Case Study: Cardiovascular Disease

Employee: An employee working in direct patient care in a clinical setting

Reason for disability: Chronic relapsing Pericarditis, characterized with symptoms of chest pain and fatigue caused by episodes of inflammation of the pericardium, the sac that contains the heart.

Treatment: Employee was treated through medication. During this period of time, employee also participated in Physical Therapy to assist with overall endurance. Employee was able to have periods of full-time work, but ultimately couldn't sustain the exertion needed for direct client care work on a permanent full-time basis.

Review team: Case Manager, Clinical Consultant, & Vocational Rehabilitation Consultant as well as input with a peer Cardiology Physician

Transitional Return to Work:

• Sun Life Clinical Consultant spoke directly with the treating Cardiologist intermittently during treatment course to understand expectations for treatment and/or improvement, as well as functional limitations and restrictions.
• After observing the employee was unable to sustain full-time hours in direct client care, the treating Cardiologist supported part-time return to work with less physically demanding tasks and activities.
• Vocational Rehabilitation Consultant (VRC) discussed with employee possible sedentary roles that allow use of the employee’s experience and degree. VRC remained in contact with employer to confirm ongoing employment status, provide expectations for return to work, and to explore the possibility of returning to work in other areas with the same employer. 

Outcome: Employee attempted to resume an accommodated role in direct client care and ultimately realized that alternative, sedentary clinical positions discussed with the VRC and employer were more appropriate.

Today: Employee is employed with same employer in a sedentary role.

Clinical Claims Innovation Lab Takeaways: Multiple touchpoints, including the direct partnership with the treating physician was key in coordinating the best care for this employee. Regular check-ins with all team members assisted with keeping the employee on track and the employer informed of all changes. The collaboration from the Clinical Claims Innovation Lab team allowed for this employee to achieve a successful return to work, allowing for positive extended financial implications for the employer through restored workplace productivity and managed claim experience.

Case study represents an actual employee, however it has been deidentified for privacy purposes