Nurse case manager assisting patient with closed head injury

Medical Case Management For Closed Head Injury Cases

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There are many reasons medical case management may be a good solution to support the care and coverage of people who sustained a head injury. Depending on the severity, head injuries may only require a few months of care, but many injuries may require continued care over the course of years or the rest of a person’s life. 

Traumatic Brain Injuries (TBI)  are at the forefront of deaths and disabilities every year. A TBI may cause long-term problems related to cognitive difficulties, paralysis, decreased mobility, memory loss, loss of hearing or vision, and even personality changes. These deeply impact the quality of life available to the person who suffered the injury.

Closed Head Injury Workers Compensation

If you, or a loved one, has a workers’ compensation case due to a work-related injury, you may need the assistance of a certified nurse life care planner or a legal expert life care planner. These types of injuries can cause overwhelming feelings surrounding the number of healthcare options and the next steps and some clarity can be gained by talking to a professional. After an injury at work occurs, usually a referral is made to a nurse consultant who can assist with the handling of complex medical issues. A certified nurse consultant can point caregivers in the direction of resources, provide guidance, and work directly with other professionals involved in a case such as:

  • Insurers
  • Attorneys
  • Employers
  • Brokers

Benefits of Early Referral

Early referrals help the nursing case manager’s timeline to receive and process files and documents including medical records, claim documents, background info, and health insurance benefits details, while prioritizing the injured party’s immediate needs in addition to assisting with:

  • Establishing relationships with the patient’s family
  • Communicating with the treatment team at the acute care hospital
  • Proactively planning for a patient’s discharge
  • Ensuring continuity of care between different medical professionals and facilities
  • Containing costs of treatment

Establishing A Relationship with Family

A medical case manager can guide families through disagreements about the best course of action regarding healthcare options. A strong relationship can also provide the opportunity for families to agree on the best use of financial resources. While helping families with difficult conversations, they can also assist with other areas of communication such as:

  • Help the family adjust to a disability and how it affects all family members
  • Develop a sense of rapport and open communication to gain trust within the family
  • Provide specialized skill and knowledge to educate the family on how lifestyle may change post-injury
  • Be available as a resource for issues as they may arise for the patient and their family

Communication with Treatment Team

Creating a treatment plan for the injured person requires professional experience as well as incorporating information from a variety of sources to ensure that it is comprehensive and accurate, while also factoring in the specifics of the injury. While treatment plans are commonly used with traumatic brain injuries or TBIs, there are other injuries that may need consideration as well. An experienced case manager can assist with a variety of injuries and help:

  • Determine the extent of the injury and how to coordinate care
  • Confer with the medical team regarding recommended treatment and plan of care
  • Facilitate and coordinate discharge planning for care after the hospital

Planning and Identifying Barriers Affecting Discharge

Medical case managers can also identify and coordinate potential issues that may arise after an individual is discharged from a hospital or care facility to streamline long-term care or rehabilitation after in-patient care. 

After discharge, a case manager can also assist in the coordination of care between multiple medical professionals and facilities as well as ensuring treatment costs are contained. If an individual finds themselves in a more complex living situation, a medical case manager can assist with the following:

  • Patient is under a guardianship or conservatorship
  • Care is needed from an acute rehabilitation facility or skilled nursing facility
  • The injured are homeless or in an unsafe living situation
  • Lacking family, friend, or peer social support
  • Pre-existing medical history that makes treatment more complicated

Discharge Planning

By not only looking at the kind of injury, but also considering the severity of the injury, the goal of the case manager is to help the person recover as much of their independence as possible while keeping in mind the physical and mental health of the person. The severity of the injury will indicate to what extent the person can recover and how quickly that recovery can take place. Case managers can handle negotiations on treatments and rehabilitation while also processing work releases and full duty releases. Case managers can identify the least restrictive environment for care from the following:

  • Acute rehabilitation facility
  • Skilled Nursing Facilities
  • Community-based residential program
  • Discharging Home

Acute Rehabilitation Setting

Depending on the care required for best outcomes, there may be a variety of clinicians needed to assist in the long term care and planning for individuals who are the victims of a traumatic brain injury. If an acute rehabilitation is determined best for an individual’s situation, a medical case manager can assist by:

  • Attending weekly team meetings as part of the treatment team
  • Determine appropriate length of stay in a rehabilitation facility
  • Collaborate with the team regarding the next level of care
  • Frequently communicate with all involved parties (i.e. guardian, family, insurer, attorney, employer) to streamline the process

Skilled Nursing Facilities

If the injuries sustained will require more in-depth care to assist with the injury, a skilled nursing facility may be the best choice to ensure safety and well-being for the individual. This would include in-patient care with the assistance of a staffed team of medical professionals as well as a case manager who:

  • Attend weekly team meetings as part of the treatment team.
  • Determine appropriate length of stay in the facility.
  • Collaborate and communicate with the care team regarding the next level of care needed.
  • Relay relevant information to all involved parties (i.e. guardian, family, insurer, attorney, employer)

Community-Based Programs

Some states provide local level assistance by means of independent living programs as well as hospital or rehabilitation programs for individuals with circumstances that don’t allow them to have care or assistance at home. Community based programs are sometimes indicated when a home situation can’t accommodate the needs of the patient or fall into one of the following situations: 

  • 24 hour supervision is required for the safety of the patient
  • Behavioral issues that require medical guidance or supervision
  • Patient is homeless or doesn’t have a safe living environment

Discharging Home

It’s crucial when released home that the proper care plans have been set up and established by a care team specifically and tailored to the individual’s specific needs and injuries. Case managers are able to review a patient’s specific injury and post-care needs help with:

  • Ensuring their home environment is set up properly and safely
  • Coordinating any durable medical equipment that may be needed
  • Coordinate all home care and therapy services
  • Providing support to family and/or caregiver
  • Performing continual assessments regarding the injured ability to remain at home

Follow-Up Care

Follow up care is critical to a patient’s recovery to help alleviate stress as well as streamlining aspects of care and to prevent issues like prescription delays or missed appointments. These can be crucial to rehabilitation when an injured individual is out of the hospital dependent on the severity of the injury. There are three levels of severity in traumatic brain injuries:

  • Post Concussive/Mild Brain Injury
  • Moderate Brain Injury
  • Severe Brain Injury

Post Concussive/Mild Brain Injury

A mild brain injury can sometimes be referred to as a concussion and can occur from some trauma to someone’s head either with or without consciousness and can lead to only temporary cognitive impairment. The treatment is as follows:

  • Assessment and treatment provided by a brain injury specialist (NOT a primary care physician)
  • Vestibular therapy or vestibular rehabilitation therapy is a form of physical therapy that usually involves head movements
  • Physical/occupational therapy
  • Medication management if needed

Moderate Brain Injury

A moderate brain injury can have similar symptoms to a traumatic brain injury and can occur when brain function gets disrupted for longer than a few minutes. More severe that a mild injury and requires special treatment by a medical professional such as:

  • Treatment provided by a physician who specializes in the brain (neurologist)
  • Cognitive therapy to help with behavior post injury
  • Managing and medications needed to treat the injury
  • Neuropsychological evaluation to assess brain function post accident

Severe Brain Injury

These can occur when there is extensive brain damage that happens from something such as a car accident or severe injury. These injuries usually demand the most medical intervention and treatment that can be lifelong at times and require:

  • Treatment provided by neurology, neurosurgery or multiple speciality providers depending on the severity of the injury
  • Multiple medications for treatment
  • Physical and/or occupational therapy, sometimes long-term
  • Speech language therapy depending on the injury and part of the brain affected


A medical case manager can be helpful whether an individual experiences a traumatic brain injury or any type of serious injury that affects their ability to do day-to-day activities. Occupational Resource Network’s medical case management experts are able to provide a range of services and create life care plans to help individuals who have sustained traumatic injury based on years of clinical experience. Their vast knowledge allows them to give a comprehensive report that includes an outline of psychological, rehabilitation, and medical needs that may be needed in the future. With years of experience in a variety of cases, contact a professional today to discuss your needs.

Occupational Resource Network Job Placement and the ADA

Job Placement Services And The ADA – What To Know

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How can job placement services help individuals?

The American Disabilities Act of 1990 (ADA) is required for employers with more than 15 employees). All state and local governments must comply with and not discriminate against applicants based on disabilities as well as provide reasonable accommodations to qualified individuals with disabilities. Let’s dive into how job placement services can work with individuals with disabilities while following ADA guidelines. 

Job placement can encompass the vocational rehabilitation process that is designed to help people with a disability either find employment, maintain their current employment, or return to employment after a period of unemployment. The ADA requires companies to adhere to guidelines that cover all disabilities from functional and psychological disabilities to developmental, cognitive, and emotional disabilities with other impairments or health disabilities also included. 

A variety of healthcare professionals can be involved in the vocational rehabilitation process. It can also include people from a non-medical area like a disability employment advisor or career counselor. The following guideline discusses the process regarding job placement and the ADA.

Disclosure of a Disability

When starting at a new company the ADA recommends informing the potential employer if it is believed that an accommodation to perform the functions of the job being applied for due to a disability is needed. A visible disability is one that can be noticed upon sight and an invisible disability is one that may not be as apparent.

Visible Disabilities

A visible disability will let an employer know what factors they need to consider when hiring a potential new employee. The ADA advises employers that there are factors they need to consider whether an applicant has a disability that can be clearly seen or not. 

Examples of Apparent Disabilities:

  • Conditions requiring mobility devices such as wheelchairs, canes, walkers, crutches
  • Amputations
  • Paralysis

Invisible Disabilities

According to the Invisible Disabilities Association, an invisible disability is generally used to describe someone with a chronic physical struggle. It is important to disclose invisible disabilities as well if they’re believed to interfere with job performance.

Condition and Disabilities That Are Not Apparent:

  • Sensory impairments (low vision or hearing loss)
  • Chronic illness (arthritis, asthma, diabetes)
  • Mental health conditions
  • Learning disabilities
  • Acute illness (cancer)

Stages For Disclosure

When applying for a position within a company there are times when to let companies know whether the condition is chronic and may need to have accommodations made to ensure a comfortable and safe working environment. The stages in the hiring process that can be used to disclose a disability are:

  • Pre-Employment
  • Third Party Involvement
  • Post Job Offer
  • During the Course of Employment

Pre-Employment Disclosure

According to the US Equal Employment Opportunity Commission (EEOC) the law limits disability questioning during the interview process. The law does allow questioning or exams related to the disability only if the employer thinks the medical condition will interfere with the employee’s job performance. There may be workplace barriers that prevent someone from competing for a job such as whether the workplace is accessible for mobility devices, if a service dog is allowed in the workplace, or if a deaf applicant requires an interpreter or adaptive equipment for an interview. 

When there is a visible disability seen during the pre-employment period, an employer may ask limited questions whether the individual can perform the essential functions of the job and, if not, what reasonable accommodation would be required.

Third Party Disclosure

Some companies may choose to use third parties in their accommodation processes that can streamline requests while utilizing professionals who have experience in handling disability accommodations. Some individuals find themselves more comfortable discussing the accommodations they need for their disability with a third party, and not someone they will see regularly in their day-to-day job functions. Working with a vocational rehabilitation service may provide assistance from state rehabilitation services, non-profit human service organizations or agencies, or workers compensation and/or long-term disability vocational services.

Post Job Offer

Once an offer has been extended, some experts recommend to disclose a potential accommodation needed for employment. If the individual believes they do need an accommodation to be successful in their role, it’s important to let the employer know before job performance is affected. It is important to note that up until the job offer, an employer can’t request any disability-related information or medical information. Once the job offer is made, an employer can require the applicant to undergo a medical evaluation or ask disability related questions as long as it is done for all employees. Any information revealed after the job is offered can’t be used to rescind the offer unless it can be shown that the individual would be unable to perform the essential functions of the job (with or without accommodation), or would pose a direct threat to themselves or others.

During the Course of Employment

It is up to the individual when to disclose their disability but is recommended to discuss needs before the position begins to help with workplace morale as well as for the employee to have the best job performance in their position possible while increasing the success for the employer and company as well. If an employee finds themselves becoming disabled during their employment it is recommended to consider requesting accommodations. Especially if their work performance suggests an accommodation is needed (even if not requested). The employee should discuss this with their HR department or the company’s recommended department.

How to Disclose

Once a job offer has been extended and accepted, it’s essential that you discuss and provide information regarding your disability as an employer has the right to know if an employee needs assistance to perform the job they were hired for. It is recommended that the employee make the request in “plain English”, as well as putting the request in writing, and discussing with the appropriate people within the company.

What to Disclose

Disclosing the disability to the correct departments is imperative to help ensure that the needs that are required to be successful in the role are met by the employer and to keep open communication between the employer and employee for a safe and inclusive workplace. The employee is encouraged to disclose the nature of their disability, limitations that may result from said disability, how their disability affects their work performance, and lastly what potential accommodations they may need for their disability.

Reasonable Accommodation

According to the US Department of Labor, employers are required to provide reasonable accommodations in the application process. These accommodations help to assist an individual with a disability in their ability to perform their job and so an employee can experience equal job privileges and benefits of employment as an individual without a disability. It is also suggested that the employer and the individual with a disability engage in an informal process to clarify what the individual needs and identify the appropriate reasonable accommodation. Companies are encouraged to have several resources to help employers and individuals with disabilities to explore possible accommodations.


For an individual getting into the workforce with a disability, a vocational assessment or job placement service can help them to be prepared as well as know their rights according to the ADA. When speaking to a vocational rehabilitation expert regarding a return to work, it’s helpful to provide the vocational rehabilitation expert all necessary information such as any cognitive deficits, details about any injuries. A current resume, as well as all educational records and certificates for training, employment history, reports from doctors and other healthcare professionals, hospital records, and any other pertinent information might also be needed to conduct the assessment accurately. 

Occupational Resource Network has been a provider of vocational rehabilitation, evaluations, and assessments to help with job placements since 1995. Our licensed and certified counselors are happy to answer any questions and discuss the details of your case today!

Occupational Resource Network Ergonomic Evaluations Services

9 Reasons To Hire An Ergonomic Evaluation Expert

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What are the benefits of ergonomic evaluations and assessments?

Ergonomic evaluations and assessments are designed to assess workspaces, offices and stations to highlight potential issues, recommend changes and modifications and encourage employees to reap the rewards of their working environment. There are several benefits of an ergonomic workplace evaluation. In this article, we’ll explore nine reasons to hire a certified office ergonomics evaluator. 

1. Identifying risks

Did you know that in the US, the average employee loses 11 working days per year as a result of injuries or work-related illness? One of the primary benefits of office ergonomic evaluation is identifying risks, which could increase the chances of employees sustaining injuries or having to take time off sick. It’s always better to identify potential hazards and dangers than to respond to accidents. Evaluation can help businesses to be proactive, rather than reactive. 

2. Preventing accidents and illnesses

Workplace accidents and work-related illnesses, including back pain and stress, cost US businesses over $60 billion per year. An office ergonomics evaluation is a simple, cost-effective means of preventing accidents and illnesses. Evaluating the environment flags weaknesses and gaps that can be addressed and in turn, used to enhance health, safety, wellbeing and reduce the risk of people being involved in accidents or struggling with chronic pain. 

3. Reducing the risk of back pain

Back pain is one of the most common ailments among office workers and employees who spend long periods sitting at a desk. According to the American Chiropractic Association, around 50% of American employees experience symptoms of back pain. A computer workstation ergonomic evaluation and assessment is designed to pinpoint issues or shortcomings that could exacerbate symptoms or contribute to pain and provide tailored recommendations to prevent back and neck pain, improve posture, and ensure that employees are comfortable. 

4. Boosting productivity

Your working environment can have a significant impact on productivity, as well as health and wellbeing. If you are comfortable, you are free from pain and you’re able to tackle tasks without worrying about your safety, you will be able to focus on your job and devote all your time and energy to your to-do list. 

5. Reducing the number of sick days

Sick days can be costly for both employees and employers and they can also hold talented, dedicated workers back and prevent them from fulfilling their potential. Ergonomic assessments identify risks and hazards and provide targeted advice and recommendations to encourage employers to modify working environments to facilitate efficient working and lower the risk of accidents and injuries. Providing employees with ergonomic workstations and furniture, offering training and instruction to promote good posture and eliminating hazards could all have a positive impact on the number of working days lost.

6. Saving money

Businesses have to make money to survive, and most are keen to improve efficiency and make savings while simultaneously optimizing customer service and employee well-being. An ergonomic evaluation report offers a means of lowering costs and boosting profits by reducing the risk of sick days, increasing productivity and decreasing the risk of workplace illnesses and accidents. Prevention is often much less expensive than cure. 

7. Employee wellbeing and engagement

Every employee wants to thrive in their working environment and they want to be able to do their job without any anxiety about safety, pain or injuries. Making changes to the working environment and creating ergonomic workspaces can have incredible benefits for employees well-being but also plays an integral role in building strong relationships between employees and employers making employees feel valued. By hiring an ergonomic evaluation expert, employers demonstrate a commitment to providing their workforce with safe, comfortable workspaces and being proactive in reducing injuries and improving morale and wellbeing. 

8. Employer reputation

Employees today want more than a well-paid role. Studies show that job satisfaction, flexibility and work-life balance are highly sought-after, particularly among millennials. Employees want to work for employers who prioritize a positive culture and ethos and take care of their team. By organizing office ergonomic evaluations, employers can enhance their reputation and show that they care about their employees. Happy teams tend to be more productive and looking after staff can also boost employee retention rates. 

9. Rehabilitation

Many employees who experience health issues or injuries want to return to work as quickly as possible following treatment, surgery or a period of rest and recuperation at home. Businesses can take steps to ensure a smooth transition and provide support for the individual so that they are as comfortable and confident as possible when returning to work. Ergonomic workstation evaluations play a crucial role in aiding rehabilitation and ensuring that workstations and offices are suitable for people who are coming back to work after an accident or injury. An expert report can highlight issues that could pose problems for somebody who has restricted mobility, for example, as well as flagging up modifications that could be made to create a more comfortable, accessible environment that will enable the employee to return to the office. An expert can offer tailored recommendations based on the requirements of the individual, their role and the environment.


Workplace injuries, accidents, illnesses and pain can all hamper productivity, team morale and well-being. It may not be possible to prevent every incident or injury, but it’s hugely beneficial to be proactive as an employer. 

Taking steps to identify risks and hazards and make changes to create safe, comfortable, and inspirational workspaces can contribute to improved morale, a lower risk of injuries, losing employees to sickness, and enhanced company reputation. Evaluations can also help to tackle common ailments, such as back pain and provide additional support and help for individuals who experience chronic pain and those returning to work following an accident or a period of time off. Hiring an ergonomic evaluation specialist can be mutually beneficial for employees and employers alike. 

With decades of experience, Occupational Resource Network offers ergonomic evaluation and assessments to assist companies in a variety of settings and can discuss your options tod