Partial Medical Claims Management
By adding targeted medical management services to our Comprehensive Claims Management program, we can help you decrease claim durations, deliver a higher level of care for your employees, and increase your claims management ROI.
How it works
Our Partial Medical Claims Management program is designed to optimize your claim outcomes by combining Claims Administration services from our Comprehensive Claims Management program with selected services from our Full Medical Management program.
While the Medical Management initiatives in this program aren’t as comprehensive as the Full Medical Management program, they’re prioritized in such a way as to optimize results with the available resources to minimize paid claim durations and associated costs, with an emphasis on challenging time-loss decisions and staffing outages.
Nurse Interaction
A Registered Nurse (RN) makes initial contact with the injured employee who remains under the primary care of their own attending physician. The RN follows up periodically, usually bi-weekly, to monitor whether the employee is recovering within the respective published medical guidelines and coordinates the medical management with priorities as follows:
Determination of preexisting medical conditions that warrant Cost-Relief Challenging Time Loss decisions in real time when it’s medically warranted
Medically documenting and supporting all Cost Relief Applications and other legal appeals, for example Claim Protests, etc.
Establishing or verifying Full Return to Work (FRTW) and Modified Work goal dates, using widely accepted published medical guidelines
Escalating medical review and management to involve internal Occupational Physicians and specialists, primarily when recovery durations have exceeded published guidelines
Coordinating recommended medical interventions such as diagnostic testing and treatment modalities
Partial Medical Claims Management is
frequently bundled with our Nurse Triage program.
1
Minimizes the need for employees to seek 3rd party medical care in cases where it is medically deemed unwarranted/inappropriate.
2
Reduces the number of medical aid, restricted work and time loss claims incurred when an injured employee sees a doctor for a minor injury that could otherwise have been maintained as a straight forward first-aid claim with nurse follow up/intervention.
3
Helps ensure that the employee is directed to timely medical care when required. Too often employees refuse or delay seeking initial medical attention.
Without early Nurse intervention these claims can escalate into more serious injuries.
4
Eliminates the burden on supervisors who otherwise need to determine whether or not to direct the employee to medical and under what circumstances.
How can Nurse Triage help your organization?
Who Uses This Service?
This service program is the ideal solution for a wide range of Canadian businesses, including:
• Miscellaneous Public & Private Employers
• Some internal DM personnel and Processes
• Companies that can benefit from medical and legal expertise and administrative technology/reporting
• Unionized workplaces
Windley Ely can improve your Workers’ Compensation Claims Management by striving to outpace our peers in five key areas:
Unmatched Service
Challenging Entitlement
Minimizing Lost Time
Cost Relief and Cost Transfer
Account Management
We take a holistic approach to workers’ compensation, with a sharp eye for cost management and workplace productivity. Our end-to-end managed service model provides superior claims management at a lower price than your current solution.
