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