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When a Workers’ Compensation Paralegal Wears the Medical Case Manager Hat

For many paralegals that work with clients injured on the job, a big part of our role is assisting with medical case management. Sometimes the insurance carriers assign medical case managers, often RNs, to the case. A great medical case manager can make things run much more smoothly by coordinating appointments and assisting in obtaining recommended treatment, as well as following up with the patients to make sure they have what they need.
But sometimes our clients do not have medical case managers. Sometimes when they do, the case management services are less than satisfactory. Even when there is a case manager assigned, experienced workers’ compensation paralegals often assist clients with medical case management in the following ways:

  1. Frequently contacting clients to see how they are doing with the current treatment regimen. Don’t make the clients call you. Keep track of their medical appointments and make a note to call the day after the appointment, if you haven’t already heard from them. Try to involve clients in the update process by encouraging them to call you after they see any medical provider.
  2. Obtaining medical records as soon as possible after each visit or admission, and thoroughly reviewing them. It is critical to understand what you are reading. If you don’t, it’s important to read reputable publications about medical records, and obtain the CLE training or mentoring to become proficient at deciphering medical records.
  3. Preparing accurate medical record summaries in every case, which include diagnoses and treatment plans, including prescribed medications, work status, durable medical equipment, and referrals.
  4. Determining if clients are getting medical treatment ordered by the treating physician(s), including medication, durable medical equipment, diagnostic testing, interventional pain therapies, surgeries, and follow-up appointments.
  5. Contacting medical case managers, defense counsel, or adjusters to follow-up on the status of medical treatment and prescription authorizations.
  6. Keep following up until the requested treatment is either approved and scheduled in accepted cases – or you reach the point that a medical motion or request for approval of treatment to the workers’ compensation agency or board has to be prepared and filed.
I spend much of my day reviewing and summarizing medical records, calling clients to see how they are doing with their current medical treatment – and contacting various parties to assist with the authorization and scheduling of medical treatment requested by treating physicians. Of course, I’m not a registered nurse or a certified medical case manager, but sometimes I feel like one, especially when there are no medical case managers assigned to the case. 
When I’m wearing the medical case manager hat, the P in paralegal stands for proactive and persistent, in order to get our clients what they need.
Readers, what other kinds of professional hats do you wear in your specialty areas?
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Want to learn more about case management, reviewing and summarizing medical records, and preparing for mediations and hearings in workers’ compensation and other kinds of civil injury cases?  Check out Workers’ Compensation Practice for Paralegals (Carolina Academic Press, 2008) available via Amazon.

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