May 18, 2016 • Ametros Updates

Freedom from Utilization Review

"I've gone to hell and back fighting the denials," Sarah, an injured nurse living in rural California, recently related to me. * Sarah was injured in 1992 and, after one back surgery, has had her second back surgery denied for the last eight years. At age 73, she tells me how she and her husband must drive two hours to the closest doctor in her workers compensation carrier's medical provider network to get a checkup. She says her attorney, after settling the lost wages portion of her claim, has long since given up fighting for her to get the second surgery that her own doctor says would greatly benefit her condition.

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Stories like Sarah's are well known at CareGuard, where we help injured individuals get the healthcare they need after they've settled their case. At CareGuard, we understand the
workers compensation system has rules and guidelines to make sure that the treatment
being delivered is fair and appropriate. However, as a professional administrator of
medical funds post-settlement, we specialize in making life easy for the injured
individuals; we give them full control to choose the doctors they prefer and we help them
save money along the way. Most importantly, with CareGuard, the injured individual is no longer subject to the utilization review process. The injured individual has the freedom to treat the way they want with the support in place to help them after settlement, which in many instances leads to more settlements of future medical.

Many injured individuals, like Sarah, feel trapped and neglected by the workers compensation system. They are contacting their adjusters, doctors and attorneys so much to get the medical care they need that they have little time to consider if settling their case and having the help of a professional administrator may be a better option.

Settling their case and working with a professional administrator allows the injured individual to be totally free from workers compensation utilization review; they become the decision-maker with 24/7 support, systems and online tools to make sure their experience is as convenient as possible so they can just focus on feeling better.

Below is a glimpse of the key differences between an open, pre-settlement claim and a settled claim with the professional administration of the medical funds CareGuard provides:


Settling the case and working with a professional administrator offers injured workers freedom from the bureaucracy of the workers compensation system and, with CareGuard's cost savings, we maximize the chance that their settlement funds will last beyond their lifetime and even be left over in their account for their family or estate when they pass away.

After speaking with Sarah and her husband at length, she decided to become a CareGuard member. She recently had successful back surgery and is now seeing her own doctors as she progresses through physical therapy. CareGuard was able to save her 47 percent off of the billed charges for her surgery so she has substantial funds remaining for future checkups.

"Your team removed a huge stress off me and my husband's shoulders," she told with me last week.  She went on to share that she is feeling much better and is hopeful that as she continues to improve she won’t need to use her settlement money and can leave most of it behind for her three grandchildren.

*Sarah’s name and location are altered for purposes of this story.

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