Case Management

CompCHOICE has developed and maintains a dedicated staff of Registered Nurse professionals to provide all aspects of case management, including the implementation of medical oversight and management for every injured worker whose case meets or exceeds levels of medical complexity or triggers.  Examples of triggers include:

  • Lost time cases >3 Days
  • Specialty referral
  • Surgery recommendation
  • Dispute regarding medical care
  • Exposures (e.g., blood-borne pathogens, industrial)
  • Outpatient diagnostic testing (MRI, CT, EMG, etc.)
  • Adjuster discretion if no other trigger is met

CompCHOICE offers two types of case management: Telephonic and Field-based.  Both types of case management have the same essential functions, which include:

  • Initial contacts within 24 hours of claim assignment
  • Coordination of all medical care for injured employees
  • Communication with adjuster, injured employee, provider, and employer
  • Accessible 24 hours / 7 days per week

The CompCHOICE Field-based Case Management (FBCM) program is tailored to provide a customized case management strategy to help the injured employee recover and return to work in a timely manner, while reducing medical and indemnity costs.  The FBCM program’s main highlight is the face-to-face RN interaction with the physicians and injured employees, as indicated.

Our Case Managers communicate with the assigned adjuster, as well as the treating physician, regarding treatment plans, medical costs, major cause, and return-to-work options, with the goal of progressing care.  Employers receive timely reports with estimated return-to-work status throughout the treatment process.