As a claims professional, we recognize you’re encountering new daily challenges. We want you to know that Genex is here to help. In this ever-changing environment, it’s not always clear when a claim should be considered for field case management. Genex takes the guesswork out of when to refer a case and helps get your injured employees on the road to recovery and return to work.
Reasons You Might Need a Case Manager
- History of multiple work injuries
- Pre-existing conditions affecting recovery
- Potential lost time of 60 days or more
- Cases exceeding $2,000 in medical expenses
- Multiple medical providers or frequent changes in providers
- Injured workers that are 60 years of age or older
- One or more comorbid conditions
- Working light duty with no progression to regular duty in near future
- Conflict of medical status between physician and injured worker
- Medical diagnosis does not corroborate with cause of injury
- Claims in telephonic case management for 90 days
- Aggravation of pre-existing condition
- Re-injury shortly after return to work
- Questionable motivation to return to work
- Legitimacy of injury or work relatedness/causation in question
- Barriers to re-employment
- Social issues (transportation problems, child-care, finances and other issues)
- Return to work will require job modification
- Unable to return to usual job which is medium to heavy work but has been released to work light duty
- Return to repetitive work, potential for re-injury aggravation
- Employer needs recommendations concerning ergonomic job modifications
- Employer unclear if job is available for client to return to work
- Client needs assistance with job seeking skills or resume preparation
- Client needs assistance in identifying employers within his/her labor market
The following guidelines were developed to assist claims professionals in making the determination of when to place a referral.