VerEecke noted that Fund employees involved in claim management are sharing information all the time. However, the nature of more complex claims is that many people across different areas in the Fund are required to get involved. For example, on a particular case, an adjuster can be investigating the claim while a preauthorization nurse is reviewing requested medical treatment for appropriateness. In addition, case managers may get involved coordinating medical appointments for injured workers, identifying future job opportunities, and ensuring the processing of important documents. One of the benefits of the case staffing process is that it formalizes the interactions among all these parties, providing clarity of direction for everyone involved.
Policyholders benefit from the process as well.
The more we talk about a claim and develop a plan of action, the greater the chances of achieving optimal claim outcome which saves money. But that's not all there is to this story. How the Fund even came to a decision to develop this pilot program is significant and speaks to the Fund's commitment to be the model provider of workers' compensation insurance in Texas. My experience made me realize that we needed to find a way to ensure that all the different experts are regularly communicating with each other. More importantly for VerEecke, this commitment also means that Fund managers are open to new ideas that will benefit the in-jured worker and Fund policyholders.