Field Case Management Specialty Solutions

From Simple to Complex, Our Field Case Managers Can Help

Explore our comprehensive suite of field case management specialty solutions, encompassing everything from catastrophic injury management to ergonomic services. Designed for claims professionals wanting to learn more, this page is a resource hub offering in-depth information on the specialty services that can help you with your toughest claims.

Catastrophic Injury Management

A highly specialized solution to manage life-altering workplace injuries. Catastrophic case managers help individuals receive the care needed to optimize both their medical and functional ability to mitigate the financial risk associated with these high-dollar claims.

Injuries that Trigger a Catastrophic Injury Management Referral

  • Spinal cord injury
  • Traumatic brain injury
  • Burns (life-threatening): electrical, thermal or chemical
  • Electrical shock, including lightning injury
  • Traumatic eye injury or other sensory deficits
  • Crush injuries
  • Gunshot wounds
  • Multiple traumas
  • Traumatic amputation of limb
  • Occupational radiation or chemical exposure

Highlights of our catastrophic injury management program include:

24/7/365 catastrophic call center
500 Catastrophic Case Managers
National oversight
$40 million+ in annual savings

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Crisis Response

Crisis response assists employers and payers by supporting the victims and witnesses of traumatic workplace incidents, including robberies, assaults, deaths, severe injuries and natural disasters. Crisis Specialists work to provide "psychological first aid" to normalize the event and to identify individuals who may be at risk for psychological conditions. Debriefing sessions can take place face-to-face, by phone or video conference.

Genex's Crisis Response Program provides:

A national network of specialty trained clinicians
A national oversight team certified in Critical Incident Stress Management (CISM)

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Cost Projection Services

Our suite of cost projection services provides unbiased third-party comprehensive assessments, staffed by a national network of certified professionals. We provide a variety of cost projection services tailored to fit your needs and the specific circumstances surrounding a claim.

Certifications for our certified cost projection professionals include:

Certified Life Care Planner (CLCP)
Certified Nurse Life Care Planner (CNLCP)
Medicare Set-Aside Certified Consultant (MSCC)

Life Care Planning

An analytical method that estimates medical damages resulting from an injury or illness and provides a comprehensive outline of current and future medical, vocational, educational, and psychosocial needs of a chronically or catastrophically ill or injured individual. Life care planning addresses life expectancy and includes a comprehensive review and summary of medical records.

 

Medical Cost Projections

Sets reserves for an injury and addresses future medical, prescription drug, and DME needs for a defined segment of time from one year to lifetime expectancy. All medical cost projections include a medical record review and summary, a comprehensive report, a narrative, and a cost analysis worksheet.

 

Medicare Set-Aside Services

Payers are under increasing pressure to protect Medicare's interest when settling claims. Federal law directs that the burden of paying for future medical expenses is not shifted to Medicare. Failure to protect Medicare’s interest can result in legal action. Medicare Set-Aside (MSA) Services assist workers’ compensation payers in meeting this obligation by determining appropriate set-aside amounts and securing Medicare approval. Our comprehensive suite of MSA services includes:

  • MSA cost projection
  • Rated age
  • Social Security and Medicare status determination
  • Conditional lien search
  • Seed and annuity quote
  • Free revisions for up to six months
  • Cost driver letter

MSA results:

1,555,448 Conditional Payment Dispute Savings
92% CMS approval rate

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Legal/Liability Nurse Review

Legal/liability nurse review is the application of nursing education and experience in conjunction with legal/liability standards in the evaluation and critical analysis of claims. Consequent to the review and analysis of records, the legal/liability nurse formulates and communicates an evidence-based opinion. The resultant opinion, as well as the foundation for that opinion, is communicated to the client through a standardized report.

Expertise Chart

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Ergonomic Services

Our staff of certified ergonomics specialists have expertise in preventive, accommodation, and return-to-work services for both office and industrial settings. We assist employers with eliminating risk, reducing discomfort, increasing productivity, and maintaining a safe work environment. In addition, we provide the following services which are customized to fit the needs of each employer.

    Ergnomic services include:
    • Remote ergonomic assessments
    • Onsite ergonomic assessments
    • Ergonomics consulting
    • Ergonomics training

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    Alternative Transitional Duty

    When an employer is unable to accommodate temporary work restrictions, alternative transitional duty is an ideal solution that places the injured employee with a nonprofit organization. This program provides a solution to reduce disability costs by helping the injured employee return to a work routine during their recovery.

    Studies show that employees who are out of work for more than six months have less than a 50% chance of ever returning to work in any capacity

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