The Role Of A Nurse Case Manager In A NC Workers’ Comp Case

What Is The Role Of The Nurse Case Manager In A North Carolina Workers’ Compensation Case?

Workers’ compensation insurance companies do not always hire nurse case managers. When they do, there is usually a medical reason that they’re concerned about. The insurance company worries that the claimant will not get all the treatment they need or that the doctor and the injured worker might form a bond against their interests.

Workers’ compensation insurance companies sometimes hire a field nurse case manager to attend appointments. This way, somebody on the insurance company’s side speaks directly to the doctor and asks questions about the timeframe. The nurse case manager will also ask when the doctor expects the patient to reach maximum medical improvement.

They will also handle some ancillary medical issues in a case. The nurse case manager will discuss with the treating physician about getting prescriptions filled, and durable medical devices purchased and delivered to the worker. The nurse case manager will also confirm the patient’s work status and functional capacity with their doctor.

Other times, workers’ compensation insurance companies hire a telephonic nurse case manager, which is more of a nurse administrative role. This person calls the doctor’s office and speaks to the injured worker after their appointments. This phone call confirms the information and ensures a follow-up appointment is scheduled. They also confirm they’re getting the medical records and work notes needed from the appointment.

The same rules apply to a telephonic nurse case manager as a field nurse case manager. Whether insurance companies hire one or the other depends on the case.

Who Hires The Nurse Case Manager?

The workers’ compensation insurance companies hire nurse case managers. If an injured worker is assigned a nurse case manager, their employer is liable through their workers’ compensation insurance company. The insurance company will decide to pay benefits, including medical compensation.

When a nurse case manager is hired, they’re almost always hired and paid by the insurance company. In rare circumstances, through counsel, an injured worker can request or motion the Industrial Commission to order a nurse case manager on a case that is a complicated medical issue. Sometimes this will happen, but the insurance carrier always pays for the nurse case manager.

Do I Have A Right To Meet With My Physician Without The Nurse Case Manager Present? Or Getting All The Information From My Appointments?

In North Carolina, there is a lengthy and detailed list of rehabilitation professional rules called the “North Carolina Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims.” These rules apply to nurse case managers and vocational counselors under the section of attending physician appointments.

Field nurse case managers cannot participate between the injured worker and their physician during the exam. The injured worker is allowed to request a private exam and get their examination and their initial meeting with the physician outside of the presence of the insurance company’s nurse case manager.

Under the law, the nurse case manager has the right to attend a visit and meet with a doctor in the presence of the injured worker at the end of the appointment. The nurse can then ask questions about the patient’s status and work capabilities. They also ask about recommended medical treatments, including new prescriptions that will need to be authorized. You get a private exam as an injured worker, but there are no measures to prevent the nurse case manager from meeting with the treating doctor and asking routine questions.

Can The Nurse Case Manager Speak To My Doctors Without Me?

This issue has been litigated in North Carolina. The North Carolina Industrial Commission has determined that nurse case managers, as insurance company agents, aren’t allowed to engage in Ex-Parte Communication with the treating doctors. This means the nurse case manager is not permitted to discuss the case outside the presence of the injured worker.

After a treating physician examines an injured worker, the nurse case manager cannot request to speak to the doctor in private. This is not allowed. If it happens, the insurance company runs the risk of that doctor’s opinion not being allowed, should court proceedings be necessary. This is a critical issue and something we advise all of our clients.

There is no way to prevent nurse case managers from attending appointments. But, if you suspect that a nurse case manager is talking to your doctor outside of your presence, you need to be aware of this and possibly ask questions.

Nurse case managers might have three or four appointments throughout the day. If they arrive late to one of their patient’s doctor visits, they want to make their trip worthwhile. The nurse may ask staff or front desk folks for any notes or information they can get before they leave.

We all know that doctors have a busy schedule to keep. If you arrive at your appointment too early, the doctor may take you back for your exam early or put you in an exam room sooner than if you had arrived on time or late. The injured worker must recognize this issue and reserves that issue for concern.

Realize that it would be difficult for the nurse case manager not to discuss the case with your doctor, even if you’ve already checked out and are on your way home. After all, speaking to the doctor is why they made the trip in the first place. If you’re the patient that’s already left and the nurse arrives late, that can be a problem. For more information on Nurse Case Manager In A NC Workers’ Comp Case, an initial consultation is your next best step.