Getting Worker’s Compensation Benefits? What You Need to Know about Your Nurse Case Manager

One thing that many people are unaware of when it comes to receiving worker's compensation benefits is that they may be assigned a nurse case manager. If you are receiving worker's comp or expect to in the future, it's important that you understand as much as possible about the role of your nurse case manager, who he or she works for, and how to handle conflicts if they arise. Here's what you need to know.

What Does a Nurse Case Manager Do?

A nurse case manager has several roles that will help you overcome your injuries so you can return to work as quickly as possible while taking your health into consideration. To do this, your nurse case manager will schedule appointments and treatments on your behalf, facilitate meetings with your health care providers, and keep your claims adjuster posted about your recovery process. He or she will also make sure you follow through with all of your treatments and medical services and report back to the claims adjuster whether or not you've met your responsibilities in getting medical treatment to help you in your recovery. Sometimes, to do this, they have to accompany patients to their treatments, especially when the insurance company requires it, which is typical when insurance companies believe there is fraud.

Why Are Nurse Case Managers Assigned?

Essentially, nurse case managers are assigned to protect the bottom line of the insurance company that is paying your worker's compensation benefits. But in doing so, they also make sure that you recover from your injuries safely, which can prevent subsequent injuries in the long run. And this, in turn, protects the insurance company even further. Nurse case managers are especially helpful in coordinating various types of treatments and dealing with scheduling conflicts that may come up when several different medical offices are involved, such as primary care doctors, orthopedic surgeons, and physical therapists.

Who Does the Nurse Case Manager Work For?

Nurse case managers are typically hired by claims adjusters from workers compensation insurance companies, but they typically work as unbiased independent contractors or subcontractors. It's important to understand that nurse case managers are required by law to follow medical ethics guidelines and HIPAA privacy laws. Therefore, even though they work for, get paid by, and report to an insurance company, they cannot speed up your recovery process or make decisions that override your medical team. In other words, even though the nurse case manager is hired by the insurance company, he or she works their schedule around everyone involved in your case, including yourself, the insurance company, your employer, and your medical team. This can make it seem like your treatments are scheduled more according to your nurse case manager's hours of availability than your own, particularly if they are required to be present for your appointments.

What If You Don't Like Your Nurse Case Manager?

Since nurse case managers become so deeply involved and do have a lot of control of the schedule of treatments and office visits, sometimes there are conflicts that come up between patients and their case managers. It's important for you to understand that even though one of the roles of your nurse case manager may be to accompany you to your treatment, it does not mean that they will be in the examination or treatment room with you. However, you can expect them to discuss your treatment and prognosis with your medical team immediately after your appointment. If at any time you feel that your privacy is being violated by your nurse case manager or anyone else or you simply do not get along with your nurse case manager, speak with a worker's compensation attorney. An attorney can draft a letter for you asking for a change or a different nurse to be assigned to you.

For further information about nurse case managers and how a worker's compensation attorney can assist you in your relationship with one, contact a firm like Hardee and Hardee LLP.