Workers' Comp

When to Place a Referral for Field Case Management

November 3, 2022

As a claims professional, we recognize you’re encountering new daily challenges. We want you to know that Genex is here to help. ‌In this ever-changing environment, it’s not always clear when a claim should be considered for field case management. Genex takes the guesswork out of when to refer a case and helps get your injured employees on the road to recovery and return to work.

Reasons You Might Need a Case Manager
  • History of multiple work injuries
  • Pre-existing conditions affecting recovery
  • Potential lost time of 60 days or more
  • Cases exceeding $2,000 in medical expenses
  • Multiple medical providers or frequent changes in providers
  • Injured workers that are 60 years of age or older
  • One or more comorbid conditions
  • Working light duty with no progression to regular duty in near future
  • Conflict of medical status between physician and injured worker
  • Medical diagnosis does not corroborate with cause of injury
  • Claims in telephonic case management for 90 days
  • Aggravation of pre-existing condition
  • Re-injury shortly after return to work
  • Questionable motivation to return to work
  • Legitimacy of injury or work relatedness/causation in question
  • Barriers to re-employment
  • Social issues (transportation problems, child-care, finances and other issues)
  • Return to work will require job modification
  • Unable to return to usual job which is medium to heavy work but has been released to work light duty
  • Return to repetitive work, potential for re-injury aggravation
  • Employer needs recommendations concerning ergonomic job modifications
  • Employer unclear if job is available for client to return to work
  • Client needs assistance with job seeking skills or resume preparation
  • Client needs assistance in identifying employers within his/her labor market

The following guidelines were developed to assist claims professionals in making the determination of when to place a referral.

Download the Full List of FCM Referral Triggers below. 


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