There's a troubling misperception in the Workers' Compensationindustry that must be addressed. Case managers, adjusters and thoseinvolved in settling injury claims have one mandate: To cut costsno matter what.

At Genex Services, we want to help employers and insurers ensureoptimal use of case managers and control costs. The misperceptionis our blind adherence to cost-cutting, rather than our humanityand compassion toward injured workers. Most in our industry workdiligently to balance appropriate use of case managers, return towork and management of costs for the benefit of all parties.

Misperceptions regarding our industry are especially prevalentwith regard to case management. Recent media accounts appear toshow a lack of caring about the plight of injured workers.

But what is reality? On a daily basis when caring, experienced case managers engage with injured workers,who are often in the midst of frightening and stressful situations,it isn't just business name, date of injury and looking attreatment guidelines, limits and denials. There is much more tocase management today. Case managers know that to do their jobwell, they must become advocates and champions for the injuredworker. That kind of relationship builds trust, which leads tobetter engagement, adherence to care plans and, ultimately,outcomes.

Saving a young man's leg
I see what reallyhappens in case management on a daily basis. Some dramatic,touching, yet typical stories come to mind. In one, a worker wasinvolved in a serious forklift accident, severely damaging hisheel. The ankle became contracted, and an orthopedist said theworker needed a below-the-knee amputation. As a relatively youngman, the worker didn't want that, but he didn't know where to turnor what to do. His case manager stepped in to advocate for him,speaking to physicians and researching alternatives. The casemanager helped identify a physician who suggested a new advancedsurgical procedure and a fixator device that helps stabilize severefoot and leg injuries after surgery, would correct the contractedankle.

After successful surgery followed by weeks using the device andphysical therapy, the worker was able to walk again. It wasn't aneasy process. In addition to finding treatment alternatives, thecase manager had to make a strong case to the insurance company toreceive approval for a relatively new procedure.

Understanding the clinical value, and because the case managerhad earned the company's trust from past experiences, the insureragreed. Soon after completion of physical therapy, the workerunderwent a functional capacity evaluation, which demonstrated hisability to return to modified work duty.

By hearing the concerns and fears of the worker, the casemanager not only saved a leg and returned a young man to hisactivities of daily living, but also helped the employer managecosts. According to the Official Disability Guidelines, costs forsurgery, fixator and therapy were approximately $33,000, whereasthe cost for amputation would have been approximately $81,000. Amedical savings of approximately $48,000 was realized by avoidingamputation, not to mention potential savings of the cost of theprosthesis and perhaps longer delays in returning to work.

Holding case management providers to highstandards
To make sure every claim is handled withcompassion, we need to focus on the following best practices, whileconsidering what is best for the employee (which, as it has beenshown time and again, is best for employers and payers aswell):

• Ensure case managers are specially trained and experienced inmanaging Workers' Compensation claims, including holdingappropriate certifications, followingindustry-driven/state-mandated/URAC-compliant case-handlingguidelines, or any other special handling protocols that provideoversight and structure to the case management process.
• Use case managers strategically for claims. Case managers canplay a role in more than just standard catastrophic claims. Studiesshow claims that effectively use case managers improve return towork by 25% as compared with Workers' Comp Research Institutestandards. Consider using case managers for historicallychallenging injuries (such as back and shoulder) and involving themin pharmaceuticals to ensure the appropriateness and safety of bothnarcotic and non-narcotic medications.
• Educate employees to help them understand the role and goal ofcase managers, as well as their own role in the medical treatmentplan, and share with them stories of how other employees have beenhelped. Case managers are the conduit liaison between the employer,injured worker and the medical providers ensuring continuity ofcare.
• Conduct surveys of the program to gain insight from casemanagers and identify problems or concerns. If there are problemsor concerns, address them immediately with your vendor.
• Look for a vendor who will partner with you. Cost isn't the No.1 factor — best RTW rates and superior outcome are.
• Hold your vendor to the highest standards of care, compassionand outcomes.

Changing perceptions regarding our industry won't happenovernight. There is much to gain from optimal Workers' Compprograms: True support and compassion for injured workers; bettercare and outcomes; and safe and appropriate return to work. Butthis won't happen unless those of us in the Workers' Compensationindustry work together to share the reality of who we are asbusinesses, people and an industry. It's time for our industry totell the real story of what happens in Workers' Comp today.

Related: 7 Workers' Comp issues to watch

Tim Howard is senior vice president for field casemanagement at Wayne, Pa.-based Genex Services.