Case Developer
The title of Medical Case Developer is a new one for me. I have been a Nurse, a Nurse Case Manager, a Nurse Life Care Planner, and a Nurse Disability Management Specialist for over 30 years but have only recently put together all this experience and skill into helping attorneys truly develop their cases. Being a Case Developer is different than managing a case, or planning for future treatment with costs, or getting the client to MMI. Developing a case is actually working with the attorney in moving the case from a value of $100,000 to a value of $250,000 or $400,000 (remember SC Worker’s Compensation benefits are extremely limited!) or in the millions for personal injury cases. And of course, while developing the monetary value of the case, I am also (first and foremost) interested in assuring that the client receives the very best medical care for every condition caused by the injury.
When Attorneys ask me to work on a case with them, it is usually because the case is a very involved and challenging file with lots of medical complications and conditions: such as a back injury with a transverse myelitis which led to a paralysis which led to a stroke, etc. These are usually fairly easy to figure out and link up, takes a lot of work, but medically and scientifically doable. The ones that pose the most challenge are the ones with hidden causes, or obscure reasons, or those that just don’t make “common sense”. Like the one we did recently that was a chemical exposure that led to an auto-immune disorder that led to cardiac failure that led to a stroke that ended up a brain injury. Or the back injury (admitted and accepted) that developed into an aggravated Hepatitis C case that resulted in cognitive disorder (not admitted or accepted) which we put together and prevailed for lifelong benefits and medical treatment.
Every case has the potential for more value, even a simple orthopedic case. My goal in developing cases is to look for more diagnoses, more restrictions, more impairment, and to move the case through temporary partial disability to temporary total disability to permanent total disability to lifelong benefits for the Worker’s Compensation cases. In Personal Injury cases the goal is to not only set up for causation but to quantify damages. But how do I develop a case?
First, I read every piece of information available on a client, including medical records, letters, legal forms, defense records, personnel records, insurance information—everything—looking for clues. I meet with the client for a couple of hours, make a home visit if necessary, asking hundreds of questions, trying to get a clear and concise picture of how he is, how he was, and what happened along the way. Eventually, I meet with treating physicians to discuss their understanding of the case. Then I start the research, consultations with experts, and case development documentation. I meet with IME physicians prior to their evaluations, attend appointments with the client, and schedule post IME conferences. Once causation is fully established, we begin the process of assessing damages through impairment ratings, life care plans, disability cost projections, and vocational evaluations.
Not every nurse is a case manager, not every case manager is a legal nurse consultant, not every legal nurse consultant is a good case developer. There are only a few of us that have the edge of creativity and are visionary enough to “view a basket of apples” and “see an apple pie”. Contact me at sheltonk@comcast.net to discuss any interesting case you might have.
