Catastrophic Claims Management: From Injury Through Settlement

It’s the call no employer wants to get – your employee has been injured. How do you handle that call and everything that comes after? In this session at WCI’s 2019 Educational Conference, panelists explore best practices for handling catastrophic injuries.

Moderator: H. George Kagan – Attorney at H. George Kagan, PA

Panel:

• Jodi Loud – Brain and Spinal Cord Injury Consultant at The Hartford
• Lauren Underhill – CEO at CorLife
• Steve Kerschke – Director of Marketing at QLI
• Ted Cranias – Structured Settlement Consultant at Brant Hickey

When we look at effective claims management, a skilled nurse case manager is the common thread through the entire process. Generally, the process involves the following steps:

1. Catastrophic Injury. Decisions are made through a collaborative approach. The primary focus in this stage is life-saving care, most often in an ICU. After stabilization, patients usually move to acute care. Later, the model starts to shift from medical care to post-acute care or rehabilitation care.

2. Rehabilitation Continuum. Centers of Excellence along the continuum are imperative to successful outcomes. When choosing a Center of Excellence, it is important to understand who the injured worker is and what their family situation is. Family support is crucial to recovery so we need to be sure that arrangements are made that allow for that family support.

3. Community Reintegration. Discharge planning begins immediately and vendor relationships are crucial. Beyond medical rehabilitation and recovery, it is important to explore how the patient can be successful in their own home and community, outside of the hospital setting. Planning for this stage should include durable medical equipment options and accessibility at the patient’s home, including potential modifications. Ideally, the durable medical equipment company would be involved in the process as early as possible.

4. Settlement and Resolution. It is important to be transparent with the injured worker about what settlement involves, outside of a specific dollar amount. Consideration of future medical needs ensures an individualized plan.

Through all stages, building trust as well as open and frequent communication are keys to success. All stakeholders and providers must work as a team to ensure that the patient receives the best care and reaches the best outcome possible.