Insurance Claim Medical Case Management
Empathy Claims has many years of experience working in the field of Workers Compensation. We are pleased to offer the best network of dedicated professionals and resources relating to the following services.
Medical Case Management
Medical case management plays a very important role in both effective cost management and care plans for people involved in worker compensation claims. The role of a medical case manager is to oversee and collaborate with other professionals in recommending appropriate care plans to ill or injured claimants. The manager’s duties include an assessment of care, personal interviews with injured employees and the coordination of treatment plans with various health care providers. The ultimate goal of a medical case manager is to have the most positive outcomes for employees and at the same time assure financial efficiencies for employers and insurance companies.
Independent Medical Exam
An independent medical exam (often called a peer review) is conducted to benefit the claimant, caregivers, insurers and all parties involved in the ongoing treatment of an individual. The purpose of this review is to gain an independent and objective perspective on the claimant’s medical condition, diagnosis, prognosis and treatment plan. Doctors who perform independent medical exams are specialists in their given field and are board certified. Professionals conducting such a review can provide an independent opinion on the direction of a claimant’s treatment and offer suggestions on how to alter, improve or enhance the process if needed.
Medical Records Review
This practice involves an ongoing examination of a claimant’s personal medical records with the purpose of confirming diagnoses and having an independent, unbiased opinion regarding the medical necessity of certain treatment plans. The professionals who conduct medical record reviews act as advocates for both patients and insurance carriers. Having a highly trained, independent party evaluate the medical records of a claimant optimizes success in ensuring that necessary care is being provided for the best outcomes and that the financial costs of that care to employers and insurance companies has the greatest return on investment possible.
Vocational rehabilitation services focus on helping injured individuals through a variety of resources to return to their previous occupation or secure substantially similar, gainful employment. It is the goal of our experienced professionals to help workers’ comp claimants return back to full employment after they have been appropriately treated. Vocational rehabilitation helps employees not only get back to work, but also facilitates the opportunity for reductions of financial liability on the part of the insurance carrier and employer.
Comprehensive Disability Management
Should an injured claimant become eligible for disability, It’s very important that an experienced professional monitors the process for the benefit of both the claimant and the employer/insurance carrier. Since disability management not only involves the medical condition/progress of the injured worker, but also the financial impact to responsible parties, it’s critical to partner with professionals who have the needed experience to manage these tasks. Disability management’s primary goal is to make sure that the worker involved is getting the best care possible and that the employer/carrier also has a strong advocate with regard to financial costs.
Life Care Planning
This area of the workers’ compensation arena centers around the evaluation of a person’s disability and both their current and future needs. Life care planning takes into account all aspects of a person’s well-being, including medical, physical, psychological and emotional. This type of work also considers any rehabilitation potential as well. Professionals who work in this area also play a very important role as a coordinator among the patient’s care givers. Life care plans act as a dual benefit to both patients and financial payers.
After treatment for an injury or disability has taken place, claimants are often able to return back to work, but not at full capacity. Light-Duty programs can offer job responsibilities that have restrictions with regard to weight bearing tolerances, time standing on feet or other limitations. The professionals in our network who specialize in creating Light-Duty programs can work with both employers and insurance carriers toward the goal of allowing people the chance to return to work, which is a great help in reducing workers’ compensation costs.
Sometimes individuals cannot return to their regular occupations as a result of a work related injury. At Empathy Claims, we have a dedicated network of people who specialize in working with individuals who are able to return to some form of work, but not necessarily their former positions. Our job search professionals work with people on preparing for a transition to new lines of work. Whether it be resume writing, networking, finding suitable positions or interviewing, claimants are encouraged, coached and professionally guided along every step of the way. The results achieved by our network of dedicated professionals can restore the dignity people feel in gainful employment and also reduce the financial impact to insurance carriers and employers.
Workers compensation injures can be devastating to individuals and bring on serious financial costs for both insurance companies and employers. The professionals at Empathy Claims are ready to help you coordinate the best care and outcomes for injured people and also do everything possible to professionally manage costs for insurance companies and employers.
Contact us today to learn more about our medical case management services. Together we can achieve successful outcomes for workers, employers and insurance carriers.