Case Management

Case Management in Brain Injury

A person with an acquired brain injury can often lack insight into the following:

  • Cognitive function
  • Mood
  • Behaviour
  • Physical problems
  • Independence
  • Ability to make decisions
  • Risk

This can often create problems in the family environment causing anxiety, isolation and depression. There is a significant emotional adjustment to the injury and often consequences. The family dynamics are often altered as are relationships with friends and work colleagues. All these relationships have to be managed and input from a psychological perspective may be needed to help rebuild relationships, confidence and social skills.

What is case management

A case manager may be appointed by your solicitor and by the insurance company to look after your overall health and make suitable recommendations. Case management is the process which assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet the individual’s needs. This includes looking at the following:

  • Health
  • Social
  • Care
  • Education
  • Employment

A clinical case manager will have a professional duty to you and is not involved in the litigation process. Their duty is to you not to the court or to the solicitor or insurance company.

Will a case manager be appointed in all cases?

The appointment of a case manager will generally only be necessary if your injuries are significant. Appointment will ultimately depend on the insurance company agreeing to fund the involvement of a case manager. If you are not pursuing a claim, it is unlikely that an case manager will be involved as their involvement is not funded by the NHS. In most cases an insurance company welcomes the input of a case manager as it is in the insurance company's interest to help you achieve the best possible recovery as soon as possible and it is recognised that early rehabilitation is very important.

In some cases, for example where responsibility for the accident is not accepted, the insurance company may not agree to fund the involvement of a case manager. Your solicitor should therefore work hard to prove responsibility for the accident with a view to then securing the input of a case manager. Your solicitor should:

  • Establishing contact with the insurance company representing the person who caused the accident and ask them to fund the involvement of a case manager
  • Prove responsibility for the accident as soon as possible
  • Obtaining early interim payments from the insurance company to fund the treatment and make life easier

The Rehabilitation Code of Best Practice promotes the use of rehabilitation and early intervention in the claims process so that the injured person makes the best possible medical, social and physiological recovery. The code encourages the preparation of a report for consideration by both the solicitor and the insurer. Once the report is agreed, it falls on the insurance company to decide whether the recommendations made in the report can be authorised. Authority to proceed can sometimes be given even though responsibility for the accident is not yet resolved.

What will my case manager do for me?

Your case manager will be responsible for:

  • Establishing and coordinating a rehabilitation programme and to try and meet your complex needs
  • Review therapy recommendations
  • Try and reduce hospital admissions by taking a proactive approach to rehabilitation
  • Preparing a structured program with clearly defined goals to help achieve the best possible recovery
  • Build in time for aerobic exercise, mental stimulation and pleasurable activities
  • Introduce new interests, variations of old hobbies
  • Help to facilitate a gradual return to work or communicate with your employers
  • Look at educational issues focusing on building a platform for the future
  • Making the most of the NHS funding for treatment and then looking to make use of private treatment funded by the insurance company
  • Making the most of Social Services in providing support generally
  • Risk assess your accommodation on release from hospital and if your accommodation is not suitable make recommendations to adapt the property or rent suitable accommodation.
  • Source equipment for you to use at home to help make life easier
  • Recruit staff to assist you which can not be met by social services and deal with training issues
  • Involve your family in the process
  • Organise dates for a regular review meeting

How will my case manager go about this?

The case manager will meet you in order to prepare an Immediate Needs Assessment Report which will make recommendations to the solicitor and the insurer. Once this is prepared, the recommendations can be considered. Your case manager will;

  • Assess you – Have a one to one meeting with you and consider all problems
  • Plan – Decide what needs to be done to help achieve the best possible outcome. This will involve prioritising and setting short and long term goals
  • Implementing – Once the recommendations are authorised, implement them as soon as possible
  • Monitor - regularly monitor you and keep in contact to ensure that treatment is progressing appropriately
  • Evaluate – Continue to re-assess the rehabilitation programme to see if any improvements need to be made

Other factors which contribute to a successful outcome

  • Family support – an injured person needs to have the support of the family. What must not be forgotten is that in most cases, the family also need support to come to terms with a serious injury to their loved ones. They may need to receive appropriate assistance, training, emotional support to properly look after you
  • Social Networks – These are important to improve quality of life. Making the most of social services is often very important in terms of improving the support you and your family receive
  • Social events – for those seriously injured, life does not need to stop. Social events will help improve mood and outcome
  • Sympathetic employer – it is important that the employer remains sympathetic to your situation and is prepared to assist in helping you adapt to getting back to work if you feel ready to go back to work. Adaptations to the work place may be necessary. It may also be necessary to significantly reduce your workload
  • Compensation –You may have lost money after being away from work or incurred the expense of medical bills or care which can all either be paid for in advance by the insurance company or at the conclusion of your claim. Compensation for your injuries is also important

Important legislation you may need to know about

  • Under Section 47 of the NHS and Community Care Act 1990, the Local Authority are responsible for carrying out an assessment of an injured persons for anyone who appears to be sufficiently injured to require help. A formal assessment must be prepared and if a person requires help, the Local Authority must then put in place a state funded programme to help address those needs as far as the budget allows. Due to budget constraints, the level of support provided from one Local Authority to another can vary. If an injured persons circumstances change, the Local Authority should reassess the needs and the programme
  • Under Section 21 of the National Assistance Act 1948, the Local Authority are responsible for providing residential accommodation for a person aged 18 or over who due to illness or disability is in need of care and attention which is not otherwise available to them
  • Under Section 29 of the National Assistance Act 1948, the Local Authority are responsible for providing social work advice and support, facilities for rehabilitation and adjustment to disability and facilities for occupational, social, cultural and recreational activities for any person who is permanently handicapped by illness or injury
  • Child in Need Assessments under Section 17 of the Children Act 1989 – The Local Authority, if approached, have a legal duty to carry out a full assessment of a child’s needs. Social Services have no right to opt out of this obligation on the grounds that they have no resources. A child in need is someone who:
    • Is unable to achieve or maintain a reasonable standard of health without the provision of services by the Local Authority
    • His or her health is likely to be significantly impaired without the provision of such services
    • Is disabled

Generally, if a need is established the Local Authority may be obliged to provide:

  • Accommodation – suitable accommodation
  • Home adaptations – adapt the family home to make it suitable for a person with a disability
  • Nursing care – regular carers to assist with day to day tasks
  • Equipment – provided to make life easier in the home
  • Treatment – state funded treatment

Please note that some assistance may be dependent on assessing the amount of money that you receive or have saved.

Whilst these provisions are important for someone who might have a legal claim, they are even more important for someone who cannot recover the costs of private treatment and care from an insurance company via a compensation claim. It is advisable for any injured party must therefore contact their Local Authority for assistance following any significant injury and request a Section 47 assessment. It is also important to request re-assessment if the condition deteriorates.

To contact a member of the Head Injury team please call us on: 0800 073 0988 or Email: info@headinjuryuk.com