Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial.

Eligibility was judged subjectively by superior staff, and patients who explicitly requested intensive coaching were excluded, so the sample was not a random sample of all severe accidents. The trial ran while intensive case management was being introduced, so case managers were newly trained and inexperienced, while claims specialists were experienced. Some patients allocated to standard management received intensive coaching, and some allocated to intensive coaching never received it; this may understate differences between groups. Intensive case management was a bundle of coordination, planning, personal assistance and monitoring, so the study cannot separate which component mattered. Outcomes were administrative insurance records and reflected the insurer's perspective, not total societal costs or patients' work situation after benefits ended. Treatment costs excluded the wages of claims specialists and case managers.

Do not conclude that intensive case management was harmful because treatment costs were higher. Average loss of work capacity was not significantly worse, and the trial tested a newly introduced insurance coaching programme with inexperienced case managers.