Healthcare Provider (HCP) interactions with injured workers and insurers in workers’ compensation (WC) systems are complex relationships that influence an injured worker’s recovery process. Interactions between HCPs and insurers can also affect injured workers’ engagement in rehabilitation and subsequently their recovery and return to work. An adjuster cannot be expected to effectively manage the demands of ever increasing caseloads and foster HCP relationships as well as oversee injured workers with complex injures. Here is where case management provides the needed support and guidance.
The fact is, supportive patient-centered interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers create adversarial relations. Other influences are the insurer and compensation systems processes exert pressures on therapeutic relationships. It is vital to improve relationships including streamlining administrative demands and increasing education and communication between the parties. Outcomes and bottom line costs are wildly affected by these relationships.
In conclusion, injured workers with long term complex injuries experience difficulties in the WC systems. Positive support through case management, changes in insurer administrative demands and compensation processes could increase HCP participation, help achieve RTW, increase job satisfaction, and in turn improve an injured worker’s recovery…all while reducing cost.
Reference: Journal of OCC Rehab 2015 March 25: Kilgour E1, Kosny A, McKenzie D, Collie A.