Risk & Claims Management

Sargent & Associates practices early intervention to impact the risk management and safe return to work for individuals injured on the job. A risk manager is assigned to a case within receipt of an injury notification. Their focus is to work with the medical provider(s), employer, insurance carrier and other associated parties as an active team member in facilitating care and overseeing the claims management process while the employee is recovering.

The risk manager’s responsibility is to provide timely access to medical care, coordinate specialty resources, when appropriate, and work with the treating physician to obtain a work capacity to assist the employee back to work quickly and safely. If the injured worker needs to return to work with restrictions, the risk manager can work with the employer in identifying modified light duty positions. The risk manager is an advocate for the injured worker during the recovery process and a communicator to the employer enhancing the employee/employer
working relationship.

In addition the Sargent & Associates risk manager has specialized expertise and offers the following detailed services:

• provides initial reserves review on each claim and then at least monthly or as the claim indicates.
• provides initial action plan and outcome goals for each old claims to designated contact person.
• attends trials and settlement conferences when necessary.
• pursues reasonable subrogation.
• utilizes varying forms of information management, including but not limited to email, reports, phone updates, and internet.
• maintains our own database of all old/open claims.
• regularly communicates with the risk manager on all injured workers with open claims that are likely to return to work.
• would be available to attend claims meetings.
• provides one designated claims manager to handle the old/open claims.
• coordinates the release of employees to modified work when appropriate and works with appropriate parties to accomplish this.
• initial receipt of each new injury report to conduct a thorough accident investigation
• reports on all new injuries to respective carrier.
• works continuously with your carrier on all new claims.
• works with case managers that your carrier may assign to case.
• updates all parties on the status of the claims.
• assists with transitional work when appropriate.
• interfaces with treating physicians when appropriate on status of return to work.
• provides training and education as it related to safety and works with loss prevention staff at client organizations.
• attends DIA proceeding if appropriate.

Risk & Claims Management
Opioid Addiction Recovery Program

Sargent and Associates is available to offer case management services for the pilot program that is designed for individuals with settled workers’ compensation cases, who are still being treated with opioids. The program will be voluntary for both the injured worker and the insurance company.

Entering into addiction treatment can be overwhelming, especially when dealing with multiple services across several organizations. Case Managers help injured workers by properly and effectively managing all of their services through a single point of contact. In most situations, Case Managers are vital to ensure a successful recovery. Case management is client-driven in this field there is an overriding belief that the injured worker must take the lead in identifying needed resources. The case manager uses their expertise to identify options for the injured worker, but the worker’s right of self-determination is emphasized. Once the injured worker chooses from the options identified, the case manager's expertise comes into play again in helping the worker access the chosen services. The aim of case management is to provide the least restrictive level of care necessary so that the client's life is disrupted as little as possible.

What is a Case Manager?

A Case Manager is an advocate to help injured workers receive the services they need to promote quality, mental health and addiction treatment. Case management requires an ability to understand the natural course of addiction and recovery, to foresee a problem, to understand the options available to manage it, and to take appropriate action. In some instances, the case manager may intervene directly; in others, the case manager will take action to ensure that another person on the care team intervenes as needed. The case manager, working with the treatment team, lays the foundation for the next phase of treatment.

To make the process as simple as possible, Sargent and Associates will assign a single case manager to each injured worker. This allows the injured worker’s to have one single point of contact across all of their services and develop a relationship and open line of communication with their Case Manager.

What do Case Managers Do?

Case Managers do more than coordinate, consolidate and organize addiction treatment. They play a critical role as advocates for clients as well. Case Managers do everything in their power to eliminate disruption and hardship from the injured worker’s lives so that they may focus solely on building better futures.

As a Case management co, we possess particular knowledge, skills, and attitudes, which prepare us to facilitate more treatment-specific services. We strive to establish rapport quickly, and we have an awareness of how to maintain appropriate boundaries in the fluid case management relationship, and have the willingness to be nonjudgmental toward the injured workers’. These foundations of understanding addiction, treatment knowledge, application to practice, and professional readiness are important to an individual’s success rate because the goal is to raise each injured workers chance for a successful recovery.

What are the Benefits of Case Management?

Several studies have proven that case management improves:

• Medical Adherence

• Self-Management Skills

• Overall Quality of Care

• Appointment Attendance

We understand that this is a voluntary program and that the function of case manager will be initialed when the injured workers desires to seek assistance. The case manager will work with the insurer, treating practitioners and all team members associated with their recovery.