Why Autopilot Care Is an Ethical Issue

Ethics is about doing the right thing for the injured worker, not just following routines.

When care stays on autopilot:

• Injured workers may receive care that no longer helps them.
• Important changes in condition can be missed.
• Emotional or social needs may be ignored.
• Costs grow without improving recovery.

That’s not good for the worker or the claim.

Long-Term Claims Need Fresh Eyes

People change over time.
Injuries change.
Environments change.
Relationships decline and grow.
What was appropriate two years ago may not be appropriate today.

Long-term and legacy claims should be reviewed regularly to ask simple questions:

• Is this care still medically necessary?
• Is the injured worker improving, stable, or declining?
• Are there safety risks we haven’t looked at lately?
• Are we addressing mobility, wound care, or mental health needs?
• Are you still using those medical supplies?
• How is the level of care you are receiving?

If no one asks these questions, care can drift.

Autopilot Can Look Like “Maintenance,” But It’s Not Always Helpful

Some injured workers truly need ongoing care. That’s okay.
The problem is when care continues without goals or reassessment.

Examples of autopilot care include:

• The same home health visits with no updated plan.
• The home health notes with the exact same routine every week.
• Old equipment that no longer fits or supports the worker.
• Therapy continuing with no clear progress.
• No review of transportation needs as mobility changes.
• Increased HHA hours to assist with transfers based on injured workers weight.

Ethical oversight means checking in and validating, not cutting off care.

What Ethical Oversight Looks Like

Ethical oversight is simple:

• Pause and review the plan.
• Ask if care still matches current needs and or the near future needs..
• Look for missed opportunities to improve quality of life.
• Make sure the injured worker isn’t forgotten because the claim is old.
• Address aging factors that may or may not tied directly the worker compensable injury.

This doesn’t mean “do less.”
It means “do what makes sense now.”

Why This Matters to Adjusters and Nurse Case Managers

Adjusters and nurse case managers are often the only ones who see the full picture.
Providers see pieces. Vendors see tasks and sometimes the family sees nothing..
You see the whole claim.

That gives you an ethical responsibility to:

• Question care that feels stuck.
• Ask for updated assessments.
• Advocate for changes when the plan no longer fits.
• Address and question scripts, ask for more clinical justification.
• Request accurate and more detailed home health notes.

Real-World Example

An injured worker had a serious injury years ago and received daily home health support. Over time, the worker’s condition improved, but the care plan never changed. No one reviewed mobility, equipment needs, or goals.

A reassessment showed the worker no longer needed daily assistance but did need updated mobility equipment and occasional support. Care was adjusted. Independence improved. Costs stabilized.

Nothing was taken away unfairly.
The care just finally matched the injured workers functional needs..

Long-term claims need attention, not autopilot. Ethical oversight means checking in, reassessing, and validating to ensure care continues to help the injured worker live as safely and independently as possible.