Episode 5 of ADJUSTED, a claims podcast features Angie Carlisle. In this episode, co-hosts Greg Hamlin and Claire Muselman discuss managing medical claims: what resources to use, the importance of on-site nurse case managers, and getting a successful outcome for all parties involved.
Angie Carlisle is the Regional RESOLUTION Manager for Berkley Industrial Comp a leading monoline workers’ compensation insurance company that specializes in high hazard employers. Her unit strives to be the best catastrophic resolution team in the nation. Angie holds a Bachelor of Science degree in Nursing from Eastern Kentucky University and has been a Registered Nurse for 25 years with experience in trauma, general surgery, and orthopedic surgery. She began her career as an Occupational Health Nurse at Toyota Motor Manufacturing where she obtained her Certification in Case Management, Certified Occupational Health Specialist, and also became certified in Occupational Hearing Loss. She worked for the state fund in Kentucky where she enjoyed working as a CAT adjuster and later worked in a leadership and training role. Angie enjoys spending time wither her husband and 4 children.
WHAT MAKES A GOOD PHYSICIAN?
All the qualities that make an impressive physician outside of workers’ compensation apply. They should be experts in their field and put the patient first. Especially important for Workers’ Compensation injuries is being a good communicator as well as having an understanding of occupational medicine and the Workers’ Compensation system. After every visit, the physician should provide the injured worker’s work status and target dates for return to work. Establishing parameters and expectations around the healing process allows employers to offer modified duty work options so the injured worker can return to their employment.
Planning for discharge starts on day one of admittance to the hospital for the injured worker. It is essential to understand the support system and personal network of the injured worker. Do they have family that can assist with wound care, or is skilled nursing needed? What does their home able to accommodate? Is it a second-floor apartment with stairs that will solution a solution-focus mentality to return the injured worker to their home environment? What medications will they need upon discharge? Could we verify these medications have been approved and waiting for the injured worker to ensure no pharmacy delays? Thinking proactively for the care of the injured worker and asking these questions before discharge will allow for a smooth transition to the next phase of recovery.
NURSE CASE MANAGERS ROLE
Nurse Case Managers can be invaluable as they are the face of the workers’ compensation process. Nurse Case Managers are an extension of the claims handler, improving communication between the adjuster, the employer, and the injured worker. They can provide education on complicated medical procedures and help explain the confusing elements of the Workers’ Compensation system. Nurse Case Managers can identify potential barriers and provide education on aspects unknown to the injured worker. They can give an idea of what will transpire before a medical appointment to help alleviate the fear an injured worker may have, such as what to expect during an MRI. Nurse Case Managers also reiterate medical information communicated during appointments. A substantial amount of information can be missed or not consumed in a manner understood by the injured worker and their support system. Most importantly, a good Nurse Case Manager helps build trust and creates a relationship.
FACTORS IMPACTING RECOVERY
Many factors can slow the recovery of an injured worker. Obesity, diabetes, smoking, hypertension, and pregnancy can double both the time and recovery cost. Depression can also play a role. When reviewing medical records looking for factors that indicate whether psychosocial issues may be at play is critical. Is there documentation of weight gain, loss of appetite? Are there notes about the injured worker not sleeping well? How supportive is the family in helping the injured worker get back to life? Is there a discussion about the fear of returning to work? Any discussion of the relationships with the fellow employees or communication from the supervisor of the injured worker? All of these factors play a role in the recovery process and can significantly impact healing.
From the Sound Booth
With each episode recap, you can find exclusive bits of fun in this portion of the blog, From the Sound Booth. These golden nuggets come from the recording studio of ADJUSTED and help listeners get to know our co-hosts, hosts, and the Berkley teams a bit more along the way…
These pups might not have made it to the Puppy Bowl but they are our co-hosts’ MVPs!