The world of workers' compensation case management has not changed in design in more than a decade. Just as people become accustomed to a pair of old, comfortable shoes, many users and providers of case-management services are unwilling to part with familiar methods that, while comfortable, are undeniably worn and outdated.
Purchasers of these services have chosen from two basic delivery models: task-based, in which there is a flat fee for services, and full case management, which consists predominantly of an hourly fee for services. Case managers who serve as the clinical purveyors of these services traditionally have been rewarded through ongoing case activity. The quality of these services and the actual return-to-work outcomes have not been the primary benchmarks of success.
Beyond being out of fashion, the "old shoes" are putting the industry in jeopardy of becoming a claim-mitigation tool of last resort. The cost of case management is too often driven by escalating per-case fees, and outcomes are poorly measured (if at all) against any independent or reliable data to establish a return on investment. In the small arsenal of claim adjusting, case management has in some settings acquired the stigma of being costly and used only when all other efforts fail. Claim professionals see "old-world case management" often as an option of last resort — with many files being referred 16-18 months post-injury status.
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