When to assign a NCM

Safety Witch · October 2003

I am a w/c consultant to several clients. Presently they are not using Nurse Case Managers. Their litigation, voc rehab and investigation expenses are astronomical. In creating a presentation to encourage the use of nurse case managers to lower their other expenses, I need to develop parameters for when to use a nurse. I have included frequent flyers, surgical cases, emergency hospitalization, and type of injury vs. mechanism of injury.
My question to the Forum is when do you call in a nurse case manager on a worker's comp case?

Thanks for your feedback.

Safety Witch

Don D · October 2003

Dear Witch: How can you hold yourself out to the employer community as a Workers Compensation consultant and not know the answer to your own question? I find that problematic. If you are a safety expert and are doing paid walk arounds to point out safety violations, that's one thing. The type of information you seek typically comes from Comp Carriers, since HR Managers are not the ones who typically make the decision to assign case management.

The other thing I find problematic is that you would take the information gleaned from the Forum and use it as a basis to increase your personal income. If I'm not mistaken that violates one of the basic tenets of the Forum. I'm just trying to level with you here....am by no means being unking to you. I'll let others judge that though, as I take my licks every day.

Safety Witch · October 2003

Don D.:
As you may have read, I did give examples of some parameters for hiring a NCM. I was asking in case I missed something. My memory is not what it used to be:)

I never said I was a safety expert paid to do walk arounds. I also know that this is the W/C Thread, so I was not asking HR Professionals, but W/C professionals. I am consulting because the client belongs to a w/c pool, and the carrier or TPA (pool administrator) does not currently use NCM. My job is to help the client save money on their pool premium. Because their other expenses are so high, I know that a NCM can significantly reduce those expenses if assigned early in the case. The client does not have much knowledge about case management, so I need to convince them of the reasons NCM's reduce the total claims costs.

Also, I am not a private consultant. I work for an insurance agency in the Risk Management department, so the knowledge gained here will not benefit my personal income, other than keeping my job and collecting a bi-weekly paycheck.

I think your reprimand is too harsh. Reading posts in the HR threads would lead one to conclude that not every HR Professional knows how to deal with every aspect of HR issues. My understanding of the Forum is to pose questions to get opinions and feedback from others in the field, to clarify and help look at situations from other angles. Personally, I look forward to your comments, as you appear to be very knowledgable and eager to share your experience.

Safety Witch (this was my nickname in a previous job, so I continue to think of it fondly)

Don D · October 2003

Perhaps if your first post had allowed that degree of clarity more people would have offered you advice.

Safety Witch · October 2003

Don D
I am used to working for "bottom-line" managers, who don't want all the details unless they ask.

marc · October 2003

Now that you two have kissed and made up, perhaps some answers will be forthcoming. I am not a WC expert, but hopefully others will join in.

Don D · October 2003

No bottom feeders here. Only top of the line managers on the Forum. x:-)

ssims · October 2003

Maybe this will help and maybe not. We contract with a physician who provides staff to see our employees at our facilities. We do not pass these costs along to the carrier. One of the things we required of this agreement was the a nurse would attend every specialist appointment with the employee. It is an extrememly valuable tool for us as we know what the employee is telling the authorized specialist and we know what the doctor has told the employee immediately. As we are in MO we can choose the treating physician, which is a great benefit. Insurance carriers appreciate us once they realize the we are going to control all aspects of treatment. We work with the carrier, but do retain the right to approve or disapprove any treatment or settlement. I think NCM can be a great deal of help and does save clients money.

When to assign a NCM

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