Discussions are common within the claims industry about the ins-and-outs of the workers’ compensation claims process and the importance of ensuring an injured employee’s case crosses the finish line to settlement. But between point A and point B, the position of an injured worker — whose physical and financial outlook is often bleak or unclear — is a vulnerable one.
Sustaining an injury can be arduous. The experience is only exacerbated by losing one’s basic safeguards — physical capabilities, a daily routine, the ability to work, and in some cases, the ability to provide for their respective families.
Who advocates for the injured worker’s best interests and guides them down the path of recovery? Who coordinates the employee’s recovery process, facilitates appropriate medical treatment, ensures needs are addressed and promotes a prompt return to work?
Enter case managers: multidisciplinary clinicians who build relationships with injured workers to help drive positive outcomes.
A nurse case manager’s story
Constance, a Sedgwick nurse case manager, was assigned to advocate for an injured worker whose story changed her life. Constance describes Mason* as an American success story. After losing his parents to violence, Mason* was raised by his grandmother in New York. He began his career 20 years ago as a flight attendant, most recently setting down in Mississippi.
Shortly after his move, Mason* was kicked in the foot while on the job, resulting in a peroneal tendon tear — a debilitating injury. Because the federal aviation industry prohibits modified work duty, in addition to the severity of the injury, Mason* faced the devastating reality of being barred from work for the foreseeable future.
Constance guided him through the subsequent lengthy recovery process: an injection, followed by a surgery he was terrified of having. Constance coordinated dozens of doctor’s visits and physical therapy appointments and helped him manage unbearable bouts of pain. Throughout the process, Constance spoke with Mason* every day.
Nurse case managers like Constance facilitate appropriate medical treatment while keeping claim costs down. From the initial point of contact, she worked with the treating physician, Mason’s* employer and the claims examiner to ensure a positive outcome. She identified barriers to the injured worker’s recovery and implemented solutions, all while forging a meaningful, supportive relationship.
An injured worker’s greatest hope is to recover in a way that allows them to return to their everyday routines, to improve their health, to get back to work and to continue doing the things they love to do. At times, all Mason* needed from Constance was peace of mind when he felt fearful about the future. After more than a year, Mason* was back to full duty as a flight attendant — a career he loved.
Making a difference
Injured workers need genuine support as they navigate an uncertain trajectory and recover. Across the U.S., case managers like Constance are committed to protecting the lives of injured workers, listening to their concerns, providing reassurance and coordinating their recovery. Each year, during the second full week of October, National Case Management Week (NCMW) provides an opportunity to recognize and celebrate case managers for improving health outcomes and advocating for injured workers. This October 8-14, join Sedgwick in shining a spotlight on this valuable profession. This year’s theme is one Constance embodies: keeping the person at the heart of collaborative care.
By providing the right care and coordination solutions — from clinical case management to networks and support — we’re driving better outcomes for injured workers. Find out how.
Learn more > If you’re interested in career opportunities as a case manager at Sedgwick, visit sedgwick.com/careers.
*Names have been changed in these cases to protect privacy.