Workers' Comp

Long-Term Catastrophic Assessments

February 18, 2025
2 MIN READ

Catastrophic injuries often require life-long medical care and a myriad of supportive services for injured employees. Depending upon life expectancy and injury severity, catastrophic claims can cost millions of dollars over an individual’s lifetime. Periodic comprehensive medical assessments are considered a best practice to ensure the injured employee’s medical needs are being met and to prevent complications from occurring. These comprehensive assessments can occur at the injured employee’s home or long-term care facility. The timing of these assessments will vary based upon the injured employee’s unique needs but should occur at least yearly.

Comprehensive assessments will include:
  • Current medical status
  • Long-term treatment plan and goals
  • Compliance with treatment plan
  • Over or under utilization of medications, durable medical and other ancillary services
  • Identification of any unmet medical needs or social determinants of health
  • Injured employee and family education
  • Current Official Disability Guidelines (ODG) risk assessment score
     
 
  • Comprehensive medical records review, assessment, and reporting
  • Recommendations for reassessment frequency
  • Coordination of medical care for claims in active treatment, if warranted
  • Oversight by catastrophic RN clinical consultants, and program manager
  • Medical Director consultation as indicated
  • Updates to cost projections or life care plan for reserve setting 
     

 

General triggers for referral include:

 

  • “Plegia” diagnoses
  • Traumatic brain injuries (TBIs) and head injury diagnoses
  • Traumatic amputation diagnoses Home modification requests
  • Under the care of two or more physicians
  • Any high dollar claims with ongoing treatment needs

 

Benefits: 
  • Provides medical status updates and identifies concerns that need to be addressed to prevent further complications
  • Identifies current and future risks
  • Transition of Care planning (if applicable) to reduce hospital readmissions
  • Establishes trust with injured employee, family and caregivers 
     
 
  • Ensures current treatment is within evidence-based treatment guidelines
  • Establishes a line of communication for injured employee, family, providers and facility (if applicable)
  • Provides claims professional with updates needed for reserve setting

  • Reduces risk of complications


     

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