Worker Compensation Claims and Nurse Triage

BY LESTER L. SACKS MD, PHD, MEDICAL DIRECTOR AT ARISSA COST STRATEGIES

Worker Compensation Claims And Nurse Triage

If one of your employees is injured, what do you as an employer do? Has your human resources department written protocols, so your employees know exactly what to do? Communicating the proper information and process is important so that the injured employee receives the most immediate and appropriate care. Nurse triage can be the most effective approach to managing an incident! Nurse triage service by trained, telephonic licensed professionals can support the 24/7 needs of the employer and employee.

 

The nurse triage team will make all the arrangements for your organization, including the desired medical process and protocols to effectively support the individualized protocols, including addressing the utilization of appropriate physicians in your network.

 

Process For Care

  1. In addition to managing the medical aspects of immediate care, triage nurses use not only credible guidelines but also their experience and judgment, so that immediate care is delivered without always referring to a physician.
  2. The team will handle the required reporting to the appropriate offices as required by the State’s guidelines.
  3. If more formal care is required, the nurse will make the necessary referral to the physician within a network or company recommendation and discuss medical findings.
  4. When necessary, the triage nurse will pre-certify needs and authorizations for care.
  5. Most importantly, the triage nurse can give immediate instructions to the injured worker for self-care, making

it unnecessary for the worker to lose time and visit the physician’s office.

 

Next Steps Protocol

Once the necessary medical attention is managed, the nurse manages the required “paperwork” with emails to the necessary parties identified initially in the protocols, such as the State, the claims organization, and, of course, the employer (maintaining all mandatory HIPAA rules).

Why a Nurse Triage Program?

The value of a nurse triage program can be discussed forever because we all have difficulty embracing a change in the process. It becomes obvious to those mindful of future projections that a more efficient method of dealing with workplace injuries can be of significant value. Here are a few ways the nurse triage program offers value:

  1. It reduces the direct and indirect costs of a claim.
  2. It provides the injured worker with appropriate medical service immediately.
  3. It ensures timely State reporting.
  4. It avoids unnecessary emergency room and physician office care.
  5. It removes the supervisor from making a medical decision, which is not their job.
  6. It delivers rapid information to claims.
  7. All calls can be recorded for accuracy and a permanent record.
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