What is Workers' Comp Case Management?

Many states use a form of workers’ comp case management to maximize the chances of an injured employee returning to work. This sort of medical case management operates to coordinate the health care and rehabilitation needs of the injured employee, with the ultimate goal being a complete recovery and return to work for the employee. Among other things, the workers’ comp case management system aims to ensure that an injured employee reasonably receives all necessary medical care related to his or her injury, so he or she will be able to fully recover.

Some examples of the functions a case manager may perform are scheduling appointments with physical therapists or specialists, locating convenient facilities where the worker can undergo tests or medical procedures, and providing information to the injured worker about his or her doctors or treatment. While some injured workers may welcome the assistance of a case manager, other workers may wish to handle their own workers’ comp case. An injured worker, however, typically does not get to choose whether to be involved in the workers’ comp case management system. Rather, state laws about workers’ comp case management and the insurance company’s practices and preferences may all impact whether an injured worker has the help of a case manager, and to what extent the case manager will be involved in the case.

The role of case management in a workers’ comp system may differ from one state to the next, and state law generally prescribes the extent to which case management is required in a certain workers’ comp case. In some states, for instance, employers must utilize medical case management for their pending workers’ comp claims to receive benefits. In other states, employers or their insurance carriers may hire medical case managers to manage their workers’ comp cases, but it's not required. Some insurance companies may even employ their own medical case managers on a perpetual basis to handle workers’ comp claims. As a result, medical case managers usually disclose their working or employment relationship with the insurance company to the injured worker at the outset of the case.

Eligibility requirements to be a medical case manager also vary from state to state. Some states require that medical case managers be licensed or registered under state law if they want to work within the workers’ comp system. Medical case managers in a workers’ comp case management system are often registered nurses.