Posted by Rick Brush in Member Spotlight in the Excess Insurance Authority blog.
Catastrophic and complex injuries are uncommon, but when they occur, they are costly in so many ways! The employer wants to find their employee the best possible care to get them the best possible outcome! This is in the best interest of our employees, the entity, and the EIA.
The City of Oakland was recently faced with just such a predicament. An employee had a catastrophic brain and spinal cord injury. The City began the claims process working with their TPA. The injured worker’s wife was concerned about him and didn’t know where to turn. She quickly retained an attorney. Thanks to the rapport between the attorney and our service partner, Paradigm, a trusting relationship was built.
Paradigm provides catastrophic and complex claims management services. They work with the TPA, member and injured employee to have the injured employee seen at Centers of Excellence, pushing for best possible outcomes. In this case, the injured worker was transferred to a Center of Excellence for acute rehabilitation, and then to a sub-acute facility until his home could be prepared.
Every step of the way, Paradigm’s Network Manager coordinated with medical and rehabilitation providers to ensure the right care was delivered at the right time, and kept the TPA claims examiner up-to-date.
Benefits to the employee include treatment at a Center of Excellence that focusses on the specific catastrophic critical medical conditions.
Benefits to the City include capping the claim expense at a guaranteed amount for contractually agreed upon outcomes.
With better care, comes better outcomes and faster recovery.
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