A Catastrophic Injury Checklist for Employers

Catastrophic injury claims demand a higher level of focus, coordination, and care from day one. The stakes are high, with complex medical needs, significant exposure, and lives permanently altered in an instant. A clear, proactive checklist can help ensure important steps are followed during the moments that matter most.

“Preparation is critical for employers, where a single catastrophic loss can significantly impact reserves, collateral, and long-term funding,” said Stephen Peacock, Assistant Vice President of Client Engagement at Safety National. “Proactive management is essential to ensuring the best possible outcomes for an injured worker.”

Catastrophic claims are not linear, but involving the right resources early can ease the adjustment and re-engagement process. This high-level checklist can help employers identify who should be involved at various stages following a catastrophic injury.

1. Prior to an Injury

Employers should identify the integral people who need to know and can handle the necessary steps quickly for reporting catastrophic injuries, whether it is the risk manager, HR manager, or supervisor within their organization.

2. First 24 Hours Post-Injury

Employers will need to reach out to the appropriate contacts, including self-insured group staff, a third-party administrator (TPA), and other stakeholders. The TPA is typically responsible for immediately assigning a field case nurse (FCN) or a telephonic nurse. The FCN will initiate communication with the injured worker’s family while prioritizing compassion and empathy during this extremely difficult time.

3. First Week Post-Injury

Early visibility into severity and potential exposure is key. At this point, the FCN should communicate with an acute care facility. Employers can reach out to the hospital social worker to initiate contact with the field case or telephonic nurse. The following groups should be notified and included in status updates:

• Family
• Excess workers’ compensation carrier or reinsurer
• Broker
• Field case or telephonic nurse
• Claims staff
• Rehab facility, if timing is appropriate

This is also the time to assess if the most appropriate medical facility or center of excellence is being utilized. Any additional medical resources should also be identified.

4. 1-2 Weeks Post-Injury

The FCN will communicate with all stakeholders to determine what an injured worker will need for their return home as long-term planning begins. This includes durable medical equipment (DME), home health care, and a field case manager. The FCN will also begin assessing their comorbidities, diagnoses, treatment plans, and future care.

5. 3-4 Weeks Post-Injury

For employers, this stage often designs significant reserve adjustments and medical strategies. Employers should set up bi-weekly calls with treating specialists and invite all other parties involved in the case, including employers, nurses, claim staff, and reinsurance carriers. The discussion should cover:

• Injury summary
• Past and future medical treatments
• Possible complications, setbacks, and unrelated health conditions
• Long-term prognosis
• Ability to return home
• Future residential capabilities and needs

6. Ongoing and Long-Term Considerations

Catastrophic claims can span years and entail high medical costs, so it is critical to work with an adjuster and reinsurer to secure appropriate bill adjustments. Home health care or live-in medical facility needs should be evaluated for more accurate reserving. Consider whether home modifications and vehicle resources will be needed.

Medicare, Medicaid, and Medicare Set-Aside (MSA) plans will also need to be made, while life care planner consultations can assist in future cost projections. If relevant, there will need to be a medical opinion on life expectancy.

If an employee has attorney representation, an employer will need to plan for a defense attorney, with considerations for structured settlement options where appropriate.