COMMUNICATING WITH NURSE CASE MANAGERS

Can My Attorney Speak To The Assigned Nurse Case Manager On My Behalf?

There are numerous reasons why injured workers may hire an attorney to represent them in a worker’s compensation case. Usually, it’s because there are concerns about the stress of a worker’s compensation case potentially damaging the relationship between the employer and the injured worker.

Often, an attorney is hired because the injured worker is having difficulties with the doctors that the workers’ compensation insurance company chose. When a workers’ compensation insurance company provides medical compensation, they are not only paying the doctors’ bills but also selecting and choosing the doctors. This can raise much suspicion if you’re the one who’s been hurt.

Injured workers worry if the insurance company has their best interests and health in mind or if they are more aligned with the insurance company’s best interest. It’s common for injured workers not to want to review every doctor’s visit or prescription refill with a nurse case manager. Injured workers frequently ask that the communications involving their cases be directed to their attorney’s offices. The attorneys and staff who practice workers’ compensation and represent injured workers will then play the lead role in those communications with a nurse case manager.

Often, the injured worker’s attorney will email the nurse case manager when a prescription isn’t being authorized or filled at the pharmacy or when an appointment needs to be changed because of a family emergency or other health issues. This keeps the injured worker and nurse case manager’s communications to a minimum because the Industrial Commission will frown upon anything that could interfere with the job of a nurse case manager.

There’s no reason for an injured worker to become friends with their worker’s comp nurse case manager. There’s no need to be constantly texting, calling, or emailing and providing information to the nurse case manager. The insurance company hired the nurse case managers, so there’s always going to be a reason to be concerned about where the loyalties of the nurse case managers lie.

Is The Case Manager Going To Provide A Fair Assessment Of My Injury In My Case?

The nurse case manager’s role is to help. They are to ensure that the medical treatment the doctors are recommending is being authorized and that the treatment is moving along in a timely and efficient manner. The nurse case managers aren’t supposed to provide their own medical opinions about what’s medically necessary. What is medically necessary comes from the physicians treating the injured worker.

However, if a nurse case manager wants to pick a side, sometimes it’s a matter of not asking the questions that maybe need to be asked. Suppose the treating physician has recommended a particular medication. In that case, the nurse’s goal should be to get that prescription authorized by the workers’ compensation insurance company and get that prescription to the injured worker as quickly as possible.

However, suppose the nurse case manager feels it’s necessary to try to save the insurance company money. In that case, they could ask the doctor to prescribe a cheaper medication or a generic version of a medication. That cheaper medication could do nothing to help the injured worker’s progress, but it would help the insurance company save money.

Do Nurse Case Managers Aim To Keep Treatment Costs Down?

Insurance companies can benefit from having nurse case managers working for them, which can be concerning. Attorneys repeatedly see nurse case managers focusing on the insurance company’s interests rather than what the doctors recommend for their patients. Nurse case managers shouldn’t be involved in determining an injured worker’s disability rating or work restrictions – the treating physician determines those.

The hope is that the workers’ compensation insurance company or their nurse case manager isn’t pushing the doctor to approve light-duty work or certain work restrictions that may benefit the employer. Injured workers need to understand that if this happens, it needs to be brought to their attorney’s attention sooner rather than later. For more information on Communicating With Nurse Case Managers, an initial consultation is your next best step.