Rehabilitation and Case Management in the claims process

Unless you have been involved in an accident and sustained a serious injury, or know someone who has, you probably would not have come across a Case Manager or understand their role in the claims process.

It is assumed that bringing a claim following an accident is to obtain compensation for the injuries sustained. This is only part of the role of Claimant Lawyers. The aim of the compensation is to put the injured person back in the position they would have been in had the accident not occurred. With more serious injuries this is not always possible and Claimant Lawyers recognise that after a serious injury, a person will need help and support to cope with a life-changing situation. This is where rehabilitation comes into play.

It is well documented that early rehabilitation after serious injury is in every body’s best interests particularly when a medical or personal injury claim is being pursued. But what does rehabilitation mean?

Rehabilitation in the claims process means to address what is needed so that the individual can make as good as recovery as possible.  The correct assessment of an individual’s rehabilitation needs and early intervention is essential in order to correctly assess the likely size of any claim as well as ensuring the best possible outcome for all concerned.

The term “rehabilitation” in the claims process can encompass not only physical and psychological therapies but also case management to coordinate the rehabilitation programme. It can include dealing with housing issues, vocational issues and the needs of the family who support the injured individual. Family members/ informal carers are crucial to the success of any rehabilitation but are often excluded from statutory rehabilitation programmes. Rehabilitation provided by statutory services has a much more limited remit and can be fragmented, subject to long waiting lists and variable in quality.

An all-party parliamentary group on acquired brain injury report in September 2018(“ACQUIRED BRAIN INJURY AND NEUROREHABILITATION  TIME FOR CHANGE”) by The United Kingdom Acquired Brain Injury Forum (UKABIF)  clearly demonstrates the issues for people accessing brain injury rehabilitation via the NHS.

“Substantial and robust evidence emphatically supports the clinical effectiveness and cost-effectiveness of neurorehabilitation. It is one of the most cost-effective interventions

Available to the National Health Service (NHS), with positive financial impacts on both health and social care. However, despite these proven benefits, investment in neurorehabilitation, in-patient neurorehabilitation beds and service provision are all inadequate and hugely variable across the United Kingdom (UK).”

The revised Rehabilitation Code 2015

The aim of the code is to put the injured persons recovery needs at the heart of the claims process.  It is a voluntary code but the Personal Injury Protocol requires that it is considered in all claims. The code is designed to ensure the injured persons need for rehabilitation is assessed and addressed as a priority. It requires Claimant Lawyers and Compensators to work together in providing rehabilitation at the early stages, and often before liability has been decided.

This early intervention allows the injured person to makes the best and quickest possible recovery. The best outcome is that they are able to return to their previous mental, physical and financial position. If this is not possible then it is aimed at reasonably maximising their independence and quality of life.

Whilst the code promotes collaborative working to provide rehabilitation,  where liability is in dispute, the injuries are unclear, or the Compensator is not engaging under the code, then a the funds for early rehabilitation may not be available. This can leave an injured party in a vulnerable position in their recovery. In house Client Liaison Managers (“CLM”) can bridge this gap in ensuring rehabilitation is in place within the resources available. CLM’s are experienced health and social care professionals or case managers who work alongside legal teams. They are invaluable to Claimants lawyers and often at the front line of the case. CLM’s  can assist with the early assessment of rehabilitation needs, support the claimant to access appropriate statutory services or charitable funds and notify the lawyers of any gaps and urgent issues. They can gather information on the injured person’s needs and recovery to assist the Claimant Lawyer as well as providing practical and emotional support at an extremely stressful time for the claimant and their family.

What is case management?

The Guide for Case Managers defines case management as “a collaborative process which: assesses, plans, implements, co-ordinates, monitors and evaluates the options and services required to meet an individual’s health, social care, educational and employment needs, using communication and available resources to promote quality cost effective outcomes.”

Early instruction of a Case Manager is essential in the claims process. This allows the Case Manager to carry out an immediate needs assessment of the injured person. This means looking at accommodation, adaptations, aids and equipment needed at home. They also look at what assistance can be put in place if a person needs to adapt or change their job or if the injured person is entitled to any state benefits and assist with any applications.

The role of the case manager is critical to the litigation process as it provides objective evidence of the person’s rehabilitation needs and options as well as providing a wealth of information for the lawyer to plan the litigation.

Wright V Sullivan 2005 clarifies the role of the case manager as independent of the litigation process. The clinical Case Manager owes a duty to the injured person alone and makes decisions in the best interest of that person.

Choosing a case manager

A good case manager or rehabilitation provider is essential to ensure quality outcomes for the injured person and the parties to the claim. Investing time and effort at the outset to select the most appropriate case manager can pay dividends. Trust is essential between all parties so it is important to be able to evidence why a particular case manager is chosen based on their experience, skills and quality as well as location and “best fit” for the injured person.

CLM’s as former case managers, are ideally placed to assist lawyers in this process by getting to know the client and various services offered, checking the quality standards and providing objective advice on the suitability of case managers/ providers for particular clients/ injuries.

The case of Loughlin v Singh [2013] EWHC 1641 (QB),

Demonstrates the importance of good case management which is proactive, goal orientated and outcome driven. Case management which fell below this standard resulted in a 20% reduction of overall care and case management costs claimed. It is worth noting that the case manager involved was highly experienced and from a well-established case management company, so ongoing monitoring is essential.

Case management progress reports need to have smart goals which relate to the identified needs as well as an analysis of progress in rehabilitation. There needs to be a rationale provided if needs are not being addressed or if progress is not being made.  Recommendations should also be made to remedy any barriers to progress.

Rehabilitation can be a lifelong process. Many injured people retain case management services long after their litigation case settles. This can be to coordinate on going medical interventions and therapy services, manage employed support workers and to support the client and their families to maintain the best quality of life possible.