This session at the WCI 2015 Conference took a look into new strategies for catastrophic injuries from the leading experts in the catastrophic case management.
The speakers included Darrel Brown, Executive Vice President, Chief Claims Officer, Sedgwick, Scott Goll, Senior Vice President of Operations, Paradigm Outcomes, and Karen Derrico, Vice President Workers’ Compensation and Critical Care Division, Best Doctors.
1% of all claims are catastrophic claims and they make up 20% of costs. Catastrophic claim frequency is not high but when you see catastrophic claims you know something big happened. Unfortunately no one wins in this type of claims. Characteristics of a catastrophic claim include high medical costs, specialists involved, range of physicians involved, several transactions and complexity. One of the panelists stated a claim is a cat claim when life is compromised, threatened, inability to perform tasks permanently. There are some claims that are immediately cat claims and there are other claims that start out small and end up as a cat claim due to several things that have happened over the course of the claim.
What is the best approach to medical care when it comes to cat claims? The employer and carrier should seek out the best and highest level of care for the injured worker. Do your homework with these claims and research which facility that will give the injured worker the best care for their current situation. It is vital to be aware of resources are available to the worker.
What are some advancements in catastrophic care claims?
Brain injury-there is neurostimulation, rehab care is essential and can dictate where the injured worker will end up in their recovery
Spinal cord injury- trials with stem cell regeneration (not FDA approved), important to look at costs of new innovation and potential outcome for injured
Burn injury-when and how to graph patients, this can be expensive but beneficial to mitigate long term injuries
The key to success is to maintain communication with the injured worker and their family during this process. Without the constant communication there cannot be an optimal outcome, this sets the pace towards recovery. This communication between every party involved should start immediately. There are several things that can be researched and decisions evaluated while the patient is even in the ICU. There are challenges for the injured worker and their family so the sooner they see there is a team behind them wanting the best care the better. There needs to be trust and understanding. Success is at the foundation of this relationship.
The panelists wrapped up the session by discussing some of the challenges faced when working with cat claims. These issues include but are not limited to narcotics and opioids and comorbidities. Opioids and narcotics have to be watched diligently. These can lead to other issues such as renal failure or other diseases when there are alternatives that could be prescribed. Comorbidities can be something as simple as hypertension or as severe as a previous head injury. There is a high degree of impact but this is not the initial part of the claim. These other items can have a cascading effect to the injured worker. The claim could double or triple in severity because of these other diseases that arise. It is vital to quickly expedite these claims to make sure the injured worker receives the best care possible.