Costs versus Trust for Insurers and Case Managers

I have been working as a rehabilitation case manager for over 12 years now and I still get as frustrated today as I did when I started, with people’s inability to see the bigger picture.

There is no doubt if rehabilitation is implemented properly, it works to the benefit of everyone involved in the process, people get better more quickly and get back to work sooner if this is the long term goal, which allows insurers to put a more realistic value on the case and enables them to settle it earlier.

Despite this being the concept of rehabilitation, on a daily basis I continually come up against insurers inadvertently delaying the process and costing themselves more money than necessary,  through indirect costs such as time delays and legal and case management costs, by cherry picking the rehabilitation services they think the clients need.

An example of this, that springs to mind, was a man who was in road traffic accident and was having difficulty coming to terms with his injuries, so was unable to move forward with his life.

A recommendation for an assessment and a course of Cognitive Behavioural Therapy that was put forward by the rehabilitation case manager, was rejected in favour of exploring options on the NHS.

An experienced rehabilitation case manager knows it is common knowledge, that CBT is not a priority service and NHS waiting lists can be as long as 18 months in some areas.

Having met the injured person and exploring  these services in their area, prior to submitting the immediate needs assessment, this point of view was put forward to the insurer and supported by the solicitor, only to be ignored until there was written medical evidence for the request.

With GP’s already under extreme pressure and having to prioritise their own time, it took almost 6 months to get confirmation on something that the rehabilitation case manager had already identified in their initial needs assessment.

On this case the long term goal was a return to work, so the 6 month delay alone  had cost the insurer more money in the loss of earnings than the actual treatment would have cost.  That was without including the rehabilitation case managers time, the costs of the GP’s report and any legal fees incurred.

Most insurers don’t hold any professional health qualification, nor have they ever met the injured person, so should be  utilising the services of rehabilitation case managers for their experience and professional judgement.  However, it can be argued, that it is difficult for insurers  to trust rehabilitation case managers, as currently, there isn’t any accreditation in the UK and there have been cases where the lack of commercial understanding by less experienced rehabilitation case managers, has led to overspending, on what the client wants rather than what they need.

Until accreditation becomes an option for our profession, rehabilitation case managers need to be realistic with the management of their client’s expectations and the financial implications for the insurer. Whilst insurers need to have more faith in the case managers ability as a health professional and have the ability to look at the cost implications of the bigger picture.

 

 

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