Nurses are also spending more time addressing
behavioral and psychosocial issues beyond the
original workplace injury, Thompson said.
“Nurse case managers are really needed to help
the insurance community navigate through these
complex issues,” Thompson said.
BURGEONING JOB ROLLS
The proof of that need is that workers’ comp
insurers and third-party administrators interviewed
for this story said they employ many more nurses
today than they did a decade ago.
Sedgwick Claims Management Services Inc., for
example, employs more than 400 nurses, double the
amount of five years ago, said Teresa Bartlett, senior
VP and medical director at the company.
Travelers employs more than 500 registered
nurses servicing workers’ comp claims nationwide.
Their use was made necessary as the ratio of
medical expense to indemnity costs for an average
claim increased, said Jim Wucherpfenning, VP of
workers’ compensation for Travelers.
Assigning nurses with the knowledge and
communication skills to interact with injured workers
and doctors alike speeds the recovery process and
gets workers back on the job sooner, he said.
“We believe you get the best medical case
management when those pieces of a claim are
handled by a medical professional,” Wucherpfenning
Other claims payers have also increased in-house
nursing staff to manage medical care costs.
“The operational models of carriers or payers
increasingly have some commitment to in-house
nursing to supplement adjusting staff,” said
Ronald J. Skrocki, VP, product management and
development at GENEX Services Inc. “Maybe 15
years ago there was some of that.”
Skrocki said it is hard to find a major payer today
that isn’t using more nurses either in-house or in an
outsourced function. No matter how the industry
accesses the talent, it needs more of it, he said.
Melinda Hayes, president and CEO of managed-care company MHayes, said that while some large
workers’ comp insurers employ hundreds of nurses,
they also contract with her company for nurse
field case managers and to bolster their telephonic
For older, complex claims, she has seen her
nurse field case managers called in earlier today,
with the average time from injury to referral
dropping from 2.53 years in 2011 to 1.84 years in
2014, Hayes said.
Predictive analytics also plays a role, as it helps
adjusters determine which cases will benefit from
nurse oversight of medical care. The technology also
helps ensure nurses are not unnecessarily assigned
to cases that won’t benefit from their involvement,
preventing wasteful expenses, experts said.
SLAVES TO PROCESS
Insurers and other companies providing case
managers and other nursing services also have best
practices, treatment guidelines, protocols and client
handling instructions that their nurses must follow.
The measures are intended to help deliver proper
care to speed recovery.
Chances are greater today than ever that a workers’
compensation claimant will speak with a registered
nurse, either telephonically or in person.
There is also greater likelihood that an injured
worker with an ongoing claim will interact with a
nurse case manager earlier in the life of that claim
than occurred in the past. Those with new injuries,
meanwhile, are more likely to speak with a “triage”
nurse to help determine whether they need further
Increasingly, nurses are being used in a variety
of workers’ comp roles, from providing counseling
for injured workers, to becoming more aggressive
questioners and overseers of medical treatment.
Hence, the constant appearance of want ads
placed by workers’ comp companies seeking
registered nurses, usually with case management
skills, capable of helping manage disabilities and
returning injured workers to the job.
Expect to see the number of those want ads grow
as workers’ comp payers look to stem increasing
claims complexity and medical expenses.
Over the next several years, employment of
U.S. nurse case managers is expected to grow 3. 3
percent annually. At the same time, the medical
case management industry’s revenue is expected
to grow by 3. 6 percent annually, to an estimated
$6.7 billion in 2018, according to a September 2013
report by IBIS World, an industry intelligence and
Those statistics reflect an expected growth in
demand for all nurse case managers, including those
working in group health. But much of the growth
will come from workers’ comp, as the number of
workers in the U.S. increases, the report stated.
Historically, hiring trends for nurses in group
health and workers’ comp are cyclical.
Efforts to hire workers’ comp nurse case
managers plateaued about five to seven years ago
following a “huge increase,” said Linda Walker,
a board member of the American Association of
Occupational Health Nurses.
The growth spurt came when workers’ comp
insurers and third-party administrators found they
needed more registered nurses to help comply with
increasingly complex medical laws and to ensure
medical providers followed treatment guidelines, she
The hiring run ended due to the Great
Recession’s impact on employment, according to
Part of the reason case nurses are so much
more in demand today is that claims are much
more complex today than in years past, said Liz
Thompson, CEO at Encore Unlimited LLC, a case
BY ROBERTO CENICEROS
management company in Stevens Point, Wisc.
Comorbidities, an aging workforce, and narcotic
prescriptions are driving claims complexities.
Payers are looking for spirited nurse case managers who will be
patient motivators and advocates, not slaves to process.
RISK & INSURANCE®
IN-DEPTH: WORKERS’ COMPENSATION
• Even up-front liberal spending on nurse case
managers is cost-effective in the long run.
• Payers value nurse case managers who are
aggressive and opinionated.
• The ability to motivate workers is a big piece of the
necessary skill set for nurse case managers.
INCREASINGLY, NURSE case managers are asked to motivate — and advocate for — injured workers.
OCTOBER 15, 2014
On the Case