Lifecare Planning Review (LCP)
  • Purpose: Create an overall strategy for a lifecare plan for an injured worker’s lifetime that includes medical treatment, pain management regimen and ancillary but important components like adjustments to their home environment or rehabilitative care. While Lifecare planning typically just extrapolates current care over the injured worker’s potential lifetime, this review will project what changes can be made immediately or over the long-term to best fit the injured worker’s circumstances in conjunction with an overall strategy as to their quality of life.
  • Triggers:
    • Settlement is desired
    • Future medical costs to exceed $5000/year
    • Lifetime medical treatment is expected
    • Causal relationship issues to WC persist
    • Co-morbidity conditions effect treatment
  • Scope:
    • Plan of care (procedures and treatment present and anticipated)
    • Medical necessity
    • Reasonableness
    • Causal relatedness
    • Pain management regimen (present and anticipated)
  • Reviewer: Active practice MD
  • Inputs:
    • Medical records (no limit)
    • RX scripts and bills
    • Other reviews like DUR or IME or peer reviews
    • Peer-to-peer discussion
    • Evidence Based Medicine
    • Reviewer’s active clinical and academic experience
    • Latest medical research
    • Onsite interview of treatment provider(s) and injured worker
  • Discussion: Unless otherwise stipulated by the customer, all treatment provider(s) will be contacted
  • Option: Unless otherwise stipulated by the customer, PRIUM will attempt to get the treatment provider(s) to agree in writing to any recommended modifications
  • Option: Reviewer available for appeal process and testimony