Medical Management Services

Since 1979 the WCRA has been working collaboratively with its members to support quality outcomes in the management of catastrophic and serious injuries.  Through its experience, the WCRA has compiled extensive information that can complement our members’ case management programs and help them with managing overall medical claims costs.  Medical Management Advisory Services are provided to our members or their TPA representatives at no cost.  The goal of the WCRA’s medical management staff is to assist members in identifying the most appropriate and cost-effective rehabilitation programs for severely injured Minnesota workers.

Case Consultation

Catastrophic, serious injury, or high-cost complex claims can be very challenging — even for the most experienced claims professional. Once the initial injury information is gathered, our claims and medical management staff assess the level of reinsurance exposure and seriousness of the injury. As a part of our involvement, the WCRA injury management staff assists by:

• Reviewing claims and making recommendations for case management, including potential treatment options and case outcomes.
• Participating in roundtable discussions with claims and rehabilitation professionals to strategize on case direction.
• Providing information on medical costs in similar injuries, including initial medical cost projections and short- and long-term medical cost drivers.
• Identifying potential short- and long-term rehabilitation needs.
• Providing resource information to assist in making medical treatment decisions.
• Identifying appropriate rehabilitation facilities, Centers of Excellence, and providers.

In an effort to better understand the complex challenges surrounding a particular claim, the WCRA medical management staff may at times participate in onsite care conferences being held by either a rehabilitation facility or medical provider and/or request an onsite claims review. Our goal with these onsite reviews is to gather information as well as provide the members with more case-specific recommendations in order to ensure that optimum care is being provided.

Catastrophic Injury Guidebooks

WCRA’s Catastrophic Injury Guidebooks for Management of Serious Claims contain valuable information about anticipated medical and rehabilitation treatment; cost projections; guidance for home care, home modifications and transportation issues; durable medical equipment needs; prosthetics; as well as information regarding permanent partial disability (PPD) ratings and reimbursement questions. Members who have WCRA eMember accounts may access these guidebooks online via our eMember site. In addition, any member may request an electronic or printed copy of these guidebooks by contacting the WCRA at 651-293-0999 or wcra@wcra.biz.

Guidebooks are currently available for the following areas:

• Amputation
• Major Burns
• Chronic Pain
• Home Health Care
• Spinal Cord Injuries
• Traumatic Brain Injuries

Rehab Advisories

In addition to the guidebooks, we also provide brief informational reports on medical and rehabilitation issues relevant to managing catastrophic and complex claims.  A few recent advisories include topics such as:

• Chronic Pain Management
• Spinal Cord Stimulation
• Urine Drug Testing of Chronic Opioids Users
• Home Remodeling and Vehicle Modifications
• Family-Provided Nursing Services

Rehab Advisories are available here: Rehabilitation Advisories

Literature Research

The WCRA medical management staff is available to perform basic literature and Internet searches for information on various surgical recommendations, rehab centers of excellence, and industry trends in treatment of certain conditions.  As part of the literature search, the WCRA has access to nationally and locally recognized resources for current information targeting evidence-based medicine and high-tech treatments such as:

• Minnesota Workers’ Compensation Treatment Parameters
• Official Disability Guidelines – ODG by mcg
• American College of Occupational and Environmental Medicine (ACOEM) Guidelines

Onsite Training and Educational Seminars

The WCRA medical management staff is available to provide onsite training at the request of our members.  Some training topics include:

• Effective management of catastrophic injuries
• Chronic pain
• Planning for long-term home health care
• Home and vehicle remodeling
• Medical settlements
• Other topics as requested

The WCRA hosts annual educational seminars featuring both local and nationally recognized experts speaking on aspects related to catastrophic/serious injury claims. Continuing education hours are usually available for adjuster licensure, CCM, CRC, and CDMS certifications.

For more information regarding any of the above services, please contact the WCRA claims services department at ClaimServices@wcra.biz.