Cases deteriorate for 5 simple reasons:
1. The patient is not providing all, or even accurate, information.
2. The employer is withholding important data regarding the accident.
3. Insurers are containing costs in the wrong areas and destroying trust.
4. Health care providers do not ask key questions and ignore key areas.
5. Attorneys manipulate patients and attempt to practice healthcare.
The employer, insurer and provider attempt to manage injuries solely in terms of objectively measured physical damage. All then become frustrated when that approach works for many, but not all, injuries. And the injuries for which that game plan does not work are then a source of annoyance, frustration and bewilderment.
Key Problem Areas:
_ The injury is seen as a single event inflicted on a fully functioning and healthy worker. This is, in fact, rarely, if ever, the case.
_ Seldom do all involved understand how the employee_s background explains not only the response to injury but, in many cases, the actual occurrence of the injury itself.
The worker carries into the injury intellectual, physical, emotional, attitudinal and motivational factors which will determine the course of care, the seeking of disability status, and even pain tolerance.
When It Becomes Personal:
Perhaps the single most destructive element in claims management occurs when a patient targets a specific person (typically the claims adjustor) as the enemy. This belief may have arisen from delays in authorization, delays in financial compensation, and the belief that their physician changed a diagnosis or recommendation after talking to an adjustor. A patient with endless idle hours will value even minor events much more than will a claims adjustor with full workload. The only solution to this problem lies in early detection and/or prevention.”