When a claim moves from standard to complex, involving catastrophic injuries, comorbidities, adaptive housing, or highly specialized equipment, the stakes rise sharply. Employers, payers, and case managers find themselves navigating a maze of medical, operational, and logistical challenges. Fortunately, with the right partner and approach, you can steer these claims toward optimal outcomes with less friction and more control.  

Why “Complex” Claims Require a Different Approach 

1. Complexity means higher cost + longer duration

• • According to the National Council on Compensation Insurance (NCCI), lost time claim frequency declined 8% in the past year while medical claim severity rose ~2% and indemnity severity rose ~5%. 
  • A survey of 500 workers’ comp professionals found that 45% cited “complex claims” as one of their top 10 challenges, according to Risk & Insurance. 
  • Another study found that 51% of claims professionals say “too many claims to manage and lack of support” is the greatest obstacle to facilitating medical care for injured workers. 
  • These numbers underscore that complexity isn’t just about the injury; it’s about the system around it.

2. Multiple “moving parts”

Complex claims frequently involve: 

• • Catastrophic injuries (e.g., spinal cord injury (SCI), traumatic brain injury (TBI), and burns). 
  • For example, ATF’s blog notes that SCI frequency of large (> $1 M) workers’ comp claims has grown nearly 7% per year since 2012. 
  • Comorbidities and psychosocial factors (mental health, chronic conditions), according to Risk & Insurance. 
  • Durable medical equipment (DME) and assistive technology plus adaptive housing modifications. 
  • Coordination across medical, rehabilitation, equipment, housing, home health, and case management. 
  • Lifelong monitoring, servicing, and adjustment.  

3. Operational & regulatory drag

Complex claims often bring: 

• • Delays in care and treatment (which in turn can increase cost and extend duration). 
  • A need for highly specialized vendor networks. 
  • Administrative burdens (tracking equipment, housing modifications, ongoing adjustments). 
  • Rising medical cost inflation and wage growth pressures (both raise indemnity & medical expense expectations. 

Given this landscape, the difference between managing a complex claim well vs. getting bogged down can be dramatic. 

How ATF Medical Helps Take the Headache Out 

You’ve found a high-value partner for complex or catastrophic workers’ compensation claims that can provide: 

One-stop, clinically driven solutions 

• • Total solution for all equipment, supplies and services that catastrophic workers’ compensation claims require. 
  • Many providers focus only on specific product lines; ATF combines equipment, adaptive housing, and long-term servicing. 
  • We work with an in-house team of rehab specialists, occupational therapists, and adaptive housing experts who collaborate with case managers and adjusters. 

End-to-end coordination + life of claim support 

• • After the equipment is delivered, we stay involved over the life of the claim – monitoring, servicing, adjusting to the injured worker’s evolving needs. 
  • Our model helps claims professionals by shifting many operational details to a partner which frees up internal bandwidth to focus on outcomes and strategy rather than vendor logistics.  

Cost-effective without compromising outcomes 

• • We provide substantial savings, without compromising care, quality, or service. 
  • Because complexity often drives cost escalation, having a partner who can streamline equipment/housing logistics, align to clinically supported solutions, and reduce internal administrative burden is a strategic advantage.

Customized for workers’ compensation 

• • Our solutions are tailored specifically for workers’ compensation. We understand the adjustment/case-manager/claims world, not just generic DME. 
  • We also run continuing education for case managers focused on complex rehab technology and home modifications. 

Five Best Practices to Manage Complex Claims Smoothly 

In addition to partnering with a skilled vendor, here are five practices you should adopt to keep complex claims from spiraling: 

1.) Early identification and triage

• • • Use predictive modeling to spot claims that have a high risk of escalating cost, delay, or complexity. 
    • Flag injuries with catastrophic potential (SCI/TBI, multiple comorbidities) or complex equipment/home modification needs. 
    • The earlier you engage with specialized resources, the fewer surprises you’ll face.

2.) Single-point coordination

• • • Designate a coordinator (internal or through your vendor partner) who owns the workflow: equipment ordering, adaptive housing, delivery, training, servicing. 
    • ATF’s model of assigning a Rehab Tech specialist to liaise with you, and the injured worker is a proven structure. 
    • This avoids fragmentation and confusion among multiple vendors, therapists, and case stakeholders.  

3.) Clinically aligned equipment + housing decisions

• • • For complex claims, what you buy matters. It’s not enough to check the box on equipment. Matching the injured worker’s functional goals, living environment, family/support system, and expected changes is critical. 
    • Similarly, adaptive housing should be consistent with long-term goals, not just short-term fixes.  

4.) Life-of-claim servicing and adjustment

• • • Care plans may work well initially, but as the injured worker’s condition changes, technology evolves, housing needs shift, you’ll need adjustments (room layout, equipment upgrade, maintenance). 
    • Ongoing monitoring helps you identify changes early, avoid downtime, non-use, or escalation in cost. 
    • Having a partner with this built-in avoids surprises later and improves injured worker outcomes.  

5.) Transparent communication and cost control

• • • A key service benefit is frequent, clear updates to the case manager/adjuster.  
    • Cost escalation often comes from lack of visibility or delayed intervention. When you know what’s happening and when, you’re in better control of reserve setting and outcome tracking.

Make Complex Claims More Manageable 

• • Recognize early that a “complex” claim is qualitatively different: higher risk, more moving parts, and greater potential for cost and delay. 
  • Partner with a vendor that brings clinical depth, full-service capability, and long-term servicing, not just a supplier of equipment. 
  • Adopt best practices such as early triage, single-point coordination, clinically aligned solutions, life-of-claim servicing, and transparent communication. 
  • Ultimately: you don’t eliminate the complexity, you manage it so it doesn’t manage you. 

Get in touch today.