The Dilemma of the Case Manager in Workers' Compensation: Decision-Maker, System Player, Para Legal/Medical Specialist, Mediator or Enemy?

Abstract

This paper explores the complexities of the role of the workers' compensation case manager working for claims agents in South Australia. It provides a brief outline of the many skills required by case managers as they deal with the worker's injury, issues of compliance, the legislation, the social and psychological aspects of the worker's claim and the treatment and management of the worker's welfare. It describes the tensions brought about by the dual nature of the case manager's role that encompasses claims processing and injury management, and the conflicts between human and organisational motivations. These findings, although imprecise, demonstrate that in order to achieve sustainable return to work outcomes, case managers need to be competent, well-trained and team players capable of acting as mediators or brokers across the stakeholders. The aim of this paper is to explore the different views of the problems and possibilities of the role of the claims/injury manager from the perspective of the major stakeholders. Some views on the redesign of the role incorporating a partnership and holistic emphasis rather than the claims processing focus are suggested.