Meet Clarice Morris, FCM, RN, BA, CCM
Clarice Morris is a Registered Nurse and maintains National Certification for Case Management (CCM). She has 20 years of case management experience, including clinical nurse consulting, territory sales consultation for wound care, pharmaceutical sales, home health, and infectious disease as well as critical care nursing.
“Every successful outcome begins with a dedicated nurse case manager who understands the workers’ compensation process, meets people where they are, and expertly coordinates resources, removes barriers and guides the injured employee toward meaningful and successful outcomes.”
Challenge
*William is a 65-year-old male who sustained an industrial injury in November 2021, while employed full-time as a maintenance mechanic with a retail store’s distribution center, where he had worked since October 2006. The injury occurred while lifting a box from a conveyor belt that became jammed, during which the injured employee used a scissor lift to remove the obstruction and developed right-sided pain. He was initially evaluated in December 2021 and diagnosed with a lumbar spine strain.
Over the course of treatment, lumbar surgery was requested a total of eight times and consistently denied, with the denials ultimately upheld through independent medical review. As a result of these repeated denials, limited treatment options remained, and the claim faced prolonged functional limitations and ongoing uncertainty regarding appropriate treatment direction.
Despite extensive conservative care, including physical therapy, acupuncture, chiropractic treatment, and a home exercise program, William continued to report persistent low back pain with worsening right lower-extremity radicular symptoms. The continued pursuit of surgical intervention without updated diagnostic clarity posed a risk of unnecessary and invasive treatment without clear medical justification.
Solution
During the initial evaluation, Clarice conducted a comprehensive review of William’s medical history and hand-carried the most recent surgical denial to the primary treating physician, requesting that each reviewer concern be directly addressed. Upon further review, Clarice identified that the existing lumbar MRI was more than one year old, limiting its usefulness in accurately assessing William’s current condition. She advocated for a repeat MRI to allow for objective comparison and determine whether any clinical changes had occurred.
Following Clarice’s advocacy, the claims adjuster approved a repeat lumbar MRI. Clarice coordinated and scheduled the MRI as STAT, with the initial appointment set for April 2026. Through continued follow-up and coordination, she was able to secure an earlier appointment, allowing William to complete the MRI nine days sooner than originally scheduled. The updated imaging provided objective data that allowed providers to reassess the injury and redirect the course of care away from surgical intervention.
Result
Based on the new diagnostic information, it was determined that lumbar surgery and post-surgical rehabilitation were not required. The updated imaging supported a revised diagnosis of piriformis syndrome rather than a surgically correctable lumbar condition. As a result, a conservative treatment plan was implemented consisting of physical therapy twice weekly for four weeks. William demonstrated sufficient improvement to be released to full duty, with follow-up scheduled in eight weeks.
This case illustrates the value of proactive field case management, detailed clinical review, and timely advocacy. Through Clarice’s efforts to obtain updated diagnostics, address reviewer concerns, and coordinate care efficiently, the claim was redirected away from unnecessary surgical intervention and toward appropriate, evidence-based treatment. Her involvement reduced medical risk, avoided invasive procedures, accelerated return to work, and ensured William received the right care at the right time.
*Name changed for privacy purposes