Positive case management fosters positive recovery outcomes. It pays to care.
As a case manager, you operate in an environment that can foster your ability to be effective.
Low turnover of staff, comprehensive training, strong emotional support, manageable caseloads, streamlined administrative requirements, clear expectations, user-friendly claims software, and adequate funding can all play a role in enhancing an individual case manager's ability to support and engage workers.
Focusing on long-term solutions via well-designed performance metrics or other carefully considered targets support work that leads to the outcome that is sought, with better results for workers and schemes.
Your responsibilities in the claims process may vary depending on your jurisdiction, but will commonly include:
- Claims determinations.
- Decisions about access to treatment and rehabilitation services.
- Building relationships and effectively communicating with all claims stakeholders (e.g. injured workers, employers and service providers).
- Managing paperwork and other administrative aspects of claims.
No matter how it’s cut, case managers hold a large and challenging workload. Case management has been described as a difficult and emotionally demanding job that requires strong interpersonal skills (including written and verbal communication and conflict resolution), good time management, problem-solving skills, a clear RTW focus and administrative efficiency, as well as a degree of technical knowledge.
There is a need for effective systemic and institutional action that empowers the work of case managers, which in turn will lead to more successful recovery and return to work journeys.
The Research
Evidence supports case management practices that are proactive, timely, and fair. Best practice case management prioritises accurate early identification of the needs and risks of workers, targeting care accordingly and evaluating the results, and they track worker progress, monitor biopsychosocial influences and proactively trigger intervention as required. Fair and transparent processes, with open sharing of information between stakeholders, are likely to build trust and safeguard engagement. An effective case manager will also promote cooperation amongst stakeholders.
Evidence also shows:
- Delays to claims determinations, wage replacement payments and treatment are linked to prolonged disability, worse RTW outcomes, the development of secondary injuries and strong feelings of injustice in workers.
- Arduous and repetitive administrative requirements damage workers’ mental health and recovery prospects and reduce cooperation between insurers and healthcare professionals. Treating practitioners say that more paperwork leaves less time for therapeutic work, and reduces their willingness to treat compensable patients.
- Adversarial contexts result in poorer health outcomes for injured workers, lower rates of RTW and more negative emotions for stakeholders. Independent Medical Examinations (IMEs) are frequently a source of tension, distrust and conflict in the RTW process, and may delay recovery.
Action Areas
To improve case management, and ensure practices promote recovery and return to work, requires:
- Case management approaches that are procedurally fair, evidence-based, and culturally appropriate. Case management requires a systematic and biopsychosocial approach to early identification of the needs and risks of workers, and address those needs through targeted support. There is also a need for significant improvements in the workers’ compensation and health systems for Māori workers, Aboriginal and Torres Strait Islander workers and other workers who have reduced access and greater needs in rehabilitation.
- Retaining well-trained and adequately resourced case managers. Systems should support the cultivation and retention of a skilled, experienced workforce of workers’ compensation case managers should be an urgent priority in every jurisdiction.
- Consistency of case managers over the life of a claim. Case management systems should be structured to promote continuity of care, avoiding unnecessary changes that hamper claims and affect outcomes.
- National principles of practice for insurer case management. There is need to clarify the responsibilities of case managers within workers’ compensation systems and identify the key competencies and skills (including human or ‘soft’ skills) required to meet those responsibilities.
- Greater transparency regarding case management resources, costs, and approaches. This includes reporting of turnover rates, case managers’ perceptions of effectiveness, caseloads, and costs.
You can find more information on areas of action for case management in It Pays to Care: Bringing evidence-informed practice to work injury schemes helps workers and their workplaces.
References
These are indicative references only. For complete reference list, please see the It Pays to Care policy paper.
- Gardner BT, Pransky G, Shaw WS, Hong QN & Loisel P. Researcher perspectives on competencies of return-to-work coordinators. Disability and Rehabilitation. 2010;32(1):72-78.
- Iles RA, Wyatt M & Pransky G. Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia. Journal of Occupational Rehabilitation. 2012;22(4):478-488.
- Kilgour E & Kosny A. Victorian Injured Worker Outcomes Study Study 1 – A qualitative enquiry into outcomes for injured workers in Victoria who have longer term claims. Melbourne: ISCRR and Monash University; April 2018.
- Newnam S, Petersen A, Keleher H, Collie A, Vogel A & McClure R. Stuck in the middle: The emotional labours of case managers in the personal injury compensation system. Work. 2016;55(2):347-357.
- Schaafsma F, De Wolf A, Kayaian A & Cameron I. Changing insurance company claims handling processes improves some outcomes for people injured in road traffic crashes. BMC Public Health. 2012.
- Victorian Ombudsman. Investigation into the management of complex workers compensation claims and WorkSafe oversight. 2016.
- Wyatt M & Lane T. Return to Work: A comparison of psychological and physical injury claims: Analysis of the Return to Work Survey Results: Safe Work Australia; 2017.