Challenge
*Markus, a telephonic case manager, was reviewing an in-progress claim when he realized the injured employee, *Claire, was experiencing problems, but not from anything she had done. Markus immediately contacted an adjuster and explained the issue – the network provider Claire was directed to was not sending orders or referrals and had rescheduled Claire’s emergent follow up. Markus advised the adjuster that Claire would like to see a specific rehabilitation facility due to complications with the previously suggested one. Markus facilitated this appointment, and Claire was seen within one week. After this, Markus thought the claim would progress smoothly, but he kept a close eye on it to ensure Claire’s recovery continued.
Solution
Under Markus’s supervision, diagnostic and physical therapy orders were received and Markus continued to discuss the treatment with the adjuster. What Markus was not aware of was that Claire was struggling financially but kept it close to her chest out of embarrassment and fear. Because of her financial hardships, she was unable to attend her MRI appointment and her initial physical therapy evaluation. Claire opened up to Markus and reported that her utilities had been shut off. After this conversation, Markus was suddenly unable to contact Claire, anticipating that her phone had been shut off as well.
Determined to help her succeed, Markus started searching, and he found a document that indicated Claire had been awarded an advanced payment to get her utilities reinstated. Markus alerted a clinical manager and team lead, and the payment was immediately processed.
Result
Though her utilities were back, Markus knew he could not stop there. He researched community resources in Claire’s county and emailed Claire a list of resources to assist her. As they continued to talk, he advised her to contact her manager or internal HR as they may have additional resources for her as well.
With this claim, Markus proved that addressing the needs of injured employees goes beyond just the medical treatment. Through empathy and proactive case management, Claire was able to get back on track. A new adjuster recently spoke with Claire and Claire reported she is now in a good place and could not be more appreciative of the assistance Markus gave her.
*Names changed for privacy purposes