Nurse Case Managers – Who Are They Really Helping?

A recent post on the site Workers’ Compensation Watch asks an important question — Should I trust the nurse case manager for my workers’ compensation claim?  That author then responded to his own question with the perfect answer — “be careful.” Through the years, I have seen many claims where the carrier hired a nurse case manager. This post is not intended to criticize all nurse case managers.  I have met case nurses who were genuinely concerned for the injured worker.  With that said, it is important to remember who pays the case nurse.  The insurance carrier is often motivated by its own interest in saving overall medical costs rather than providing the best care to you.

How can the insurance carrier’s nurse save them costs at your expense?  The nurse can direct your care to doctors that might not act in your best interest.  The nurse can meet with doctors and attempt to get you released back to work before you are medically able.  The nurse can attempt to influence the doctors to provide opinions more favorable to the carrier.  In some instances, the nurse can attempt to use her relationship with you to obtain information the carrier can use later to fight your claim. It’s important to remember that the case nurse may not truly be working in your best interest.  Then, be careful.

The use of nurse case managers by insurance carriers is a frequent topic of discussion among attorneys handling workers’ compensation cases.  Almost all attorneys who regularly handle such claims can relate stories of situations where a bad case nurse has had a harmful impact on a severely injured client.  Recently, another workers’ compensation attorney posted three tips for injured workers dealing with case nurses. I will repeat his three tips and then add a fourth of my own:

  1. Always insist upon a private examination by your doctor outside the presence of the nurse case manager.
  2. Never let the nurse case manager switch your treating physician without your consent.
  3. Keep your lawyer informed
  4. Do not provide the nurse with personal information that is not necessary to schedule necessary medical care.  Often, case nurses will pry for information concerning prior injuries, other health conditions, work history, and other personal information.  This information will often be used later by the carrier to fight your claim.
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