Your Catastrophic Claims Handling Questions Answered

Handling catastrophic claims requires a multidisciplinary approach, with success hinging on the collaboration of adjusters, case managers, medical professionals, cost containment teams, and legal experts. Leveraging all available resources is required to provide the best possible outcome for these injured workers.

Safety National’s Senior Medical Manager, Carol Franklin, Director of Cost Containment, Karen Clifton, and Senior Claims Manager, Christa Manwaring, answer some of our most frequently asked questions about catastrophic claims handling.

How do you address behavioral issues associated with a traumatic brain injury (TBI)?

One of the most common challenges in catastrophic claims involves managing behavioral changes following a TBI. Early medical evaluation and personalized care that includes neurologists and neuropsychologists can help diagnose and treat these issues. Resulting behaviors like impulsivity, aggression, emotional instability, and social cue mismanagement might benefit from cognitive behavioral therapy, medication management, family education and support, and skill-building rehabilitation programs.

What strategies are used to track medical provider and facility bills efficiently?

This process starts with proactive outreach to medical providers to track charges and prevent delays, followed by early collaboration with a cost containment team to help negotiate savings. Work with your adjusters and regularly check in to monitor any outstanding medical expenses and adjust reserves accordingly.

Do catastrophic case managers have specific training?

Catastrophic case managers undergo a combination of formal training and on-the-job experience. They work closely with medical professionals, vendors, and adjusters to coordinate care and mitigate costs. For adjusters new to catastrophic claims, it is crucial to communicate openly with the team to receive proper guidance.

How can a claims team assist in reserving for complex catastrophic claims?

Catastrophic claims reserving is a team effort. Around five months into the claim, the team obtains a rated age report and conducts a detailed exposure analysis. Medical managers help assess expected future needs, including wheelchair replacements and potential future hospitalizations, to ensure reserves are accurate.

Is therapy provided to the family of an injured worker who may struggle to adjust to the changes following a catastrophic injury?

Families often experience overwhelming stress when a loved one suffers a life-changing injury. Centers of Excellence and rehabilitation facilities provide structured training for families, including hands-on education in using medical equipment like Hoyer lifts and mobility aids, counseling support to help cope with emotional changes, and ongoing assistance from field case managers who remain available for questions and crisis intervention.

How do you accommodate home modifications if an injured worker is renting?

If an injured worker resides in a rental, modifications are completed based on the landlord’s approval. This could mean prioritizing temporary modifications until you receive their full approval. Work with vendors to ensure cost-effective solutions and possibly plan for a long-term housing solution, such as transitioning to a permanent, accessible home.

If an injured worker’s family assists in their care, do they receive home healthcare wages?

In some jurisdictions, family members can be compensated for providing home healthcare, though requirements vary. Some states require formal caregiver certification, while others impose hourly wage caps. When a family is responsible for an injured worker’s care, monitoring caregiver fatigue and providing respite care when necessary is extremely important.