Catastrophic damage care is greater than scientific. The commerce affiliation wants to know the worth of compassion
Although catastrophic injuries represent only a small percentage of total worker injury claims, the recovery of these injured workers requires shared care.
A catastrophic injury can occur in any workplace. Imagine an employee slipping on a wet floor or tripping over a cable and hitting their head or breaking their hip, and it’s easy to see why all organizations need to be prepared for the worst possible injury scenario.
Although catastrophic injuries represent only a small percentage of total claims, they require the attention of employers, medical professionals, insurers, caseworkers, workers’ compensation representatives and others to ensure that an injured employee’s case is handled with care and compassion.
These cases must also be handled correctly on behalf of employers who might otherwise suffer financially.
So, what are the best practices to take right action by workers and employers?
First, experts say it is important to understand what a catastrophic injury is: “Catastrophic injuries are most commonly defined as life-altering injuries, often impairing the ability to perform activities of daily living as they have done in the past, often in the short or long term have,” said Ray DiCello, senior vice president and chief claims officer at PMA Companies.
“These injuries can be purely physical injuries or cognitive injuries, often resulting from traumatic brain injury. They can impact not only the injured worker, but often their immediate family members as well as the family works to find a new normal.”
Robert Biltz, vice president of claims at AmTrust Financial, added that catastrophic injuries also carry the risk of hospitalization, rehab and/or a complicated and extensive recovery. Typical catastrophic injuries include severe brain injuries, spinal cord injuries, injuries resulting from violent crime, crush injuries, amputations, internal injuries, and severe eye injuries.
Achieve the best outcomes for disaster claims
While a catastrophic injury can be devastating on many levels, it does not necessarily prevent a worker from eventually returning to the workplace.
“Many of the injured workers who sustain a catastrophic injury eventually have an opportunity to return to work,” Biltz said. “They may not be able to return to the same type of work or employer, but we are working with them to reintegrate them into the labor market where possible. We are also seeing some injured workers who have made a fantastic recovery and are able to return to full duty or any occupation they desire.”
Robert Hall, corporate medical director at diversified healthcare services company Optum Workers’ Comp and Auto No-Fault, said there are a few steps to follow to ensure excellent patient care and minimize an employer’s costs.
The first, similar to the oath doctors take not to harm, is to focus on preventing a patient’s health from deteriorating, which will certainly result in additional costs.
“When we take care of anything from a sprained ankle to a spinal cord injury, the first thing we do is prevent complications and hospital readmissions and all of those things,” Hall said. “And after that, we work to improve a person’s function that helps them get their quality of life back. This will help reduce their dependency on home health care and reduce home health care costs.”
Of course, the scene of an accident or traumatic injury can be messy. It is crucial that a person gets the emergency care they need as soon as possible.
“Medically, if his life is in danger, there is a need to get the patient safe and to a place where their condition can be treated immediately and their life can be saved,” Hall said.
Communication is key
Once this occurs, communication between all parties involved in providing care or monitoring the patient’s progress is paramount, especially when transitioning through the stages of care.
“It’s always about communication, from day one through recovery,” Hall said. “That means communication between everyone involved in the case, be it their medical team, their nurse practitioner, their payers’ claims experts, their benefits administrators such as their pharmacy or ancillary benefits providers, and their family members or carers. ”
A patient who starts in the ER may then be transferred to a medical floor and the ER and MD must discuss the patient’s injuries, required medications, and other special circumstances.
The same high level of coordination and communication is required when a patient moves into rehab or home.
“For example, if they handed this patient over with an inaccurate list of medications and required drug doses, it could put that patient at risk of receiving a drug they are allergic to or receiving a higher dose than they need.” said hall.
Whether they’re called roundtables, conferences, or team meetings, Hall said the best way to communicate is to bring everyone involved in a patient’s care together.
“Everyone’s talking about the same patient,” he said. “That way, any questions, misunderstandings, or ignorance about the patient’s treatment plan are resolved there.”
DiCello agreed that a multidisciplinary approach is necessary: ”An integrated process across disciplines means we work together to achieve the most successful outcomes,” DiCello said. “We focus on what is medically the best option for the injured employee and what will result in the best overall outcomes. To achieve positive results, we have a shared responsibility with all partners and our managed care and claims team colleagues work together to deliver the highest level of service and results.”
Biltz said his company moves quickly to address a patient’s needs.
“We have escalation criteria that will notify our major claims team of a new breach as soon as it’s reported,” he said. “The team then immediately organizes a roundtable discussion with anyone we think is needed.”
This team may include AmTrust’s Managed Care Team, Claims Team, Recourse Team, Legal Team, Special Investigations Unit, and Loss Control Team.
The round table discussed:
- What happened?
- What is our strategy?
- Who should be there?
- How do we get in touch with those we need?
- How do we best address the needs of the injured employee?
- What investigation is required?
- Where are they getting medical attention and is it the right place for the nature of the injury?
Biltz said they are also trying to be on site to meet with the insured, family and the injured worker.
“This gives them the opportunity to educate them on how the system works, explain its benefits and answer any questions,” he said. “We want to build a relationship of trust and reassure them that we want to do everything we can to help the injured worker recover.”
A multidisciplinary approach
Continuously monitoring a patient’s progress can set off an alarm when care is overdone.
“There are certain usage patterns that are outside of the norm, and that’s a trigger to look more closely at an individual’s needs,” Hall said. “If someone has 24-hour medical care at home, we would take a closer look at what that injury is and we would ask, ‘What is the medical basis for that?’ ”
Hall said his company will review the claim, the diagnosis of the injured person, the notes from the treatment provider and whether the level of care is consistent with the nature of the injury and a patient’s current level of functioning.
“Usually it’s very clear when the level of care they’re receiving is excessive,” Hall said. “If that’s the case, we’ll work with him [team] to better understand why they think the level is appropriate – just to make sure we haven’t misunderstood or overlooked anything.”
It is important not to neglect a patient’s mental health either.
“Often when there are so many [different] Level of complexity and different types of injuries, it’s almost like focusing too much on their specifics [physical] Injuries, because they’re there, they’re documented,” Hall said. “Mental health can be overlooked.”
“It may not just be the injured worker who needs care after a catastrophic accident,” added Biltz. “A catastrophic injury has repercussions on the injured worker’s family, co-workers and others close to those individuals.” &