Workers’ Compensation Case Management Model

I. Physician Initial and Follow-up Visits

• Unless otherwise directed, the status of each visit will be communicated by phone to the Company contact by the Physician or Nurse. After the phone call, the injury status form will be faxed. This form will also document the time the patient signs in and what time they sign out.
• Please note the Physician is always available to answer any questions or address any concerns you may have.

II. Rehabilitation Visits

• Unless otherwise directed, the status of each visit will be faxed to the Company contact. This form will also document the time in and time out.

III. Notification of No Shows and Cancellations

• Unless otherwise directed, if an injured employee no shows or cancels their appointment, we will send a fax to the Company contact on the day this occurs that documents this non-compliance.
• After five (5) business days, if the injured employee has not been seen or the visit has not been rescheduled, we will contact the Company Contact via phone to discuss the case.

IV. Referrals

• If an injured employee requires an outside referral, we will notify the Company contact for approval prior to making this referral and coordinate with the Insurance Carrier as well.
• After the referral and appointment have been made, we will follow up with the referral source and notify the Company contact of the findings.

V. Ongoing Treatment

• The National average for acute work related injuries is 4 physician visits and 6 rehabilitation visits. To adhere to this benchmark, we have developed a protocol to help you manage cases more efficiently and effectively.
• If an injured employee exceeds the 4th physician visit or 6th rehabilitation visit, the chart will be flagged for the physician to conduct an in-depth case review regarding the status. Information related to this review will be provided via our medical note and/or phone call to the Company contact. This may include but not limited to, referral for diagnostic testing, referral to outside Physician for evaluation, and/or future physician and rehabilitation visits.

For any and all case management needs, please contact Cindy Stephens, CWCP at (478) 751-2918