Case Management Threshold

(1) Catastrophic Injuries. An employer or insurer shall provide case management services in all cases where an employee has suffered a catastrophic injury. The employer or insured should assign a case manager who is currently and actively registered with the Bureau within seven (7) calendar days of receiving notice that the employee has suffered a catastrophic injury. There shall be one (1) face-to-face meeting within fourteen (14) calendar days after the assignment. After the initial meeting, there should be face-to-face meetings or other communications as necessary for the progress of the patient until such time as case management services are concluded. Should an employee experience a significant decline in their medical condition, there should be a face-to-face meeting between the case manager and the employee within fourteen (14) calendar days of notification of such a change. Documentation evidencing the first face-to-face meetings shall be submitted to the Medical Director of the Tennessee Bureau of Workers’ Compensation within thirty (30) calendar days of the first meeting on the Bureau’s required case management form. (2) Non-Catastrophic Injuries. For non-catastrophic injuries, there shall be one (1) initial meeting (face-to-face meeting preferred) or virtual meeting if and when a case manager is assigned to the claim. This should occur within twenty-one (21) calendar days of the assignment. Virtual meetings shall be reserved for circumstances when and where a face-to-face meeting is not feasible within the required twenty-one (21) calendar days. The case management notification from documenting the initial meeting shall be submitted to the Bureau within thirty GENERAL RULES OF THE WORKERS’ COMPENSATION PROGRAM CHAPTER 0800-02-07 CASE MANAGEMENT (30) days after the occurrence of the initial meeting. Further meetings and communications should occur as the case warrants. (3) It is appropriate to consider case management services if any of the following are anticipated: medical expenses over $10,000, an inpatient hospitalization, or lost work time over three (3) months is anticipated. Further meetings and communication should occur as the case warrants. (4) The case management closure form shall be completed within thirty (30) calendar days of closing case management services for both catastrophic, and non-catastrophic injuries. (5) The carrier shall be responsible for responsible for paying the case manager or the case manager assistant for the completion of the required case management forms. (6) When case management is transferred within the same company, one (1) notification and one (1) closure should be reported within the thirty (30) calendar day requirement on the platform designated by the Bureau. (7) When case management is fully transferred to a different company, the first case manager shall complete a notification within thirty (30) calendar days of assignment and a closure form within thirty (30) days of closing case management services on the platform designated by the Bureau. The second case manager shall file a new notification form within thirty (30) calendar days of assignment. Upon completion of case management services the closure form shall be filed with the Bureau within thirty (30) calendar days on the platform designated by the Bureau.