Getting a Second Opinion on Care Saves Employee's Leg
InsightsWhat's Trending
By NCCI Insights July 10, 2017


Dan, a superintendent at an asphalt plant in Indiana—who had been with his employer for 34 years—suffered a severe injury to his right leg when he tried to loosen some material that had jammed in a hopper. He climbed onto a conveyor belt and when it started moving his leg was pulled into the hopper. This caused an open fracture to his shinbone, a broken ankle, and a complex cut on his thigh. Dan underwent multiple surgeries to his lower leg during his initial hospitalization.


Strong advocacy for his care began early, when Nationwide, the employer’s insurance carrier, assembled a medical case management team. Although the hospital recommended discharging Dan four days following the injury, the medical case management team advocated for further treatment, directing him to in-patient acute rehabilitation.

Despite excellent care, Dan had preexisting diabetes, which caused complications leading to an infection in his leg. The medical recommendation was to amputate his leg below the knee, which was very traumatic and devastating news for Dan. Nationwide quickly assigned an on-site catastrophic nurse and an in-house nurse to the case. Working together with Dan’s wife and a claim associate, they ultimately decided to seek a second medical opinion to try to save the leg.

The physicians in the area where Dan lived all recommended amputation, but Nationwide found a physician farther away who recommended a treatment plan that would keep his leg intact. In the end, two of his toes were amputated, but his leg was saved. Both Dan and his wife were thankful that Nationwide supported and worked with them in their decision to seek a second opinion. The trust and collaboration that was built between all parties was key to saving his leg.


  • A medical case management team was formed to coordinate the complicated care the employee required
  • Insurer supports employee's decision to seek second opinion on treatment, avoiding previously recommended leg amputation
  • Employer understands the need for a coordinated recovery plan and puts numerous accommodations in place to support him and ease his transition back to work
  • Employee returns to work feeling valued by his employer and grateful for all the support he received


The employer remained in close contact with Dan throughout his recovery and recognized that several accommodations would be needed for him to return to work successfully. That included creating a flexible work schedule allowing him to come and go for physical therapy appointments, arranging for transportation to and from work each day—he was restricted from driving—and providing a modified work schedule, such as allowing him to elevate his leg throughout the workday. The employer also understood that he would have some permanent limitations, but was committed to keeping him on the team. The employer's efforts made Dan feel valued and appreciated.


When Dan was ready to return to work, the employer gave him an office position near the plant. Given his experience, he could provide valuable insight into the plant’s operations. He continued with office work until he was more mobile and able to gradually increase his time at the plant. Even when he missed time at work due to some minor complications, the employer continued his salary. Dan said that he was very happy to be back at work and grateful for the flexibility and assistance that his employer provided.