The following are some of ADM’s “red flags” for referral to field case management services:
• Catastrophic injuries (head, spinal cord, burns, amputations, crush injuries).
• Unusual diseases or disorders, (i.e.: Lyme, RSD, Chronic Pain Syndrome).
• Fractures.
• Back surgery/fusion or second back injury.
• Rotator cuff tear, ACL tear, meniscus tear.
• Pre-existing conditions affecting healing period and treatment.
• Multiple medical providers, frequent changes in providers.
• Elderly injured worker.
• Complicating factors such as smoking and/or substance abuse.
• Working light duty with no progression to regular duty.
• Potential lost time of 60-90 days or more.
• Case in telephonic case management for over 30 to 60 days.
• Aggravation of pre-existing condition or re-injury shortly after RTW.
• Negative attitude regarding return to work.
• Questionable legitimacy of injury or work relatedness/causation
• Other barriers to employment, such as communication, etc.
• History of multiple work injuries.
• Conflict of medical status between physician and injured worker.
• Medical diagnosis does not corroborate with cause of injury.
• Social issues, such as transportation problems, child-care, finances.
• Return to work will require job modification.
• Return to a job involving medium-heavy work.
• Return to repetitive work, potential for re-injury/aggravation.
• Need to define essential and secondary job functions in compliance with the
Americans with Disabilities Act.
• Need to modify jobs to meet current production needs.
• Employer needs recommendations concerning ergonomic job modifications.
• Non-compliance issues that have not been resolved successfully via telephone.
• Unable to return to usual job. However, IW has been released to U&C job.
• Employer unclear if appropriate job is available for client to return to work or job is available but requires modification.
• Injured worker out of work for four or more weeks