Medical management services

By using their medical knowledge to address health and wellness issues and offering encouragement and guidance to the injured employee, nurse case managers can help lay the groundwork for the earliest possible return to work.

Zurich nurses help oversee the care of injured workers through:

• 24/7 catastrophic injury response
• Coordination of home care, pharmacy, equipment and/or outpatient services
• Early intervention
• Telephone and/or on-site case management
• Vocational case management

Zurich delivers a consistent and rigorous bill review service to help our customers control the total cost of a loss.

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Zurich’s Narcotic Evaluation is a component of the Pharmacy Management program and is designed to address the growing concerns with narcotic use.

Claims submitted for review are assigned to a nurse case manager who reviews the file to identify potential mitigation opportunities. Each case reported to the program receives a case closure report showing the outcome and potential benefits of the referral.

There are three components to the program:

1. Targeted letters (all narcotics) - Selected parameters with regard to narcotic utilization will trigger targeted letters to the medical provider(s) addressing the identified concerns and requesting specific responses.
2. Benefits manager referral (Class II narcotics) - When the narcotic utilization escalates to hit identified triggers set forth by the narcotics program, Zurich’s pharmacy benefit manager will identify claimants for further review.
3. Claim professional referral - Since each claimant may have different needs and circumstances surrounding their narcotic medication usage, Zurich claim professionals can also identify and refer claims to the program that originally did not meet the automatic referral criteria.

For cases requiring additional knowledge, a physician adviser may also be engaged.

Zurich’s Pharmacy Management program helps deliver quick and convenient prescription fulfillment at no out of pocket cost to injured employees and at a cost savings to employers.

Benefits include:

• Complete first fill program
• Prescription ID cards can be used at more than 70,000 pharmacies
• Optional home delivery and online prescription processing
• Advanced technology tracks prescription needs
• Narcotics evaluation for workers compensation claims

Zurich networks leverage more than 1 million credentialed providers to offer high-quality, accessible service at negotiated rates for your injured workers’ medical, pharmacy and specialty needs.

The consistent use of a PPO has many benefits, but most notably the following:

• Credentialed providers help ensure a high-quality service network
• Negotiated rates, possibly below fee schedule and/or reasonable and customary rates
• Medical providers understand return-to-work goals

To locate a provider, Zurich customers can use our C.A.R.E.® Directory Online.

No matter how alert management is to an organization’s workplace risks, accidents and injuries can and do occur. Zurich’s Workplace Injury Triage service is a prompt, simple and effective way to help manage work-related injuries. A dedicated, toll-free phone line is available 24 hours a day, seven days a week for supervisors and injured workers to consult a registered nurse for recommendations on when first aid is appropriate, when off-site treatment may be necessary, or when a virtual telemedicine evaluation may meet response needs.

Benefits to employers include:

• Improved incident reporting lag times
• Improved PPO penetration and stay-at-work outcomes
• Decreased claims severity
• Reduced litigation rates and costs

Benefits to injured employees include:

• Immediate access to experienced and reliable medical professionals
• Reduced need for time-consuming visits to clinics or emergency rooms
• Reduced need for unnecessary testing or procedures
• Decreased time away from work

Zurich’s Workplace Injury Triage service can be the first step in getting valued employees back on the job, but different injuries may require different actions to reach that goal. Our Return-to-Work Program addresses variances in recovery time and post-injury capabilities and includes Alternative Work Solutions for employees who can’t immediately resume their previous role.

Zurich Care Plus is a program that uses innovative technology to predict and monitor an injured worker’s anticipated course of treatment. Coupled with timely and targeted medical professional intervention, Zurich Care Plus can help maximize medical improvement for injured workers and improve claim outcomes.

Three key program elements:

1. Care plans: Customized care plans, leveraging evidenced-based treatment guidelines and key medical information, are delivered to claim professionals on average within 24 hours of filing a workers’ compensation claim.
2. Bill review: As injured workers receive care and bills are submitted to Zurich, each charge is reviewed relative to the care plan to help ensure medical necessity and relatedness of treatment. Charges that fall outside of the care plan are flagged for nurse review.
3. Nurses: Zurich’s team of nurses plays a key role and can help:
   
   • Evaluate medical necessity for recommended treatment that deviates from care plan
   • Advise on mitigation strategies when injured workers do not progress as expected
   • Optimize care plans to account for each worker’s unique circumstances and comorbid conditions