• Disability Management Services
    • Full Case Management
    • Limited Case Management
  • Medical Management
    • Group Health Claims
  • Vocational Rehabilitation
    • Labor Market Surveys
    • Skills Analysis Assessment
    • Return to Work Programs
  • Catastrophic Injury Case Management
  • Life Care Planning
  • Telephonic Early Intervention Program
  • Independent Medical Examinations:
  • Peer Reviews 
  • Medical Records Reviews 
  • Impairment Rating Reviews
  • Telephonic Case Management

We proudly service customers whose businesses include:

  • Corporations m Government Entities
  • Insurance Companies & Health Maintenance Organizations
  • Public Utilities m Third Party Administrators
  • Brokers/Consultants

DISABILITY MANAGEMENT SERVICES

The cycle of work-related illness or injury can result in both disability and medical complications for the affected worker, and in ongoing cumulative expenses for the employer. Employer expenses include health care and wage-loss replacement payments, as well as hidden costs such as lost productivity.

Allegiance's Disability Management Services product involves two components: Medical Management and Vocational Rehabilitation. Each component is designed to lessen the burden of disability for all parties involved. Accompanied by early referral, Disability Management can increase the likelihood of earlier resolution.

Any injured worker suffering a disabling injury, (such as a low back injury or muscle strain/sprain), to a catastrophic or chronic condition, (such as a heart attack, head injury, or a severe burn), is suitable for referral to Allegiance. We examine each referral and use only those services necessary for the individual case, thus keeping your total costs to a minimum.

Benefits to You:
_____________________________________________________________________

  • Improved relations with your injured workers through constant communication. Allegiance's worker-contact guidelines help relations to remain positive, and can help avoid bad feelings that can lead to litigation.
  • Assurance of quality, cost-effective medical case management services and vocational assistance for your injured workers. Allegiance provides proven professional services to ensure quality medical care and effective cost savings for our customers.
  • Medical Management services provide you with a clear picture of the injured worker's illness or injury.
  • Allegiance's progress reports include not only the physician's diagnosis and plans for treatment, but also an estimated length of disability and an estimate of any permanent disability. This gives you the data you need to estimate claims costs.
  • Vocational Rehabilitation services assist the injured worker in returning to work in an appropriate job, at the earliest date possible. Return to work results in cost savings in the form of decreased wage-loss benefits, as well as improved productivity.

MEDICAL MANAGEMENT

The first phase in successful Disability Management is Medical Management. This process begins when an Allegiance nurse/vocational counselor is assigned to a case. The nurse/vocational manager meets with the injured worker at his/her home or at the hospital, to assess the worker's medical condition and the appropriateness and quality of the current medical care being provided. The nurse/vocational manager will also meet with the injured worker's family, and, if possible, the attending physician and other health care providers.

After assessing the case, Allegiance's nurse/vocational counselor contacts you and makes recommendations for continued medical care, such as:

  • Transferring the injured worker from the hospital to a specialized facility designed to treat the specific injury or illness. This helps to improve quality and less the cost of care.
  • Arranging for a second opinion, if necessary.
  • Discharging the injured worker from the hospital, with continued care in the home; administered by nurses and therapists, with assistance by the family, when possible. (This saves you dollars on unnecessary hospital room and board charges while maintaining quality care for the injured workers.)
  • Continuing medical care as scheduled, if the treatment is appropriate and effective.

Our nurse/vocational counselor maintains close communication with the injured workers, his/her family and the care givers, coordinating quality, cost-efficient care through to recovery.

The nurse/vocational counselor's assessment keeps you informed of the injured worker's medical condition and progress in the recovery cycle. If it appears that the injury or illness will result in permanent disability, you are notified accordingly, and the nurse/vocational counselor obtains verification of this from the treating physician, as soon as possible.

Return to Work

Throughout the Medical Management process, the nurse/vocational counselor assesses the injured worker's potential for return to work through on-site visits to the employer to perform a job analysis and to discuss return-to-work potential, either in the same job, a modified job or a different job, depending upon the injured worker's physical capabilities.

The nurse, by obtaining all the available information and sharing information with the treating physician and employer, can coordinate a successful, healthy return to work at the earliest possible date.

VOCATIONAL REHABILITATION

If it is not possible for the injured workers to return to work with the current employer, the second phase of the Allegiance Disability Management process -- Vocational Rehabilitation -- begins. Here, a professional rehabilitation counselor provides services to assist the injured worker's return to gainful employment. Services may include:

  • Direction is given to obtaining selected vocational testing to determine the injured worker's skills, aptitudes and interest levels.
  • Rehabilitation counseling to establish realistic and feasible vocational goals.
  • A labor market survey to research the local job market and identify appropriate positions for the injured workers.
  • Job placement services to locate viable jobs and assist the injured worker in seeking out job leads and scheduling job interviews.
  • Job-seeking skills training to assist the injured worker with interviewing, completing job applications, preparing resumes, etc.

During Vocational Rehabilitation, all efforts are made to assist injured workers in returning to gainful employment. Once this occurs, workers are truly on the road to recovery, regaining strength and independence at the highest level possible.

Ongoing Communications

During all phases of Allegiance's Disability Management process, services are conducted on site, with face-to-face communications occurring with everyone involved. We refer to your special instructions and follow all that apply to the particular referral. Concise, written reports are submitted to you on a monthly basis, and include documents such as medical records and testing results, when appropriate.

Case Closure

When it appears that Disability Management Services are no longer necessary or may not be cost-effective, you are notified accordingly. Case closure is always recommended at the first appropriate time, helping to ensure you get the most for your dollars.

LIFE CARE PLANNING

When faced with assessing medical care needs and setting reserves for a catastrophically injured or chronically ill worker, Life Care Planning offers an economical and professional way to ensure that your claim dollars are spent appropriately and in the best interests of the disabled individual. During this service, a nurse visits the injured worker and attending physician(s), then assesses the current care plan. Next, the nurse develops a Life Care Plan for the individual. The plan includes such items as:

  • A realistic assessment of both present and expected future levels of ability and disability.
  • An explanation of the worker's prognosis and reasonable/normal expectations for recovery.
  • An outline of current and alternative care, with projected cost breakdowns.
  • A blueprint for managing and providing needed care, supplies and services.
  • An estimate of lifetime care costs, broken down by treatments, supplies, etc.
  • An estimate of the disabled individual's lost earnings capabilities based on income potential, if appropriate.

Refer a Case for Life Care Planning When:

You need substantial information to assist in planning of the financial, medical and/or rehabilitation requirements of a permanently disabled individual.

EARLY INTERVENTION PROGRAM

This can be a telephonic service that helps employers reduce worker's compensation claim costs by initiating medical management support within the first 30-45 days from the date of injury. Through telephone contact with the physician, injured worker and employer, Allegiance helps speed injured worker's return to work, thus saving you money by:

  • Reducing Unnecessary Medical Treatment
  • Reducing Unnecessary Rehabilitation
  • Avoiding Litigation
  • Reducing Lost-Time Wage Payout

We contact the physician and injured worker, then assess the appropriateness of the current care plan. Then we provide you with our written recommendations, and inform you of the injured worker's return-to-work potential. You review the initial assessment and refer appropriate files for on-site medical management. Only then do we begin steering the injured worker toward early return to work with the original employer, in the same or a modified position. When no re-employment opportunity exist within your company, we may recommend vocational rehabilitation.

All during our Early Intervention service, Allegiance maintains positive communication with your injured worker, and provides written progress reports that enable you to maintain control of the case. Quarterly summary reports are also provided. These reports document your referrals and their associated costs.

Refer Cases for Early Intervention When:

  • Lost time reaches 15 days or more.
  • The injury is catastrophic or involves a recurring injury to the same body part.
  • Initial reserves are set at $5,000+ for indemnity, or $2,500+ for medical.
  • The injured worker will probably not be able to return to his/her former occupation.
  • Most any criteria you set for us in special instructions.

INDEPENDENT MEDICAL EXAMINATIONS

Allegiance will take care of paperwork, coordination of doctors appointment, assuring the physician has appropriate medical for the appointment, and any filing with the commission that needs to occur for an independent medical examination. A nurse/vocational specialist will retrieve any medical needed for an appointment, attend this appointment at the adjuster's request, and follow up on the physician's report.

PEER REVIEWS

Peer Reviews, Medical Records Reviews and Impairment Rating Reviews:

Allegiance works closely with a reputable staff of physicians. Our nurses/vocational specialists review the file to create an outline of the patients medical history. We then send the medical to the physician for their professional review. This is all done in a timely and professional manner.

TELEPHONIC CASE MANAGEMENT PROGRAM

ALLEGIANCE MEDICAL CASE MANAGEMENT WILL ASSIST YOU BY:

  • Reducing Unnecessary Medical Treatment
  • Reducing Unnecessary Visits and Tests
  • Reducing Legal Fees
  • Reducing Lost-Time Wage Payout

Initiating medical management within the first 15 days from the date of injury through contact with the physician, injured worker, and employer helps speed injured worker's return to work and results in savings cost.

Case manager's contact with the physician and injured worker assess the appropriateness of the current treatment. We provide you with our written recommendations, and inform you of the injured worker's return-to-work potential. A review of the initial assessment and referral of appropriate files for on-site medical management. We begin steering the injured worker toward early return to work with the original employer, in the same or modified position. When no re-employment opportunity exists within your company, we may recommend vocational rehabilitation.

During case management services, Allegiance maintains positive communication with your injured worker, and provides written reports that enable you to maintain control of the case. Quarterly summary reports can also be provided. These reports document your referrals and their associated costs.

Refer Cases for Early Case Management Intervention When:

  • Lost time reaches 15 days or more.
  • The injury is catastrophic in nature.
  • When the reported injury involves multiple body parts.
  • When the injured worker will not be able to return to his/her former occupation.
  • When an employee has reported multiple separate injuries.
  • When an employee is non-compliant with employer's program for loss control.
  • When an employee is non-compliant with treating doctor's recommendations.
  • When an employee fails to attend a scheduled IME.