Executive Summary

Injured employees can sometimes fall between the cracks, which can jeopardize their full recovery and return to work, according to one case management expert.

• Case managers can help prevent this by getting workers help quickly — wherever they need it.

• Patient education also can help prevent workers from stalling in their recovery.

• The nurse case manager can assist with helping injured employees return to work by collaborating with the employer, human resources department, and medical providers.


One of the more frustrating aspects of workers’ compensation cases is how easily these workers can fall between the cracks, lost somewhere between pre-injury health and full recovery with return to work.

The best way to handle this situation is to prevent it by following several important case management strategies, suggests Barbara A. DeGray, RN-BC, CRRN, vice president of case management at Managed Care Advisors of Bethesda, MD.

Here are the strategies:

1. Get the employee the needed help quickly.

CMs should help injured employees obtain any type of medical care they need, whether it’s emergency care, urgent care, orthopedic surgery, or anything else, DeGray says.

“The goal is to get the person the right care as soon as you can and with the most qualified providers,” she adds. “That’s what workers’ comp can do: open many doors and get people to the right and high-quality providers through a prompt authorization system.”

Collaboration with the worker’s healthcare providers is important to faster, more efficient handling of the case.

“Once you have a team of people taking care of the patient, you might have doctors, physical therapists, and other claims representatives, then the nurse case manager collaborates to share information and to make sure everybody knows about the case so the best care decisions can be made,” DeGray explains.

2. Patient education helps to prevent the inevitable stall in recovery.

During the middle stage of a workers’ comp case, the employee could fall between the cracks; they might be moving along slowly in their recovery and not doing very well, DeGray says.

This is where ongoing patient education can help, she says.

“This is a big part of it,” DeGray says. “If the patient understands what he has to do, and if the case manager listens to the patient and what kind of problems he’s having, it helps.”

Other things CMs should do is assess why the worker is having difficulty recovering, and then direct patient education to strategies that will help overcome those barriers.

“Are there any complications after the surgery? Are there side effects to the medication? Are they developing depression due to inactivity and being off of work and not having social activities?” DeGray says. “Depression is a common problem, but you can help by listening, providing patient education, and maybe seeking help from a mental health professional.”

Another strategy to moving employees past the stalled recovery period is to help them avoid any delays in seeking additional medical care and to educate them about the problems with prolonged exposure to prescription opioids, she says.

“If pain medication is no longer needed, but the patient still is taking pain medications, then we want to assist the provider and patient with treatment for the addiction,” DeGray says. “It’s a small percentage of patients, but we do see some addiction to pain medications among long-term, disabled patients.”

3. Assist employees with their return to work.

The nurse case manager can assist with the return to work process in collaboration with the employer, human resources department, and medical providers.

“Case managers can clarify what restrictions are placed by the physician on what the employee can do, and then can communicate those restrictions to the employer,” DeGray says.

“We can assist with reviewing what their job functions can be and share with the treating doctor what those job functions are,” she adds.

“We might work with vocational rehab specialists, so if the person needs modifications at their current job, or if they need to find another job, we can assist,” she says. “We support the employee through that process and sometimes we work behind the scenes, having contact with healthcare providers and employers and claims departments.”

Overall, one of the main goals of case management in workers’ comp is to monitor what is happening with the case, provide reports, and to oversee the case, DeGray says.

This includes collecting data on how many employees are off work due to injury or illness, how many lost time days are occurring, and cost data.

“Case managers are asked to help control costs of workers’ comp and help people recover,” DeGray says.

“So you have to be aware of information regarding the status of various factors of the cases that’s available to us from reports,” she explains.

“If each case manager has a caseload of 80 cases and the team is working with an employer with 1,000 people off work at one time, details may be lost over time,” she adds. “Reviewing reports to see what’s happening helps to identify trends, potential discrepancies, delayed recovery, and tracking how long employees have been off work.”

Analysis of reports can help CMs determine which workers may be falling through the cracks and need additional attention, she adds.

Because of all of the multiple factors presented within workers’ comp, it’s an ideal environment for utilization of CM techniques, DeGray says.