Case Summary – Telephonic Medical Case Management
(Case closed in Early 2007)

John Smith sustained a spinal compression fracture as the result of a fall.  Treatment was initiated by a Little Rock specialist, with claimant having continuing symptoms of pain and muscle spasms. 

The case was referred to Telephonic Case Management by the TPA claims adjuster.  The Systemedic RN Case Manager negotiated the rental/purchase of an RS Stimulator.  The Case Manager then facilitated approval of specific medical treatment which reduced the cost of the claim. 

Due to the nature of the job, and the significant work limitations the claimant was initially under, he had remained off work for several months.

The employer agreed to arrange an alternative/lighter job for Mr. Smith on a temporary basis.  The RN Case Manager received approval from the physician for a current Functional Capacity Evaluation (FCE), and then discussed with the claimant the reasons for, and the value of having this FCE done. The FCE showed that Mr. Smith could return to work, up to the heavy classification, and approval was received for him to return to his regular job. 

The case manager also assisted in clarifying with the physician the impairment rating, which was reduced from 5% to 3%.  The overall cost savings from facilitating treatment, DME cost negotiations, RTW and reduction of impairment rating were approximately $10,147.