Insurance companies everywhere are interested in rehabilitation services. The problems of medical, social and occupational reintegration are universal in nature and are encountered in every social system, although to different extents. There is a clear need for rehabilitation management.

Behind every bodily injury claim there is a human story, a personal fate. Whether a minor injury has a major impact on a person's ability to keep working in his chosen profession or, conversely, a relatively severe injury causes little disruption depends on a large number of factors. It is not the severity of the accident trauma alone that decides whether the patient can recover his health completely or only partially. Other important influences are the affected person's biography, lifestyle, social status and his social contacts before the traumatising event. How the person comes to terms with the accident can also significantly affect the recovery process. In many cases, professional support from an early stage may be needed.

Other factors of major importance to future recovery are the place and nature of the medical care and the quality and timing of the rehabilitation services provided. The accident victim must be given individual advice and attention, and his own wishes must be taken into account in the planning for his future working life.

In the course of his medical treatment and rehabilitation, the patient will pass through a series of institutions. In each of these, he will be dealing with different specialists, usually only for a limited time. None offers the patient beginning-to-end companionship. In many cases, he may be unable to cope with the decisions involved in planning the further course of his recovery and the re-orientation of his future life. In these circumstances, a competent contact who is able to give advice on all aspects of medical, social and occupation rehabilitation can be of great assistance.

These were the considerations that led to the foundation of ReIntra to provide medical/occupational counselling and reintegration services for accident victims.

Rehabilitation claims managers

The role of co-ordinator and companion for accident victims is shared by doctors and occupational counsellors.

The doctors come from the fields of internal medicine, industrial medicine, rehabilitation medicine, neurology and paediatrics. They function as specialised universalists with a great understanding and particular empathy for patients with serious long-term afflictions. This inner circle maintains close contacts with specialists from other medical disciplines such as accident surgery, psychiatry, psychosomatics, psychology and orthopaedics. Further links to universities and highly specialised rehabilitation clinics are in place.

The occupational counsellors combine the know-how and skills of social workers and careers consultants. They all have full vocational training plus a specialist university degree and have developed and applied inter-disciplinary expertise in long years of experience as counsellors for employees and employers. The occupational counselling activities focus on advising the accident victim on all labour market issues, especially in connection with basic vocational training, further training or re-training to enable him to return to working life. The occupational counsellors at ReIntra maintain and cultivate an ever-expanding network of contacts with institutions, public authorities and businesses.

Who can use the service?

The ReIntra medical/occupational counselling and reintegration service was founded in 1996 by Bayerische Rückversicherung Aktiengesellschaft (Bavarian Re) with the aim of providing assistance for accident victims from the day of their accident to the time of their full social and occupational reintegration. It is called in by insurance companies, which also bear the cost of its services. However, ReIntra takes on a case only if the accident victim is in agreement, and work commences only when his lawyer has given his consent and the patient has released his doctors from their duty of confidentiality.

Essentially, the service performs three tasks:

  • time management;

  • optimisation or quality management;

  • information management.

    ReIntra takes on patients with any kind of injury that causes permanent impediment or prevents the accident victim from returning to his previous occupation.

    How the service works

    Assistance is given to the patients in three phases.

    Phase I commences with the study of the patient's medical files. The next step is to contact the patient, his doctors, lawyers, family, the claims adjusters, etc. The aim of this phase is to arrive at a prognosis for reintegration and to arrange an appointment for the first visit to the patient.

    Phase II serves to build up a confidence basis with the patient; for this reason, it focuses on person-to-person talks. A multi-dimensional assessment helps the counsellor to gain an overall picture of the accident victim's current situation. This involves collecting all the available information on the patient's physical condition, his social and economic status, any medical data that is still missing, and, in short, all other facts and circumstances that could be significant in obtaining a comprehensive picture of the patient's living environment. The patient, the team doctor and the occupational counsellor then agree further procedure. The aim of Phase II is to draw up an optimised rehabilitation plan for the patient for the coming months or years.

    In Phase III, the primary task is to accompany the patient on his way to recovery and reintegration. Here the occupational counsellor and the team doctor take on the function of coordinators. They act as the patient's confidantes and liaison agents, helping and advising him on any problems that arise. Such assistance is particularly required when the patient is first released from hospital, if his medical, social or occupational circumstance change, or if he needs help with filling in forms or is otherwise unable to cope with the inevitable red tape.

    Results so far

    When their case is referred to ReIntra (on average about a year and a half after the accident), most accident victims are still struggling with serious health, occupational and social problems. The patients selected by the insurance companies for this service usually have two things in common: their medical progress has been beset by complications and their prospects of occupational and social reintegration are poor. Unlike in the conventional medical, rehabilitation and social system, the patients are accompanied by the same “case manager” over a period of, on average, two years. This makes it possible to stabilise, if necessary, any reintegration process that may just have got under way and to ensure its long-term success.

    After an average of 25 months in ReIntra's care, 49% of the accident victims were already in re-training or exploring new vocational opportunities, and 27% were back in full-time work. These figures show that the medical/occupational counselling and reintegration service is able to achieve a high reintegration ratio. The service has met with an enthusiastic response, not only from the accident victims themselves but also from the doctors, lawyers and other parties involved in the rehabilitation process.

    Germany has a well-developed social system and its health care system is generally recognised as one of the best in the world. But the deficits in the reintegration of accident victims and other injured persons into a satisfactory social and occupational environment prove that active case management for the injured is an urgent necessity. If properly provided, it can help the injured people to improve their quality of life, prevent their condition from becoming chronic, and facilitate their return to their accustomed social structures.

    Currently, ReIntra operates in Germany, Austria and the United Kingdom. It anticipates extending its services to other European countries within a few years.

    Dr Ursula Wandl is company medical executive, Bayerische Rückversicherung AG. E-mail: ursula_wandl@bayerischerueck.com

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