Many claims professionals go deep into their careers before handling a catastrophic injury, such as traumatic brain injury, spinal cord injury, burn or major multiple trauma. Catastrophic injuries encompass one-percent of total claims, so in the big picture, they don’t happen often. However, they entail 20-percent of all claims costs, so when a case does arise, it’s important to be prepared. I’ve put together my top six “Do’s and Don’ts” for handling catastrophic cases to help guide you through your next claim.
- DO gather experts early. Access to an expert team will help you establish a game plan. This team may consist of a catastrophic case manager, a medical director, a claims manager and/or your excess carrier. Each of these players brings with them their own set of unique experience that can help you move quickly to set up a care plan, establish your reserves and set expectations.
- DON’T be late to the game. At no fault of their own, claims adjusters are often not informed about an injury right away. However, no matter when the notification comes, adjusters should have a plan and be prepared to inform the injured worker and family, employer and hospital of the claims process right away. It is common for an injured worker and their family to have anxiety, but being prepared and guiding them assuredly through the process can help ease their nerves and foster trust. Let them know you are there to help.
- DO understand the levels of care and severity of injury. The sooner a claims professional understands the severity of the catastrophic injury the better. Knowing the basics of each type of injury (traumatic brain injury, spinal cord injury, burn, etc.) and understanding the different levels of care a patient might need—from the acute care hospital, to acute rehabilitation to post-acute rehabilitation—will help you communicate with the patient and keep everyone involved in the case on the same track. Additionally, it’s always best to plan for the worst case scenario.
- DON’T let the treating hospital dictate care. Many times, an acute care hospital will tell the injured worker and their family that they can recover within their own system. While this may be appealing to the injured worker and their family, particularly if the hospital is close to home, the patient may lose out on valuable time and resources they would receive at a rehabilitation facility that specializes in their type of injury. Most rehabilitation settings within an acute care hospital don’t see a large volume of catastrophic cases and therefore don’t have the expertise to effectively rehabilitate individuals requiring specialized and complex care. Madonna is one of the only specialized freestanding rehabilitation hospitals in the country and has received the highest possible level of accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) for its Brain Injury, Spinal Cord Injury and overall Inpatient Rehabilitation Programs. Make sure your case manager communicates all options and benefits with the injured worker and their family.
- DO begin discharge planning right away. Discharge planning should not wait until a patient is almost ready to come home. A patient may progress more quickly than expected, and you don’t want to be the reason they can’t return home. Work with your team to ensure any home renovations are done and/or needed durable medical equipment is purchased and installed.
DON’T base placement in rehabilitation facilities on price alone. Not all rehabilitation facilities are created equal, and making that decision based on price is not advised. Spending more money upfront to have your patient get the best treatment or rehabilitation possible, will ensure the optimum outcome for the injured worker and will save you money on the long run. Relying on a specialized rehabilitation facility like Madonna will provide your patients access to innovative rehabilitative and adaptive technology, individualized rehabilitation care plans, progressive treatments and holistic care.