Day 2: Birds of a Feather… Manage Claims Together

Day 2 is all about duos, in the classic song we sing about two turtle doves, but in workers’ comp, one of the most important partnerships is between claims adjusters and nurse case managers. When these two roles truly collaborate, magic happens: outcomes improve, costs drop, and the injured worker feels supported instead of lost in the shuffle.

Adjusters: The Anchors

Adjusters are the steady hands guiding the claim. They:

• Investigate and validate compensability.
• Authorize treatment and benefits.
• Manage reserves and compliance.

Think of adjusters as the project managers of the team — they keep the file organized, the deadlines met, and the benefits flowing.

Case Managers: The Navigators

Nurse case managers bring clinical expertise and human interaction. They:

• Coordinate medical care and appointments.
• Advocate for the injured worker.
• Spot barriers to healing (like psychosocial issues).
• Drive return-to-work readiness.

They’re navigators at the helm, charting the safest course through the stormy seas of recovery. Case Mangers make sure the injured worker doesn’t just get treatment but truly gets the right treatment at the right time.

Here’s the truth: when adjusters and case managers don’t work together, claims stall. But when they communicate and collaborate – positivity happens!

Recovery speeds up

In an incredible article by Anne Llewellyn and CMSA, Anne highlights how proactive communication between adjusters and case managers accelerates recovery. When adjusters have the inside scoop on treatment plans, upcoming appointments, and possible cost changes, they can stay one step ahead. That kind of teamwork keeps care moving forward instead of stalling out. In as much, recovery becomes more obtainable, faster.

Costs go down – but how?

Ethos Risk nails it: case managers play a huge role in cutting unnecessary spend and speeding up return‑to‑work.

Case managers bring the medical know‑how. They’re the clinically trained partners who can look at a treatment plan and say, “This makes sense to do next,” or “This avenue has been exhausted, or it might slow us down.” They also catch comorbidities and inefficiencies that could stretch out recovery.

Adjusters bring all the financial insight. They know the reserves, the compliance rules, and how to manage the checkbook. But when it comes to whether a treatment plan is effective, they can lean into the case manager’s expertise.

Fun Facts:

• Early engagement has been known to seriously pay off. Getting a case manager involved early reduces litigation — and every adjuster knows how expensive that can get.

• Return‑to‑work is the ultimate cost saver and end goal. Helping an injured worker get back to modified duty or full duty faster means fewer indemnity payments and less productivity loss for the employer.

Bottom line: the teamwork of adjusters and case managers create the perfect balance. That’s how costs go down — not by cutting corners, but by teaming up to keep care efficient, effective, and worker‑focused.

Let’s Watch the Tide

For too long, workers’ comp has been viewed as transactional: open the file, check the boxes, close the claim. That mindset needs to change.

• Adjusters: see case managers as allies, not outsiders.
• Case managers: respect the adjuster’s regulatory and financial responsibilities.
• Together: present a united front to the injured worker.

This isn’t about “closing files.” It’s about restoring lives.

How to Be the Strongest Team

• Engage early: Don’t wait until a claim is spiraling. Bring case managers in at the start of complex files. Adjusters should lay out needs, goals, and expected outcomes right at assignment — clarity upfront saves headaches later.

• Communicate often: Weekly updates aren’t optional; they are a requirement. An open, transparent line between adjuster and case manager keeps the claim moving forward.
• Set shared goals: Recovery milestones matter more than closure dates. And yes, that means communicating those goals clearly so everyone’s rowing in the same direction.
• Stay worker-centered: Success isn’t just a closed file — it’s an injured worker ready for modified or full duty. Case managers should be in touch with their injured worker (as allowed) to track progress, pain levels, treatment adherence, and appointment updates. Building that relationship gives both the case manager and the adjuster valuable insight into motivators, red flags, and recovery drivers. Don’t worry, we’ll dive deeper into this in later days of #12daysofworkcomp.
• Did we mention communicate? Because really, if you take one thing away here, it’s that communication is the glue holding this partnership together.

The turtle doves are singing it loud: partnership is everything. Adjusters know the numbers, case managers know the medicals — and when they join forces, they unlock care that’s both compassionate and effective.

Teamwork makes the dream work, y’all. See you all tomorrow for Day 3!

 #CaseManagement #Collaboration #WorkComp #12daysofworkcomp