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📂 '''Case management''' in insurance refers to the organized process of overseeing an individual [[Definition:Claim | claim]] from initial report through resolution, coordinating medical, legal, vocational, and administrative activities to achieve the best possible outcome for both the [[Definition:Claimant | claimant]] and the [[Definition:Insurance carrier | carrier]]. It is most prominent in [[Definition:Workers' compensation insurance | workers' compensation]], [[Definition:Disability insurance | disability]], and complex [[Definition:Liability insurance | liability]] lines where claims involve prolonged treatment, multiple service providers, or disputed causation. Unlike [[Definition:Care management | care management]], which focuses primarily on clinical pathways, case management encompasses the full spectrum of claim logistics — including legal strategy, [[Definition:Return to work | return-to-work]] planning, and [[Definition:Reserving | reserve]] adequacy.

🔄 Once a claim is flagged as complex — typically based on injury severity, projected duration, or litigation potential — a dedicated case manager takes ownership. This professional reviews medical reports, authorizes treatments within [[Definition:Treatment guidelines | treatment guidelines]], coordinates [[Definition:Independent medical examination (IME) | independent medical examinations]], and works with [[Definition:Defense counsel | defense counsel]] when the claim enters litigation. Throughout, the case manager updates the [[Definition:Claims adjuster | adjuster]] and adjusts the claim's [[Definition:Reserves | reserves]] as new information emerges. Many [[Definition:Third-party administrator (TPA) | TPAs]] and large carriers use [[Definition:Claims management system | claims management systems]] that assign scores to incoming claims, automatically routing the most complex cases to specialized case managers.

💡 Rigorous case management is one of the strongest levers an insurer has for controlling [[Definition:Loss adjustment expense (LAE) | loss adjustment expenses]] and [[Definition:Indemnity payment | indemnity]] outlays. Studies consistently show that early intervention — assigning a case manager within the first few days of a serious claim — leads to shorter disability durations and lower total claim costs. Beyond dollars, effective case management also reduces [[Definition:Litigation | litigation]] frequency by keeping communication channels open and demonstrating good-faith claims handling. As [[Definition:Predictive analytics | predictive analytics]] tools become more sophisticated, insurers are increasingly using data-driven triage to identify which claims will benefit most from dedicated case management resources.

'''Related concepts:'''
{{Div col|colwidth=20em}}
* [[Definition:Care management]]
* [[Definition:Claims adjuster]]
* [[Definition:Workers' compensation insurance]]
* [[Definition:Return to work]]
* [[Definition:Loss adjustment expense (LAE)]]
* [[Definition:Third-party administrator (TPA)]]
{{Div col end}}

Definition:Case management - Revision history

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