The document discusses the roles and skills of workers' compensation case managers and legal nurse consultants. It provides an example case study of a worker who was injured 15 years prior and had extensive ongoing medical treatment paid for by workers' compensation. A case manager with both workers' compensation and legal nurse consultant experience was able to conduct evaluations, coordinate return to work efforts, and significantly reduce ongoing costs for the insurance company within a few years.
These are just a few of the similarities between CM’s and LNC’s and why it makes perfect sense to be both. I can’t imagine being a WC CM without being a LNC nor can I imagine being a LNC without having the WC CM background.
These are a sampling of the types of job settings that I see WC CM’s and LNC’s co-exisiting in the same jobs.
For instance, my expertise is in TBI, SCI, Catastrophic injuries, rehab and case management. I have done catastrophic nursing for over 15 years and catastrophic case management for 11. I worked in a Traumatic Brain Injury and Spinal Cord Injury Rehab Hospital for 6 years, starting as a floor nurse and charge nurse & working up through the administrative ranks to Acute Case Manager and Clinical Nurse Liasian. My last insurance company position was as their “cat” nurse. I case managed the catastrophic cases, I got the really old, badly injured cases that didn’t appear they would ever be able to resolve and was basically told…..see if you can do something with this. This was my niche…
List the RED FLAGS: Prior Psych hx, Drug abuse x 10 years, 4 prior WC injuries Insistant on ER visit-could be drug seeking or could be wanting documentation to begin a paper trail for WC injury.
Remember, this occurred back in the late 80’s, early 90’s, when extended lengths of stays in rehab were the norm. A 6 month to 1 year stay was not unheard of.
Most TBI facilities use a system of rewards, when the patient accepts what has happened to them and “realizes” their
Basic things you and I take for granted like going to get our drivers license, looking for a place to live-he was a poor decision maker prior to the last 15 years, there had also been a lot of trouble over the 15 years which is why he was interdicted, etc.
Proving he could accomplish these steps would show that he had achieved the proper initiative, level of responsibility, etc it took to be able to live on his own. What took over 15 years to put in place, would take from 6-18 months to unravel and help him become independent again.
As he continued to be weaned off of services, the IW would have setbacks, which is why he wan’t just kicked out into the street with no services in place.
Discussion points-wc carrier will prolong settlement,