The Case Nurse — Helpful Friend Or Insurance Company Investigator?

They introduce themselves with the title of nurse, with a friendly smile, and with encouraging words. After all, nurses are supposed to help us in times of injury. Is she really working for you? Or, is the truth something far different?

I regularly advise my injured clients concerning the use of case nurses in workers’ compensation claims. Instead of being a helpful medical advocate, case nurses are often insurance company investigators in disguise.

How do case nurses go from helpful nurse to investigator? They begin asking questions about non-medical issues. They ask about issues such as your finances, your education, and your work history. They ask about bankruptcies and arrests. Do these topics have anything to do with your actual medical care? No. However, your answers may be useful to the insurance company looking to defend or deny your claim. You don’t have to answer them. You would be wise not to answer them.

Case nurses also often ask you to sign releases so that they can obtain records and information. They tell you the releases are needed to get your medical records so that they can help with your care. That’s not always true. If you read the releases closely, you will see that they often allow the insurance company to obtain your financial information, past employment information, school records, privileged psychological records, or medical records completely unrelated to your injury. Did the case nurse tell you that the insurance carrier in Alabama already has access to the records from the authorized physician treating your injury? If the insurance company has these records, then why do they need signed releases? You should not sign releases without getting good legal advice.

Be careful with the information you provide a case nurse assigned to your claim. Some case nurses genuinely want to help you with a complicated medical system. Unfortunately, many of these nurses handling comp claims see their job as helping the insurance company at your expense.

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