Blow Up Your Silos. Treat Complex Worker Injuries with Coordinated Care

At NWCDC's ‘Applying an Injury-Specific Recovery Path to Resolve Complex Cases’, presenters honed in on the importance of open communication in helping rehabilitate injured workers and their physical and mental health. 
By: | November 7, 2019

In a traditional workers’ compensation claim claim, once an injured worker is back on the job, their case is typically closed. 

Unfortunately for trauma injuries, after-effects of injury and relationships with caregivers don’t end when disability does. For patients such as amputees, there is a lasting need for emotional and physical support from medical professionals. 

The challenges of complex and specific injuries require a unique approach to return-to-work strategies and on-going care provisions, as well as open dialogue with not only the patient but all of their care providers. 

The importance of efficient traumatic injury care plans was addressed the 2019 National Workers’ Compensation and Disability Conference and Expo. 

“Applying an Injury-Specific Recovery Path to Resolve Complex Cases” was presented by Dr. Daniel Hunt, corporate medical director, AF Group, and Kim Radcliffe, senior vice president, Clinical Operations, One Call.

A Commitment to Care

As a former surgeon, Dr. Hunt knows the physical, emotional and mental effects that catastrophic injuries have on workers, their loved ones, and people like himself: their doctors. 

“I can tell you as a trauma surgeon that there isn’t a more traumatic injury. [Nothing has] a more profound effect on injured workers, their families and their lives than an amputation,” said Hunt on the challenges that come with amputations and other injuries of catastrophic nature. 

He also knows the commitment and level of trust that must be established with the patient, as well as communicating with all of their other doctors and specialists.

“A cardiologist isn’t going to talk to a prosthetist,” said Hunt of the lack of communication between hospital employees. 

“There’s a lot of siloing and fragmentation of care, and we think that’s a problem. When you have a delay in care, you see the cost of your claims go up,” added Radcliffe. 

It’s Not Just Physical

But what is more important than lowering the cost of a claim is mitigating the stress and anguish that comes with a catastrophic injury. 

By keeping an open dialogue within the hospital, rehab facility, and even the workers’ home, it helps build trust, keep the claim and its handlers focused, and improved recovery outcomes. 

“It’s not about a secret sauce,” said Radcliffe. “It’s about bringing together the resources and investing your time and effort into getting these people back to work and developing trust with patients,” 

“You have to work with the carrier and partners that are willing to put that investment forward to establish that urgency.”  

In addition to investing monetary resources, success can be achieved through early intervention–such as engaging with providers as early as the day the injury occurs–claims and injured worker assessments, evidence-based recovery plans, centers of excellence, and constant oversight and personal communication. 

Bringing Humanity to Recovery

Creating a plan that is specific to not only the patient’s injury but their lifestyle is paramount in order to achieve desired outcomes. If a worker suffers an injury that results in a traumatic loss of an extremity, rehabilitating their mental and social health should be just as important to claims handlers. 

While their recovery is being catalyzed by workers’ compensation programs, helping injured workers return to their everyday hobbies should not be lost in translation.

“We know we have to get a patient back to work, but you’re not going to have successful recovery if you don’t address their social, family, and recreational life,” said Radcliffe. 

 When focusing on technical terms, it can be forgotten that injured workers are sometimes also injured human beings.

“We’re not just preparing them for a return to work. We’re preparing them for a return to life.” &

Emily Spennato is a staff writer with Risk & Insurance. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]