When a worker suffers an injury on the job, navigating the complexities of medical care, treatment schedules, and paperwork can be daunting. This is where a Workers’ Compensation Case Manager steps in to ensure injured workers receive prompt medical care and are guided through the recovery process. The goal of these professionals is to ensure that injured workers recover as quickly and safely as possible while minimizing disruption for employers and insurers alike.

Coordinating Care for Injured Workers

From the initial injury report to the closing of the case, Workers’ Compensation Case Managers oversee the entire medical journey of an injured worker. Their job is to assess the injury by reviewing the medical reports and collaborating with healthcare professionals to understand the severity of the injury. Following the medical evaluation, they establish a care plan by outlining what treatments the worker needs and why they should be conducted. Case Managers then schedule appointments with doctors, physical therapists, or specialists and monitor the employee’s progress, adjusting the treatment plan as required and ensuring any possible complications are addressed.

Building Relationships with Stakeholders

A Workers’ Compensation Case Manager acts as the central hub between several parties within the workers’ compensation claims process:

Claimants (Injured Workers/Employees)

The Case Manager communicates directly with the injured worker to guide them through the recovery process. They explain treatment options, answer questions, and provide reassurance, making the experience less stressful.

Employers

Case Managers maintain a close relationship with the employer to provide updates on the worker’s progress and any changes in their return-to-work timeline. This ensures that the employer can plan for any necessary adjustments or accommodations, ensuring a successful return-to-work for the employee.

Insurers

Case Managers work with insurance carriers to ensure that medical bills, treatments, and other expenses related to the injury are covered under the workers’ compensation policy.

Health Professionals

Case Managers regularly communicate with doctors, therapists, and specialists to coordinate treatments and ensure that all medical care is delivered promptly.

The Burden of Claims Processing

Managing workers’ compensation cases can be highly manual and time-consuming. Case Managers often deal with large volumes of paperwork, requiring them to sort through medical records, claims forms, and reports. The administrative burden can take away from the time they could otherwise focus on the injured employee’s recovery. This process can also lead to delays in care, ultimately slowing down the entire recovery timeline, with some claims taking up to 18 months to resolve.

How AI Assists in Streamlining the Process

Thankfully, technology is changing the way workers’ compensation claims are handled. Companies can save as much as 10-20% of medical costs by turning to a digital solution and reduce operating expenses for claims processing by up to 30%. Artificial Intelligence (AI) can help Case Managers by:

• Automating Paperwork: AI can quickly process claims forms and extract relevant data from medical records, including manual entry - offloading manual burdens on claim teams.

• Expediting Approvals: AI algorithms can review claims and assess treatment eligibility faster than a human, speeding up the approval process and streaming access to care.

• Improving Communication: AI tools can automate routine follow-up communications with claimants and healthcare providers, ensuring everyone remains on the same page.

By offloading these tasks with AI, Case Managers can focus more on providing personalized care and ensuring timely medical treatments, rather than getting bogged down in administrative tasks.

Transform Your Workflow with Wisedocs

In today’s fast-paced medical environment, Case Managers require tools that help them remain efficient while providing top-notch care to injured workers. AI solutions like Wisedocs can revolutionize the workers’ compensation claims process. By automating time-consuming tasks, Wisedocs allows Case Managers to spend more time on what really matters - helping claimants recover. To learn more about how Wisedocs can streamline your workflow, book a demo to discover how we can support your team.