Reasons for Termination of WC PPO Nurse Case Management (NCM)
- Claim controverted – by law, WC PPO can no longer manage
- Terminated Employee – WC PPO cannot direct the care of a terminated employee
- Injured Worker Opt-Out – after 30 days the Injured Worker can opt-out of program. (Over 20 years of operation, UHS’ opt-out rate is less than 2 %.)
- Injured Worker engages attorney who requests termination of Nurse Case Management
(Employers report a 75% decrease in litigated claims)
WITH ALL THE ABOVE CIRCUMSTANCES THE CLAIM WOULD BE RETURNED TO TPA/Carrier FOR MANAGEMENT
UHS News
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