Reasons for Referrals | Factors Creating Need | Action | Overview and Benefits

Case Management of Health Care Services

Reasons For Referrals

• To obtain definitive diagnosis
• Causal relationship of treatment is undetermined
• Illusion of sufficient medical care without resolution
• Long standing pre-existing conditions prolonging disability
• Complicated diagnoses; diagnosis/prognosis without progress
• Two or more conditions related or unrelated to the work injury
• Claimants seeing several physicians or frequent emergency room visits
• Need for medical reports and coordination of services for timely conclusion
• To establish causal relationship between a work injury and current condition
• Prolonged conditions that may or may not need surgery
• No medical reports
• Conflicting reports and/or extended disability without apparent medical cause
• Prolonged medical care when the injured worker is able to return to work
• Documentation insufficient to return claimants to work or support disability
• Jobs which are inappropriate to sustain attendance at work
• Return to work difficulties because of unresolved medical conditions
• To prevent employer and employee misunderstandings regarding return to work
• Employment with a new company as disability continues
• Claimants suspected of working while on workers' compensation disability

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