerations in injury management today
Common questions from TPAs and self-insured employers

The Role of an Injury Manager

Injury managers oversee every stage of a workers' compensation claim on behalf of the employer. Their responsibilities include:

Determining Claim Eligibility: Assessing whether an injury qualifies under workers' compensation.
Managing Documentation: Ensuring all forms are accurately completed and submitted on time.
Wage Calculations: Assisting with calculating appropriate compensation for the injured worker.
Hearing Coordination: Scheduling hearings and arranging necessary employer representation.
Ongoing Communication: Keeping employers updated on treatment progress, medical exams, reserves, and more.

An injury manager remains a consistent point of contact throughout the claim's duration, which can often span years, even if claims adjusters change.

Primary Goals of Injury Managers:

Efficient Claim Navigation: Streamlining the claims process for employers.
Cost Savings: Helping employers reduce expenses associated with claims.
Workload Reduction: Allowing HR teams and Leave of Absence Coordinators to focus on other critical tasks, especially important in today's dynamic work environment.

Collaboration with Stakeholders:

Employers: Acting as advocates, injury managers guide employers through the claims process, ensuring compliance and efficiency.
Injured Workers: Serving as a key contact, they explain workers' compensation laws, payment calculations, medical exams, and hearing procedures.
Adjusters and Providers: Liaising to expedite claim resolution, they obtain necessary medical records and ensure treatments align with guidelines.

Key Trends in Injury Management

Staying informed about industry changes is essential for effective injury management. Here are some critical areas to focus on:

1. Evolving Regulations and Compliance

Workers' compensation laws and regulations continue to evolve. Injury managers must stay up-to-date with changes in state laws, federal guidelines, and industry standards to ensure compliance. This includes monitoring updates from agencies like OSHA and the CDC, especially in response to public health developments.

2. Technological Advancements

The integration of technology in claims processing has accelerated. New platforms and software solutions improve efficiency, data accuracy, and communication among stakeholders. Injury managers should leverage these tools to streamline processes and enhance outcomes.

3. Focus on Employee Well-being

There's a growing emphasis on holistic care that addresses both physical and mental health. Injury managers play a crucial role in facilitating resources for mental health support, rehabilitation programs, and proactive wellness initiatives.

4. Opioid Dependency Mitigation

Combatting opioid dependence remains a priority. Programs like Viscardi's Nurse Prescription Case Management (NRxCM®) proactively identify at-risk individuals and collaborate with physicians to create safe treatment plans, promoting healthier recovery paths.

5. Remote and Hybrid Work Considerations

With the rise of remote and hybrid work models, injury management must adapt to new types of workplace injuries and claims. Ergonomic assessments and virtual consultations are becoming more common to address injuries sustained in home office environments.

Injury Management FAQs for TPAs and Self-Insured Employers

1. Isn't the Claims Adjuster Handling This Work?

While claims adjusters focus on medical treatments, bills, and financial decisions, injury managers advocate for the employer, overseeing the entire claims process and ensuring it progresses toward closure.

2. Can Injury Managers Reduce the Reserves?

Only adjusters can adjust reserves. However, injury managers can review files and suggest adjustments based on medical exams and doctor's notes, prompting adjusters to reassess.

3. Why Is the Injured Worker Still Out of Work?

Possible reasons include:

The treating doctor recommends the employee remain out of work.
The employee is cleared for light-duty work, but the employer cannot accommodate restrictions.

4. Why Is the Injured Worker Receiving Payments?

Payments continue if:

The doctor determines the employee cannot return to work.
There's medical evidence supporting their inability to work.

Payments may stop if there's no medical evidence or adjust based on the disability status.

5. Why Are the C-11 and C-240 Forms Needed?

C-240: Calculates the employee's average weekly wage over the 52 weeks before the injury, determining compensation during recovery.
C-11: Tracks the employee's work status, noting absences due to injury and updates throughout the claim.

6. Should I File a Claim If I Question the Injury?

Yes. Filing allows the injury manager to notify the adjuster of any doubts. To deny a claim officially, it must first be filed.

7. What Is the Claim Filing Process?

Complete a First Report of Injury (FROI): Send it to the injury manager to file with the carrier.
Submit C-11 and C-240 Forms: Needed if the employee misses work.
Receive Claim Number: Provided by the injury manager for use with medical bills and related documents.

Why Partner with Viscardi for Injury Management

At Viscardi, we combine compassionate care with industry expertise to offer comprehensive injury management services. Here's what sets us apart:

Human-to-Human Approach: We prioritize personalized support for both employers and injured workers.
Experienced Team: Our claims experts and medical professionals collaborate seamlessly to navigate complex cases.
Proactive Communication: We keep all parties informed, facilitating quicker resolutions and reducing the likelihood of delays.

Our Clients Benefit From:

Optimized Communication: Enhancing collaboration among stakeholders.
Improved Care Trajectory: Streamlining treatment plans and return-to-work strategies.
Increased Employee Trust: Building confidence through attentive support.
Reduced Costs: Lowering indemnity and medical expenses.
Decreased Workload: Lessening administrative burdens on adjusters, HR staff, and TPAs.

Ready to Enhance Your Injury Management Process?

In today's rapidly changing work environment, effective injury management is more important than ever. By partnering with Viscardi, you gain access to a team dedicated to transforming the workers' compensation experience—ensuring that everyone wins.

Contact Viscardi today to learn how our tailored services can benefit your organization and provide the support you need for efficient, compassionate injury management.