Three Steps to Solve Unresolved Claims
White Paper Summary
Workers’ compensation case management has historically called for a continual balancing of quality of care versus cost — a give-and-take influenced by a number of factors including evidence-based clinical guidelines, employer claim philosophies, and state regulations, among others. It can be a complicated dance.
Even when treatment decisions appear clear-cut, there is no guarantee that they will yield success. Sometimes, injured workers just don’t get better.
“There are thousands of claims out there that end up well outside of the normal duration of recovery. Nearly every workers’ comp payer has a giant book of business of older claims,” said Joseph Berardo, Jr., Chief Executive Officer, Carisk Partners.
Unresolved claims drive a disproportionate percentage of total cost, baffling adjusters and leaving injured workers with no clear path forward.
The truth is that the traditional approach to workers’ comp care doesn’t always align with the realities of recovery. Treating the compensable injury and only the compensable injury, without regard for other psychological and social factors, ignores the bi-directional relationship between physical and mental health. The right evidenced based care at the right time and in the right setting is the key.
To gain a better understanding of these psychosocial determinants, and how to set unresolved claims back on track, Carisk developed Pathways™ 2 Recovery — a data-driven, clinical approach truly putting the patient at the center. Here’s how they drill down to the overlooked factors that delay recovery and incorporate them into treatment plans.
To learn more about Carisk Partners, please visit their website.