Complex care specialists at Total Medical Solutions hear stories every day where simple facts were overlooked that amount to thousands of dollars on a claim. Carriers: how many little facts do you think fall through the cracks on your complex workers' comp claims? Even though complex claims make up a small percentage of claims overall, they account for a significant amount of your workers' comp costs.
Permanent disability claims typically incude things like costly power equipment along with home and vehicle modifications. These are to be expected. However, overlooking simple facts can add significant costs to the claim very quickly.
A few real examples of missed facts
A claimant hand selected an extreme outdoor power chair because he lives in a rural area and enjoys hunting with his buddies. When the new chair arrived, the claimant realized his new power chair did not fit into his van. It was just a few inches too tall. Now, the carrier is faced with having to make costly modifications to his van, or purchase a new one. This will cost the carrier between $60,000 and $90,000.
In another case, the claimant picked out his own modified van, the carrier approved the purchase, the van was delivered, only to find that it did not fit into the claimant's garage. Now the carrier must make costly modifications to the garage, after just spending $80,000 on a new van. A visit to the claimant's home to check a few simple facts would have saved the carrier about $40,000.
Another claimant was undergoing physical therapy three times weekly for lack of sensation and paralysis. A brief home visit by a complex care specialist uncovered the fact that the claimant had left side abduction due to sitting in a wheelchair that was too wide and too tall. A smaller, lighter and more functional wheelchair was recommended. Not only is the claimant sitting more comfortably, she no longer needs physical therapy. This simple change is sure to save the carrier significant costs from related complications later on in the claim.
A simple solution: hire a complex care specialist
It pays to work with a company that specializes in complex claims. A company who specializes in complex claims is familiar with all the nuances of power equipment, home modifications and vehicle modifications. A complex care specialist understands the critical nature of working with patients who have suffered life-changing injuries and require customized care.
Ask questions. Save money.
Carriers should expect a complex care specialist to ask a lot of questions:
Is the patient male or female?
How old is the patient?
What are their living conditions?
What kind of support system does the claimant have?
What are the claimant's expectations?
How long has the claim been active?
What is medically necessary?
For more information on how a complex care specialist can help you manage your complex claims, call Total Medical Solutions, 800-700-9393.
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