Case Studies

Case Study 1: Catastrophic Injury Behavioral Health Intervention

A 42-year-old worker sustained a severe traumatic brain injury and multiple orthopedic fractures in a high-impact accident. Following prolonged hospitalization and inpatient rehab, the injured worker presented with symptoms of post-traumatic stress, mood instability, sleep disturbance, and difficulty engaging in physical therapy due to anxiety and pain avoidance. The treating physician and claims team expressed concern about delayed recovery, prolonged disability, and escalating costs, as the behavioral health factors were complicating medical progress.

ProMedView initiated intake within 72 hours and placed the individual into the Trauma Recovery Program. An interdisciplinary team of a psychiatrist, trauma-focused therapist, and neuropsychologist coordinated with the treating physician to stabilize symptoms, implement structured coping skills, and address cognitive and emotional barriers to rehabilitation. With WC-aligned documentation and regular case updates, the claims team gained clarity on functional progress and return-to-work potential. Within three months, the injured worker demonstrated improved mood regulation, increased participation in therapy, and measurable functional gains, resulting in reduced claim risk, accelerated recovery trajectory, and improved quality of life.

Case Study 2: TBI with Pre-Existing Bipolar Disorder

A 40-year-old male living in a remote geographic area with limited behavioral health services sustained a traumatic brain injury after a workplace fall. He had a documented history of bipolar disorder, which complicated the claims process as post-injury mood instability, irritability, and cognitive decline overlapped with pre-existing psychiatric symptoms. The insurer needed clarification for apportionment and treatment planning. The injured worker was placed in the Trauma Recovery Program for comprehensive behavioral health care and clarification for compensable injuries.

ProMedView assembled a top-tier psychiatrist and psychotherapist experienced in catastrophic injury and complex psychiatric history. Through comprehensive evaluation and structured therapy, the team distinguished between TBI-related deficits and pre-existing bipolar disorder. WC-aligned reports provided diagnostic clarity, apportionment rationale, and treatment recommendations. The claims team gained defensible documentation, while the injured worker received targeted therapy and medication adjustments that stabilized mood, improved cognition, and restored participation in rehab.

Case Study 3: Fear and Avoidance

A 29-year-old warehouse worker was trapped briefly under collapsed shelving during an accident. He sustained only minor physical injuries, but soon developed intrusive recollections, avoidance of the workplace, irritability, and panic symptoms. Because there was no head trauma, the treating physician initially minimized the need for behavioral health, but the claims team became concerned as symptoms persisted and return to work stalled.

ProMedView enrolled him in the PTSD Diversion Program. A trauma-informed psychotherapist provided exposure and coping interventions while a psychiatrist managed anxiety symptom. WC-specific documentation clarified that symptoms were behavioral health in origin and not neurologic. Within eight weeks, the worker demonstrated improved sleep, reduced avoidance, and was successfully transitioned back to work on a graduated schedule, preventing long-term disability and reducing overall claim exposure.

Case Study 4: PTSD Diversion

A 35-year-old first responder was involved in a workplace explosion that left colleagues injured. Although physically unharmed, he developed persistent nightmares, irritability, avoidance of work environments, and sleep disturbance. The case manager identified early signs of post-traumatic stress that threatened long-term disability and escalating claim exposure.

ProMedView quickly enrolled him in the PTSD Diversion Program. A trauma-informed therapist and psychiatrist provided early intervention, symptom containment, and sleep stabilization strategies. WC-specific documentation clearly linked functional goals to work demands, enabling the claims team to authorize ongoing care with confidence. Within two months, symptoms were reduced, coping skills were established, and the worker safely returned to modified duty, avoiding chronic PTSD and the high-cost trajectory often seen without timely behavioral health intervention.

Case Study 5: Neuropsychological Exam to Clarify Ongoing BH Needs

A 56-year-old injured worker with chronic back injury and prolonged absence from work was referred after showing signs of depression, irritability, and cognitive complaints. It was unclear whether his symptoms required ongoing behavioral health intervention or were secondary to pain and deconditioning. The adjuster questioned the necessity of continued BH care.

ProMedView coordinated a comprehensive Neuropsychological Examination. The evaluation documented significant cognitive inefficiency linked to mood disturbance and chronic pain rather than neurologic disease. The results supported the medical necessity of continued behavioral health services and provided concrete functional baselines for progress tracking. With clear WC-aligned recommendations, the claims team authorized ongoing therapy, which led to improved mood, better engagement in rehabilitation, and enhanced clarity around the injured worker’s recovery trajectory.

Case Study 6: PMV Clinical Expert Intervention Corrects Inappropriate Medical Care

A sanitation worker slipped of the back of a garbage truck that was moving at about 10 miles per hour. The fall resulted in scratches on his face and a broken tooth. He was seen the same day in an occupational medicine clinic and prescribed an antibiotic prophylactically to ensure that germs from the garbage he was handling did not cause an infection. Approximately 48 hours later, the worker developed a rash on most of his body. He went to an emergency room but left before he was seen after 4 hours waiting room. The injured worker declined to return to the emergency room as he had a follow up appointment scheduled with the Occupational Medicine clinic in 3 days. The worker’s condition worsened, and the rash spread to his mouth, eyes and intestinal tract. Unable to eat or drink, he was admitted to a level 4 hospital with limited resources, compared to a Level 1 trauma center. The assigned filed case manager visited him in the hospital the next day to find that his rash was developing into ulcers internally and externally. The hospital had him on solid foods with no IV fluids and did not have a clear diagnosis or treatment plan.

A Clinical Consultation was requested. Our Clinical Experts coordinated interdisciplinary collaboration that led to life saving interventions included contacting the hospital and requesting liquid diet and IV fluids, setting up consultations with the Mayo Clinic and an infectious disease doctor who determined the worker was experiencing a rare condition called Steven Johnson’s syndrome, a rare and unpredictable reaction to the antibiotics with a survival rate of less than 10% for his age and condition if not treated immediately and properly. Of note, when this condition is treated properly, the results are immediate.

Upon confirmation of the diagnosis, our experts contact the hospital to advise the treating physician of the findings and coordinated an air lift transfer to a Level 1 trauma center burn unit. Within 24 hours the worker responded well to the life-saving treatment at the trauma center and was discharged home in 36 hours.