Patient Engagement

Advocacy Saves Injured Worker's Life

According to a 2013 NCCI report, the share of workers’ compensation claims with a comorbidity diagnosis nearly tripled from 2000 to 2009, growing from a share of 2.4 percent to 6.6 percent – and it continues to grow. A comorbidity is a preexisting health condition that may hinder an injured worker’s recovery. Examples include factors like obesity, hypertension, smoking and age. These comorbidity claims are also found to incur twice as much medical costs than comparable claims.

“With CorVel’s additional layer of care, our employees benefit
and so does the program. It’s a win/win.”
– Chief, Division of Risk Management, CorVel Customer

Despite the rising costs of claims with the increasing amount of permeating comorbidity claims, the goal is always returning the injured worker to wellness. With CorVel’s case managers dedicated to a people first philosophy, savings are just an added benefit to the successes of better health for injured workers.

Case Synopsis
A 63-year-old maintenance worker was injured on duty when a garage door fell on his shoulder resulting in pain extending throughout his neck.

During a routine follow-up call to remind the injured worker of an upcoming appointment with the orthopedic doctor, the case manager noticed the injured worker sounded very ill. He thought he had a stomach virus, stating he had been vomiting for more than four days.

The case manager suspected a more serious ailment and she advised him to seek immediate medical attention. Beyond the scope of the injured worker’s work-related injury, the case manager was concerned about his complete wellbeing.

After two days of unreturned phone calls, the case manager became worried. Trusting her instinct that something was not right, she contacted the employer’s human resources director. The employee’s supervisor and a coworker went to the injured employee’s house to find him barely alive, and called 911. By the time the injured worker arrived at the hospital, he had already suffered from kidney failure and the physician said he would not have lived much longer.

Again stepping above the call of duty, after the injured worker’s hospitalization, stabilization and release, the case manager maintained contact with the human resources director. Together, they made sure the injured worker had a support system in addition to quality care throughout his recovery.

The case manager believed that the injured worker’s severe neck pain may have led him to neglect the rest of his health, including his hypertension, which resulted in his contraction of a potentially fatal condition.

Conclusion
As the injured worker continues to recover, CorVel is focused on healing his neck injury. The case manager is also working with his employer, who has a strong transitional work program, and has recommended an employee assistance program, suggesting that the intervention of a social worker may help with the employee’s return to work.

CorVel’s case managers maintain constant communication while keeping an eye on the bigger picture of the most accurate depiction of an injured workers’ health – never forgetting that behind every claim is an injured worker who needs compassion and quality care.