Benefits and Features
Very Briefly:
The cornerstones of effective Catastrophic Injury Case Management are Planning, Organizing, Leading (decision making) and Control (both claimant and financial).
Case management is designed to assist injured claimants and their families. Case management helps the claimant and/or family negotiate the medical and insurance maze with an emphasis on focused treatment and rehabilitation while maintaining costs. The goal is to obtain the best most cost effective treatment options, as well as, coordinating services for the well being of the claimant, thus reducing and containing overall costs. The medical/rehabilitation/insurance maze is impossible, at best, and injured claimants and/or their families have difficulty dealing with and understanding that system. Often claimant and family will choose inappropriate costly rehabilitation and treatment because that is the first option and/or only option presented. Assisting claimants through case management services can reduce anxiety, improve decision-making and focus treatment while holding the line on costs.
Counseling about options for the client – Referrals to appropriate treating doctors, professionals, and service providers. A good number of injured claimants and families are confounded and immobilized by the overwhelming array of referrals and options. Case planning, implementation and control will focus on cost effective options.
Assistance beyond the scope of first party interest, e.g. Social Security problems, Department of Social Services issues, community resource networking, socialization, substance abuse counseling, life care planning, community reentry issues are addressed to reduce the overall medical, social, vocational and financial impact of injury. The use of these resources often shift costs from insurance companies to these resources.
Educational, vocational and pre-vocational assistance – Coordination and cost containment of job related and return to work services and resources.
Life Care planning – The long-term view, which will focus on problem resolution, cost containment, reserve and settlement planning.
Cost Containment – Focus on negotiation for the vest prices for services, long term versus short-term issues, budgeting, coordination of financial resources. Often there are other funding resources for assistance that are not the responsibility of the insurance company, e.g. Federal and State funding, such as, Medicare, Medicaid, MRS, Job Service, etc., split funding, as well as, private resources through grants, scholarships, and donations.
Documentation – Assistance with form completion, record keeping and records retrieval. Records management and control of medical issues.
Catastrophic Injury Case Management; A new way to look at benefits for the injured claimants and their families. PIP – No-Fault-Auto – Workers Compensation, Third Party Liability, Eldercare Management and Pediatrics.