60% of workers who experience a Traumatic Brain Injury on the job, never return to work.**
Catastrophic claims are less than 1% of all workers’ compensation claims but account for over 20% of claims cost. Traumatic Brain Injuries are the most common and costly type accounting for 20% of reported work-related injuries* of catastrophic claims that employers and carriers face.
Catastrophic Nurse Case Management is an effective and necessary tool for employers and carriers to manage cost and improve outcomes.
Work Comp’ Traumatic Brain Injury Employee Back to Work in 14 Months
Claimant: 45 year old male
Occupation: Hotel Maintenance
Injury: Employee sustained reported injury due to a fall from a ladder
Upon initial admission to the hospital, employee required significant sedation and intubation and placed on ventilator support.
Brain Injury Diagnosis:
Cranial CT scan revealed a non-displaced right parietal /occipital skull fracture with soft tissue swelling, bi- frontal hemorrhagic contusions, swelling in both frontal lobes, and subarachnoid hemorrhage.
A secondary cranial CT scan revealed an increased edema around the contusion in the anterior frontal and temporal lobes, mild decrease of subarachnoid hemorrhage, and no new intracranial hemorrhage. Mild decrease in the overall cerebral edema (swelling) was noted.
- The claimant was placed in a drug induced coma and transferred to the ICU for multiple months.
- Upon recovery he was transferred to a Neuro Unit and received intensive physical therapy.
- CT brain scan findings listed improving bifrontal contusion, improved bifrontal edema, no new areas of hemorrhage, and mass effect or shift present and normal ventricles in size.
- The claimant was transferred to an inpatient rehab facility where he received intense multidisciplinary therapies where he made significant cognitive improvements under the rehab program and transitioned to an outpatient program and was placed under the care of a neurologist.
- After several months of intense treatment modalities and therapies, the claimant reached a maximum medical improvement with 0% impairment rating. Within 14 month of date of injury, he was released from care and able to return to work full duty..
Review Med’s Nurse was assigned to provide nurse case management for the entirety managed the case for the entirety of the claimants 14 months of recovery.
Review Med’s Catastrophic Case Management Impact:
Review Med’s Nurse Case Manager was tasked to manage the claim from the initial report of injury. She arrived at the hospital to assist employees and family through in processing. This also allowed the employer to have immediate reporting and assessment of injury prognosis.
The Nurse Case Manager complied with the carrier and employer request to visit the claimant on a daily basis in the acute phase of hospitalization.
Clarity and Understanding:
Nurse was a resource to educate the family regarding the claimant’s injury and the complex treatment recovery process.
The nurse was bilingual and functioned as a translator for the claimant and family members with providers and the carrier representative.
Expedited the request for a neurology consult and CT head scan.
The case manager met with various on-site case managers in order to maximize the claimant’s inpatient care.
The case manager diligently researched and located a rehab facility to adequately address the claimant’s medical and rehabilitative needs.
She kept the carriers’ in-house nurse case manager and adjuster thoroughly and timely informed regarding the employee’s status and progress.
Identified a billing error by the hospital and facilitated the correction of the error, saving the carrier unnecessary and unrelated treatment cost.
Review Med’s Nurse Case Management was instrumental to the successful positive outcome of this claim. Her involvement to function in multiple capacities and report to multiple agencies was executed attentively, effectively, and in the best interest of the claimant and carrier.
* Faul M, Xu L, Wald M, Coronado V. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. For Abstract Click Here
** van Velzen, J. M., van Bennekom, C. A., Edelaar, M. J., Sluiter, J. K. & Frings-Dresen, M. H. (2009). How many people return to work after acquired brain injury?: A systematic review. Brain Injury, 23(6), 473-488 link http://www.ncbi.nlm.nih.gov/pubmed/19484621 For Abstract Click Here