1. Watson, Elizabeth MS, CRC, CCM, LCPC

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Case managers working with injured workers may be providing medical case management, vocational case management, or a combination of both. Workers' compensation case managers often work with and report to a variety of professionals including insurance professionals, medical professionals, attorneys, and employers. With each one of these professionals having their own agendas of what is best, not necessarily for the injured worker but to their own employer, their own training, and their own belief system, workers' compensation case managers often are required to delicately find an ethical balance between what all the professionals working on the case want, while working ultimately for the best interest of the injured worker and within case management standards. Frequently, there is one party who does not agree with the action of the case manager. Thus, remaining objective and finding an ethical balance while working for the best interest of the injured workers is a continual challenge when providing workers' compensation case management services. In addition to finding an ethical balance is the challenge of keeping the referral or funding source satisfied with the case management services so as not to jeopardize future referrals.


Certified case managers (CCMs) must follow the Commission for Case Manager Certification (CCMC) Code of Professional Conduct for Case Mangers as well as their code of ethics for their other-state licensures and/or certifications. Many professional codes now have requirements that a verbal and/or a written disclosure must be provided to the individual whom they are working with. According to CCMC Code of Professional Conduct for Case Managers, the CCM needs to provide a description of services to the individual he or she is working for that includes, at minimum, a description of services, possible benefits, significant risks, alternatives, and the right to refuse services. If a CCM is also a certified rehabilitation counselor, there is a professional disclosure pertaining to rehabilitation counselors that must be provided to his or her client, and if a CCM holds a state counseling or state social work license, he or she most likely has a professional disclosure that he or she is required to review with the clients.


Workers' compensation case managers working with injured workers can hold a tremendous responsibility and power to direct and move a case. Their action or lack of action can move a case forward or hold a case back. When taking a workers' compensation case, the CCMs need to ask themselves, "Can I maintain objectivity with this case and can I work this case within the CCM code and within my other professional code of ethics?"


Workers' compensation referrals for case management generally vary over the course of a year. There may be times when a case management company receives numerous referrals and then months when no referrals are received. The CCM needs to decide whether to take a case or not. On one hand, it is hard to turn a case away for the fear that your referral source will start using a competitor and not have further referrals for you. On the other hand, do you have the professional time to manage a case? The state of Illinois workers' compensation system is favorable for referring injured workers for case management, and it is common to hear case managers talk about being overwhelmed and not able to keep up with their cases. Before accepting a referral, CCMs should ask themselves: "Do I have the time to schedule appointments within a reasonable time?," "Do I have the time to make telephone calls to convey important information?," "Do I have the time to return phone calls within a reasonable time?," and "Do I have the time to document, provide written correspondence, and write reports as needed?" If you take a case and do not have the time to manage it, are you not providing a disservice to the injured worker and your referral source and are you not at a risk of not meeting the CCMC Code of Professional Conduct for Case Managers and your other professional code of ethics?


A workers' compensation case manager may be asked by employers and insurance claims people to do a variety of requests that the employers or insurance claims person feels are reasonable requests, but that are not within the CCMC standards or the CCM's other professional codes of ethics. By not fulfilling the request, the CCM may risk the case being taken away from him or her. A workers' compensation claims person recently told me, "If I would not do what she requested, she knew someone that would and she would take the case away from me. What she requested was not ethical and I could not honor her request. During the phone conversation with the claims person, I was so taken back; I couldn't produce a well thought out response to her. I didn't want her to take the case away from me, which would be a disservice for my client, whom I had worked with for the past year. I didn't want to have her take her business away from me; however, I knew that I could not honor her request. After consultation with a fellow case manager and a workers' compensation defense attorney (not related to the case), I was able to formalize a well thought out response. I advised her of my ethical standards and explained that if I did not follow my ethics, her insurance company providing vocational rehabilitation case management services could be questioned, which could have implications during the settlement of the case."


Although the CCMC Code of Professional Conduct for Case Managers is in writing, because of the uniqueness of workers' compensation case management and the many parties involved, it may be difficult to determine what action to take when faced with an ethical dilemma. Through my experience with workers' compensation, I have learned that fellow case managers are an invaluable resource in sorting out the important factors and actions when faced with an ethical question. There are also many professional listserves that can be used to post ethical case management questions.


Healthcare facilities, allied healthcare providers, and medical equipment and supply companies frequently market case managers. The marketing may be in the form of written materials, invitations for lunches, free Continuing Education Unit (CEU) seminars, or free social events. Another ethical consideration when providing workers' compensation case management services is when making referrals for medical, allied health, or for medical equipment services. If you are asked to schedule an injured worker for a functional capacity evaluation, do you research and find the therapy facility closest to the injured worker's home, or do you schedule the Functional Capacity Evaluation (FCE) with the therapy facility that has better marketing, is farther from the injured worker's house, yet provides the same service? If the injured worker legally has a choice of medical providers, do you advise him of this, or do you sway them toward the provider in the insurance company's preferred provider list?


If you are to provide ethical case management services, you need to continually question what case management actions you are taking and whether you are following all your professional codes and standards.


Questions to ask yourself when accepting a workers' compensation case management referral are as follows:


Have I read and am I familiar with the CCMC Code of Professional Conduct for Case Mangers?


Am I able to adhere to those standards?


Have I read and am I familiar with my ethical standards for my other certifications or state licenses?


Am I able to adhere to those standards?


Can I explain my code of ethics when needed?


Do I have a case management disclosure as well as a disclosure from my other licenses and certifications?


Do I have the skills needed to manage a particular case?


Do I have the time to effectively provide case management services?


Am I able to remain objective with all parties involved in a case?


Am I able to say no when asked to perform an action that would be in conflict with all my ethical standards?


Answering these questions can help case managers in ensuring that they are able to provide quality case management services. If you can answer these questions before taking a case, you can focus on the goals of advocating for the injured worker; establishing and maintaining relationships with healthcare providers, insurance adjusters, and employment/training providers; controlling cost; and adhering to professional practice standards. Successful CCMs providing services in the workers' compensation arena are able to balance the ethical considerations of their professional standards while providing quality services to all parties.