C T on able o t en DISABILITY MANAGEMENT REFERENCE GUIDE ts f Purpose This document summarizes key issues pertaining to disability management. NARS W Resources for Disability Nurse Case Manager – Field or telephonic nurse and Medical Protocols IME / Second Opinion a Other Programs / Resources – Activity Checks, Surveillance, Vocational y Rehabilitation U W Resolving Discrepancies • Specialist must recognize and address discrepancies in type and duration of nit MC C anagr Between Protocols and treatment. Nurse Case Manager referral needed? edo f Physician’s Plan • Specialist must understand injury and treatment issues. eror • Use resources as needed (see prior section) to comprehend complex/unusual/ s comorbid issues and/or communicate with provider. f orW • Challenges to treating physician must be based on medical knowledge SC C • Final decision rests with treating/IME physicians. pecialistsr • Specialist must post results of any discrepancies. edo • Specialist must also identify and resolve any discrepancies between verbal information and any subsequent written documents. P Job Descriptions • Job descriptions should be requested at case creation. r acticB • Specialist is responsible to follow up for job descriptions until received (Initial es est Contact, First Payment, 30 Day Review of file). • Job descriptions (regular and modified) must be sent to physician’s office and attached to patient’s chart before next appointment. U • Specialist should send cover letter/sheet with job descriptions, so provider Checklistnit M knows why the description was sent and fact that employer is committed to anag returning employee to work (modified and regular duty). er • Persistence is key if physician is not responsive (follow-up consisting of combination of fax and phone calls may be needed). W ChecklistS • Use resources (Field Nurse, Job Task Video) if employer unable to provide pecialist C Claims written description. IME/ Second Opinion • Specialist must select credible physician within appropriate specialty. • Nurse Case Manager and defense attorneys are resources. • Obtain necessary records, films and any other documentation needed prior to 14 DExpecta IME exam. F • Prioritize and summarize records for physician. a tionsile y • Specialist should ask specific questions, including those needed to address any s discrepancies between protocols and treating physician’s plans. RTW Adjustments • Specialist must maintain ongoing communication with employee after Expecta modified/TAW RTW. Partial disability is still a form of disability and specialist’s F obligation extends through regular duty RTW, even if no TPD is owed. tionsile Specialist must also adjust payment instructions to prevent improper payment of benefits. R e • If the employer does not have TAW and the jurisdiction allows, the case f erD handler should look to involve transitional work. encisability e G continued on page 28 uide CaN t o egt orieses and 26 27