Complex Case Management / Complex Claims

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PURPOSE:  ATF Canada Complex Claims Division specializes in the assessment, management, and eventual resolution of high cost and long duration claims that have no clear direction.  


WHAT TO EXPECT FROM THE COMPLEX DIVISION:  Whether complicated by concomitant injuries or conditions, social and psychological factors, physical deconditioning or the passage of time, claims tend to become more complex the longer they linger unresolved.  As conditions become chronic, the strategies required to manage them must be carefully planned, thoughtfully initiated, and strategically followed through. 

ATF Canada Complex Division recognizes the multifactorial nature of long term claims and offers a highly individualized, comprehensive and multidisciplinary approach towards resolution. 


OUR APPROACH:  Typically, our approach begins with a detailed file review and preparation of a summary report aimed at detailing prior successful and failed interventions, and brings to light any potential concerns that have been inappropriately or inadequately addressed. 

A determination is then made as to whether or not the file can be appropriately managed through our division, followed by a decision whether or not to proceed with the case. 

When opportunity for file advancement is possible, a case manager will then be assigned. At this time any additional data collection, interpretation, or intervention can be coordinated and followed through. This may include the utilization of psychiatric consultations, psychometric applications, medical assessments, vocational analyses, special diagnostic procedures, etc… all driven towards creating a clear picture of the file and focused on the development of an individualized rehabilitation plan; complete with milestones, timelines, reporting protocols, and outcome measures. 

Finally, our approach is intended to identify key barriers to successful resolution of the claim, and means to define realistic, achievable, and cost effective outcomes that are satisfactory to both the claimant and the claims manager.


RESULTS DRIVEN: Our ultimate goal is case resolution, which in most cases means that we are able to successfully return a claimant to work.   




All In-Home BPS Assessments include a detailed intervention plan with a treatment plan and budget proposal.

1. One Point Assessment for Case Management (Includes background review and focused assessment).

2. Two Point Assessment (Includes a One Point Assessment plus contact with the Treatment Team).

3. Three Point Assessment (Includes a Two Point Assessment plus workplace contact).



ATF's Case Management process involves facilitation of any required rehabilitation services beginning with assignment of therapists followed by progress monitoring, and collaboration and consultation with treatment providers and other relevant parties.

Includes all visits/contact with claimants, employers, insurers, and physicians.

Includes necessary report writing and all related correspondence.

May include return-to-work planning, workplace education, and specific prescribed reintegration strategies.

There is also a dedicated Interdisciplinary Team Review conducted for at least one hour per month (standard).



ATF’s Field Visits are designed as a comprehensive information gathering process with a rapid reporting time with the goal of assisting to expedite claims adjudication.

Field visit are typically of approximately two hours in duration and take place at the claimants home where possible. Reporting requires an additional three hours for report generation and then about an hour to an hour and a half is required for Case Manager review and quality assurance processes.

Field visits typically do not include treatment recommendations.

Costs may vary depending on the complexity of the case and the requirement for additional resource involvement.


OTHER SERVICES...                

ATF Can provide comprehensive file review by a Clinical Team Leader and/or Medical Consultant with experience in the specific disease, condition, or issue in question.

ATF Can provide any appropriate administrative support related to specific files (report typing, etc.).

In the event that additional assessment and diagnostics are required to verify a diagnosis and/or facilitate treatment and file progress, we will coordinate any appropriate interventions you may require, through our associated Medical Assessment Services Division.  Should vocational rehabilitation services be needed, we can coordinate these interventions to assist you as well.


Please check out our Medical Assessment Services Division Pages and Vocational Rehab Division Pages for additional information!



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