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In workers' compensation the goal of medical case
management is to assist the injured worker in obtaining appropriate medical care, reach
maximum medical improvement, and return to work at the earliest possible time. The
process requires objective assessment, planning, organizing, coordination, referral and
monitoring of the services required to respond to an injured worker's health care
needs.
WHEN IS REFERRAL INDICATED?
*Length of disability exceeds
physician's initial estimate.
*Non-specific diagnosis in excess of
90 days.
*Pre-existing conditions that could
prolong disability.
*Prior workers' compensation
injuries.
*Short length of time in insured's
employ.
*Hostility between injured worker
and employer.
*Dislocation fractures, particularly
those involving joints.
*Crushing injuries.
*Neurologic abnormalities.
*Spinal cord injuries.
*Head injuries.
*Amputations.
*Multiple trauma.
*Total or industrial blindness.
*Burns.
*Occupational exposure to radiation
or chemicals.
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