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Neurological Case Management
Associates 2002

 
 

   

 Forensic Case Management: Of Benefit to All

Michael Davis, CBIS-CE &
Patricia Jackson, BS, CBIS

The Neurolaw Letter, Vol.5, Number 9, May 1996

 

 
   

     Since the 1960's the case manager has been a key organizer of services in traditional rehabilitative settings. Case management has evolved over the years form a simple cost containment focus to a well-coordinate, systematic, compressive approach to quality, cost-effective care. Case mangers today are routinely and almost universally involved in organizing and coordinating rehabilitative services and resources to maximize an injured person's functional recovery. Most recently the case manager has been recognized as a catalyst in the field of forensic or medical-legal rehabilitation. Therefore neurolawyers are increasingly utilizing professional case management services to ensure that their clients are afforded well-coordinated, quality care and treatment during the often lengthy process of litigation. Since lawyers have a duty to provide comprehensive legal services but do not have the time to oversee the medical and rehabilitative aspects of a personal injury case, it becomes their obligation to provide a case manages approach to the myriad of needs in a serious injury case.

     As more cases managers are being employed by attorneys to oversee their clients' cases however, it is important to clarify the role of a case managers in this specialty field of medical- legal rehabilitation. Since a case managers capable of wearing many hats, for the purpose of this article various components of case management will be identified so that, while contemplating the involvement of a case manager in a personal injury claim, the attorney can weigh the benefits of involving a case manger right from the start. Since time is typically of the essence in catastrophic injury claims, utilizing professional case management services to coordinate services that will maximize physical, cognitive and emotional function allows the attorneys to focus on the litigation process.

     Case Management assumes various roles throughout the different milieus of recovery from illness or injury. In the acute medical arena, the case manager serves as a discharge planner effectuating the movement of an individual from the hospital to either rehabilitation, home health care or outpatient therapies. The insurance case manager serves mostly as a cost monitor to ensure that health care dollars are expended wisely. Facility based rehabilitation case managers usually serve on a team within that facility to guide therapies towards maximum potential recovery for the patient within the confines of their facility. None of these case managers however are typically involved in the legal aspects of a patient's case. The forensic case manager is concerned with every aspect of the above while, at the same time, assuring that the legal perspective is being addressed to maximize client recovery. The personal injury attorney who utilizes the services of an experienced case manager is in fact assuring the client's access to quality treatment and medical care.

     The weeks and months immediately following a traumatic injury are full of day-today stressors that result in families being overwhelmed with information and decisions they may not be equipped to handle. All to often, families are neglected by those medical professionals who have devoted their time and efforts to preserving the life of their loved one in trauma. If immediately after being retained in a personal injury case the attorney involves a case manger, the family will benefit from the expertise of an experienced rehabilitation professional who can assume a guiding role in the care of their loved one. The attorney also benefits by identifying the case manager as the primary contact person for the family. The case manager is able to field numerous questions and run interference while allowing the attorney valuable time to proceed with the intricacies of the litigation process. Families in trauma have special needs. They can appear to be demanding at times when in fact they may simply need someone to listen to their concerns, their ideas or even more importantly , their fears. So first and foremost a case manager is a liaison for not only the client, but the family, the rehabilitation team and the attorney, as well.

     Secondly, the case manager is an advocate. Once given the opportunity to review medical records, discuss the case with all parties involved and determine the priorities considering instructions from the attorney, the case manager can oversee a treatment plan, monitor progress, advocate as necessary and create a clear pathway through the rehabilitation maze. The forensic case manager can objectively oversee the provision of services from a more holistic an client-centered approach. He/She works in conjunction with the clinical case manager and the insurance case manager, but without their internal pressures or external financial obligations. The attorneys who assign a case manager to their personal injury cases are assured that the appropriateness and effectiveness of therapies an programming will be monitored and that care will be coordinated in the best interest of their clients' long term needs. If long term rehabilitation is necessary, the involved case manager has the ability to explore and identify possible funding sources early on. Through their experience, case managers are familiar with federal, state and local resource systems available to the client whereas the attorney may be a novice in that particular arena. Understanding the systems of Medicaid, Social Security, Vocational Rehabilitation, Workers Compensation, the Public Schools and gaining access to their services is a time-consuming process. Rather than assume that task of breaking new ground, the attorney can rely on the case manager to fulfill this area of responsibility.

     Thirdly, the role of a skilled negotiator is important throughout the course of recovery. The case manager is capable of creatively negotiating a proposed plan of care, length of stay, rates of service and when necessary, identify appropriate vendors. Whether during the course of acute care, outpatient rehabilitation or in home care, negotiating services to develop a continuum of quality care is crucial as well as time consuming. Where expert life care planning is necessary, identifying service providers an ensuring the implementation of the life care plan is a long term commitment. The attorney who utilizes the expertise of a case manger is cognizant of the fact that client's needs continue long after the litigation process has ended.

     There is no easy road to recovery following a catastrophic injury. Recovery from traumatic injury can be a long arduous process not only for the injured party but for the family as well. Although not intentional, the family's emotional needs can frequently be overlooked while the professionals focus on rehabilitation of the client. The case manager serves the family as well an educator and as their guide to a support system. One of the most valuable tools a case manager brings to the table is the ability to listen. A skilled case manager listens to concerns from all parties involved, pulls the information together, develops a plan and ultimately directs the implementation of that plan. The case manager works closely with the rehabilitation team, medical consultants and the family. By bringing forth the clinical perspective, the case manager helps the attorney strategize throughout the litigation process.

     It is the attorney's duty and obligation to provide clients with the best possible means available to ensure successful resolution to their case. Since financial recovery is only one aspect of a case, personally injury attorneys should also concern themselves with the more critical aspects of a case - i.e., emotional and physical well- being. An experience forensic case manager is an asset to the plaintiff attorney's case for many reasons, some of which have been presented here. Each personal injury case presents itself with a unique situation, specific needs and a vast range of priorities. In collaboration with the attorney, the list of priorities can be defined, responsibilities delineated and a initial plan set in motion by the case manager.

     Whether a liaison, advocate, negotiator or educator, the role of a forensic case manager is key in litigating personal injury claims in today's legal arena. Ethics dictate diligence by the plaintiff counsel. Morally speaking, this diligence would serve the client equally as well in the pursuit of quality services, thus facilitating improved quality of the life for the client.



Patricia (DePersis) Jackson, BS, CBIS,  is a Case Manager with Neurological Case Management Associates and formerly for William H. Burke & Associates, Inc., a private forensic rehabilitation practice in Portsmouth, NH. as well as New Medico Associates of Boston, MA

Michael Davis, CBIS, CBIS-CE is the President of Neurological Case Management Associates specializing in the field of neurological rehabilitation throughout the greater mid-Atlantic area.

References:

Bee, C.M.(1996) Damages/Running The Gauntlet From Soft Tissue to Head Injuries/From Chiropractor to Neurosurgeon. A non-published presentation.

Burke, W.H. (1995). The Rehabilitation Expert: Analysis and Management of Brain Injury and Other Neurologic Disorders. In Burke, W.H. (Ed.) The Handbook of Forensic Rehabilitation, Houston, TX: HDI Publishers.

Burke, W.H. (1995). The Forensic Analysis of Costs in Head Injury Claims. A non-published presentation. Insurance Defense network, Las Vegas, NV.

Evans, R. & Watke, M. (1995). Catastrophic Neurologic Injury: Improving Outcomes Through Case Management: The Case Manger, July/August / Sept. 83-88.

Fawber,H.& Zorger Orstein B. (1995). Case Management In Forensic Rehabilitation. In Burke, W.H. (Ed.) The Handbook Of Forensic Rehabilitation. Houston, TX: HDI Publishers.

Howe, R. (Ed.) Inside Case Management. 1 (11), 1 (12), 2 (6). 1995.

Mullahy, C. (1995). The Case Manager Is the Catalytic Collaborator in Managed Care. The Journal Of Care Management. 1(1), June 7-9.