What is a case manager?
A case manager is a medical professional who identifies and coordinates the care and rehabilitation a person may need after a serious injury. They usually have a background in nursing, physiotherapy, occupational therapy or other medical fields. They provide valuable insight into the rehabilitation journey of the injured person.
Following an amputation, that support may include physiotherapy, prosthetics, pain management, psychological support and other forms of care that may be required over the long term.
Why is case management relevant to a medical negligence claim?
In a medical negligence claim, it is essential to understand not only how an injury affects our client today, but how it is likely to impact their future. Case management plays a vital role in identifying rehabilitation needs at an early stage, coordinating appropriate treatment and support, and helping the client achieve the best possible quality of life.
A case manager will assess the client's immediate and long-term needs, which may include therapies, specialist equipment, accommodation adaptations, care, education or vocational support. Their recommendations also help quantify the likely cost of future rehabilitation and care.
As solicitors, we use this evidence to seek compensation that reflects the full impact of the injury. The aim is not simply to recover past losses, but to secure the funding our clients will need for rehabilitation, care and support in the years ahead, so they are not left financially disadvantaged by someone else's negligence.
It is important to note that the case manager helps identify reasonable rehabilitation and future care needs supported by evidence, but the court (or settlement negotiations) determines the amount recoverable.
These issues were explored in a recent Bush & Co training seminar titled, “Beyond the Headline Injury: What to Consider when Referring a Complex Amputation Case for Case Management”.
This outlined the vital role a Case Manager can have on a medical negligence claim and how a Case Manager considers care and rehabilitation needs when dealing with a patient who has had an amputation.
When should a case manager become involved?
Bringing in a case manager early can help set rehabilitation goals, improve the support available and shape the injured person’s recovery from the outset. It also gives those involved in the claim an opportunity to confirm that the proposed case manager understands the injuries and is a good match for that individual.
The triage process
Effective case management begins with a careful triage process. Following an initial referral, the case management provider considers whether case management is appropriate by looking at the injured person's overall circumstances, not simply the diagnosis or injury itself. The focus is on understanding the individual's functional needs, support network and rehabilitation priorities.
This early assessment helps identify what support may be needed, when it should begin, and which Case Manager is best placed to meet the injured person’s needs. Keeping the injured person's best interests at the centre of every decision helps ensure that appropriate rehabilitation is introduced as early as possible.
From our perspective as solicitors, we would usually begin by approaching a case management provider to ask whether they have a suitable Case Manager available. We provide a brief overview of the circumstances of the injury together with background information about our client's current situation.
Once a suitable Case Manager has been identified, we send a detailed Letter of Instruction requesting an Immediate Needs Assessment. This sets out our client's medical history, current presentation, rehabilitation needs and any specific questions raised by either us or the client, enabling the Case Manager to make informed recommendations about future support and rehabilitation.
The Immediate Needs Assessment
Once a letter of instruction has been provided, an Immediate Needs Assessment should take place as early as possible. It develops a fuller picture of our client’s injuries and circumstances through a biopsychosocial assessment, which considers physical, psychological and social factors when shaping the rehabilitation programme.
The resulting report sets out the recommended rehabilitation and its likely cost. It can identify urgent issues that need attention and provide a clear overview of the client’s wider needs. The report would include rehabilitation and care costs at that point in time, as well as any long-term costs that would be necessary if the negligence had not taken place.
This would require an assessment of our client’s circumstances and usually requires a face-to-face assessment between the client and the Case Manager.
Once the Immediate Needs Assessment has been completed, we will review the recommendations with our client and, where appropriate, seek to agree funding for the recommended rehabilitation with the Defendant or their insurer. The aim is to secure early access to treatment, therapies and practical support wherever possible, rather than waiting until the claim concludes.
The assessment will also provide valuable evidence of our client's ongoing rehabilitation and care needs. As the claim progresses, this evidence may be used alongside expert reports to help prepare the Schedule of Loss, which sets out the financial losses and future costs we seek to recover as part of our client's compensation.
Early rehabilitation
In an amputation case, early rehabilitation may consider prosthetics, physiotherapy, pain assessment, occupational therapy, psychological support and help with care needs. Recommendations and costings make it easier to identify the services required and ensure the plan considers the whole person, not just the injury.
The assessment may also consider medication, social needs and other factors that could affect recovery. Practical assistance can include a welfare benefits assessment if required, and support with a Blue Badge application.
Ongoing rehabilitation
Once a Case Manager has been appointed, they will often remain involved throughout the life of the claim and, where appropriate, may continue to provide support after settlement if ongoing case management has been included within the compensation package.
Their role is to coordinate and review rehabilitation, ensuring that the support being provided continues to meet the client's changing needs and goals. This is not a static process. As recovery progresses, the rehabilitation plan is regularly reviewed and adapted to reflect the client's physical, psychological and practical circumstances.
Support may include arranging therapies such as hydrotherapy, physiotherapy, psychotherapy, massage and pain management, as well as sourcing prosthetics and other specialist equipment that best suit the client's lifestyle rather than simply their clinical needs. Where appropriate, rehabilitation can also extend to practical measures such as gym memberships, personal training, driving assessments and adaptations that promote greater independence.
For clients hoping to return to work, the Case Manager can assess vocational rehabilitation needs and identify any additional support, training or workplace adjustments that may assist them in achieving that goal.
Long-term needs are reviewed on an ongoing basis, including care arrangements, equipment requirements and the interaction between privately funded rehabilitation and any statutory services the client receives. By continually reassessing the client's circumstances, case management helps ensure that rehabilitation remains personalised, effective and focused on maximising quality of life.
The value of case management in amputation claims
Case management can be particularly valuable in medical negligence claims involving amputation, where the consequences of the injury can affect almost every aspect of a person's life. While compensation cannot restore the lost limb or undo what has happened, appropriate rehabilitation and support can help an individual regain independence, adapt to their circumstances and achieve the best possible quality of life.
A Case Manager can provide a detailed assessment of the client's day-to-day needs and the practical challenges they face as a result of their amputation. This may include mobility, personal care, pain management, psychological support, prosthetic provision, physiotherapy, occupational therapy, driving and returning to work. Their role is to coordinate appropriate rehabilitation and ensure that the support provided evolves as the client's needs and goals change.
The Case Manager's understanding of the individual's circumstances can also provide valuable evidence when considering the client's future needs and the compensation required to meet them. For example, an amputee may require different prosthetic limbs for different activities, ongoing prosthetic reviews and replacement, adaptations to their home or vehicle, or additional support if they wish to return to work, exercise or particular hobbies.
In complex amputation claims, this insight into the practical and long-term consequences of the injury can be invaluable. It helps ensure that the client's rehabilitation needs are identified at an early stage and that, when settlement is being considered, the likely future costs and support requirements are properly understood and supported by appropriate evidence.
Quote from author, Lauren Kerse, Associate Direction and Specialist Medical Negligence Solicitor from MDS, said “Bush & Co’s seminar provided insight into how effective case management looks beyond the injury itself. By identifying a client’s physical, psychological and practical needs early—and reviewing them as circumstances change—it helps ensure rehabilitation remains focused on achieving the best possible long-term outcome.”
