Nurse Case Managers: Be Warned and Be Aware!

Sometimes in a Workers Compensation case, the insurance company will assign a nurse case manager whose job is to attend the doctor’s visits, consult with the patient and report back to the insurance company.

In theory, that sounds like a good thing.  But in practice, it is not.

I have seen cases where the nurse case manager has told the doctor what the insurance company will and will not pay for and as a result, the doctor has changed his treatment recommendations.  It is a felony for anyone to interfere with the doctor’s recommendations but the nurse case managers get away with it because some doctors think that they have to play ball with the insurance company.  It is particularly a problem when the doctor does not document that his treatment recommendation has changed because of the nurse case manager’s interference.

Another problem that I’ve seen is that the nurse case manager will try to persuade the injured worker that he or she is ready to go back to work sooner than the injured worker should have been.

And, perhaps most importantly, the nurse case manager is working on the supervision of the insurance adjuster.  Every question that she asks you, every thing that she says to you is at the direction of the insurance company for the sole purpose of minimizing the benefits it pays to the injured worker.

And everything you say is reported directly back to the insurance company.

You do not have to accept a nurse case manager.  It is up to the injured worker whether he or she will allow anyone else in to the room during the doctor’s visits.  The insurance company cannot discontinue your benefits because you refused the nurse case manager.

Be warned and be aware.

The Law Office of Keenan Powell provides free consultations regardless of whether or not you have been controverted.   To contact Keenan Powell, use the contact form on this page or call 258-7663.

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