Field Case Management for Surgical Claims: Keep Plans Clear and Moving

The moment surgery is discussed, claims can get complex, fast. More providers. More appointments. More decisions that hinge on scheduling, not just recovery. Employers want clearer return-to-work direction, injured employees want certainty, and the number of handoffs climbs. If a defined plan is not locked in early, momentum can slip, and you spend more time chasing updates than driving progress.

Field case management brings structure to this high-change phase and keeps surgical claims on track. With on-the-ground coordination, you get clear owners, confirmed next steps, and visible milestones that prevent long stretches of “pending.” Communication stays tight across providers, the injured employee, and the employer, so decisions come faster with fewer surprises and less rework.

What can change on a claim when surgery is introduced

Surgery introduces three realities adjusters feel right away:

• The pace changes. Timelines depend on scheduling, not just recovery
• The circle gets bigger. Specialists, facilities, therapy, and additional questions from the employer around return-to-work timeframes and the injured employee’s ability to perform their pre-injury job
• The plan has more handoffs. Each handoff is a chance for delay

Even a well-run claim can lose traction when surgery is being evaluated. The common pressure points are predictable:

• Potential for multiple providers and the need for coordination of care
• Consults, imaging, and pre-steps that can delay surgery scheduling
• Extended time off work or working less than full duty
• Injured employee stress and anxiety over the idea of surgery and outcomes
• Return-to-work planning that pauses while everyone waits for “the next appointment”

When these pile up, the claim gets noisy. You spend time chasing updates, not moving the claim.

When field case management is most useful

Field case management is not a default for every surgical consult. It is most effective when the claim shows early complexity and needs tighter coordination.

Engage field support when you see:

• The consult is delayed, rescheduled, or moving slowly toward a decision
• The diagnosis or plan keeps shifting
• Restrictions are generic, inconsistent, or not progressing
• The injured employee is missing appointments, confused, or losing confidence
• Employer expectations and work capacity are drifting apart
• Post-surgery logistics are likely to be complicated, including therapy timing, equipment, or transportation

What field case management can do before surgery

Before surgery, your goal is clarity with dates and owners. Field case management can help deliver it by:

• Strengthening key visits by confirming the current plan, work status, and what must happen next
• Keeping milestones visible so weeks do not pass in “pending” status
• Providing the support and education the injured employee needs to make an informed decision around care
• Taking the lead on the coordination of all pre-op appointments to reduce delays
• Completing a holistic assessment that identifies potential barriers to recovery

What field case management can do after surgery

After surgery, the biggest risk is a broken handoff. Going from discharge to follow-up to therapy is where claims often lose momentum. Field case management can help by:

• Maintaining close contact with the injured employee post op to quickly identify potential complications such as infection
• Confirming follow-up dates and therapy start dates are in place
• Capturing updated physical capabilities clearly and quickly
• Reinforcing the plan between visits so the injured employee stays on track
• Helping the employer apply the injured employee’s physical capabilities to realistic transitional duty options
• Sending clean updates that reduce adjuster chasing and rework

When surgery is being discussed, the claim moves into a phase with more handoffs, more stakeholders, and more ways for momentum to slip. Field case management brings on-the-ground coordination to keep the plan clear, the timeline visible, and communication clean when it matters most. It helps translate a fast-changing medical path into a practical claim direction, so you can make decisions with stronger confidence and less chasing. You are not expected to carry the complexity alone. Field case management is built for these moments, especially when the claim needs face-to-face support to keep next steps organized and moving.