Case Management for Catastrophic Claims

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Case Management for Catastrophic Claims

• Dianne M. Taylor Associates

Dianne M. Taylor Reg. P.T., Case Manager Tanya
Beatty R.N., Case Manager Karyn Drewnowsky
B.Sc.P.T, Case Manager
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Overview

• How the Case Manager can help you bring
  together all the pieces of the Accident Benefit
  Puzzle

In Community
Early Referral
In Hospital
Goods
Client
Services
Long Term
Return To Work
Family
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Introduction

• Understanding the Benefit of Assigning a Case
  Manager
• Appreciation of what are Reasonable and Necessary
  Rehabilitation Goods and Services
• Understanding the Limitations of Government
  funded Programs

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Benefits of Referral to a Case Manager

• Objective Information
• Prognosis
• Rehabilitation Needs
• Setting of Reserves

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Ability to Liaise with the Medical and
Rehabilitation Team

• Diagnosis
• Glasgow Coma Scale (GCS)
• Communication

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Detailed Early Planning For Discharge

• Support for the Family
• One time Assessments

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Assessment of Attendant Care Needs

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Role of Community Care Access Centre (CCAC)

• Services
• Hours

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Home Assessments
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Home Modifications
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Vehicle/Driving Assessment
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Referral For Treatment

• Community Based Therapists
• OCF-22
• OCF-18

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Referrals For Equipment

• Assistive Devices Program (ADP)

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OCF Forms

• Submitted to Insurer Approved Prior to
  Discharge

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Maintain Clear Communication with the Insurer
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The Case Manager is The Gate Keeper

• What is reasonable and necessary?

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Building The Team

• Physiotherapist
• Occupational Therapist
• Speech Language Pathologist
• Psychologist/Social Worker
• Physicians
• Community Support
• Vocational Specialists

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• Monitoring Progress

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The Role of The Insurer
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Other Referrals
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Catastrophic Vs. Non Catastrophic
Claims

• The Role of the Case Manager

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Equipment

• Current Needs
• Future Needs
• Timing
• Funding

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Transportation
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Long Term Goals and Needs
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Vocational Assessments

• The Good, The Bad, and The Ugly
• Formal Evaluation
• Real Life Supported Vocational Placement

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The Formal Evaluation Considerations

• Credentials of Assessors
• Expertise with Specific Impairments
• Provision and Review of All Documentation
• Need for Accuracy and Objectivity
• Psychovocational Assessments
• Vocational Evaluation for Educational Planning

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Determining an Appropriate Action Plan

• Employer Support for Graduated Work Plan
• Formulating a Written Plan
• Obtaining Medical Approval
• Who will Monitor the Claimants Job Performance
  and How?
• Close Monitoring for Proactive Problem Solving
• When to Move to the Next Step
• Defining Vocational Success

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Thank You for Your Time Patience

• Dianne M. Taylor Associates