Reports Created By Nurse Case Managers

Do I Have The Right To See The Reports Or Information That The Nurse Case Manager Creates?

The “North Carolina Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims” defines how communications are delivered to the different parties in a workers’ compensation case. If a nurse case manager is assigned to a case, they are required to provide periodic reports under the law.

The Industrial Commission’s rules do not clearly show how often or how frequently those reports must be done. However, there should be a paper trail that the nurse case manager develops while working on a case. No matter how often or frequently, nurse case manager reports, even emails or quick status updates sent to the insurance company, must be sent to the injured worker’s attorney.

The first thing a good attorney will do on a case is contact the nurse case manager. The attorney will request all communications on the case to be copied and forwarded from the nurse’s file to their office for review and perhaps for further discussion later. If the insurance company is getting any information, the injured worker’s attorney should receive the same information.

The nurse case manager must be advised on where to send the reports on behalf of the insurance company, whether those reports go to the attorney, staff, or paralegal of the attorney. In many cases, the attorney will ask that a copy of the report be sent to the injured worker. This way, each worker can review the nurse case manager’s reports and confirm the records’ accuracy because the nurse case manager reports this information to all the different parties.

Do I Meet With The Nurse Case Manager?

Nurse case managers have the right to attend appointments and meet with the injured worker in front of the doctor. The Industrial Commission’s rules provide this right for the insurance company should they desire. However, the injured worker’s attorney has the right to request a meeting in their office. This meeting is at the beginning of the attorney’s work on the case or when a nurse case manager is assigned. This meeting is to review the Industrial Commission’s rules, to clarify expectations relating to the nurse case manager’s activities, and the way they are to communicate about a claim.

If you’re an injured worker, it’s best to meet the nurse case manager at your attorney’s office or someplace neutral rather than the waiting room of the doctor’s office. For practical reasons, it’s always best to have a nurse case manager meeting away from the doctor’s office. This way, if the nurse case manager starts asking questions about a private or personal matter, it won’t be within earshot of other patients at the doctor’s office.

Nurse case managers should focus on the medical aspects of a client’s case. It’s not uncommon for the nurse case manager to have questions relating to medical issues for their patients. A nurse case manager usually asks questions about the injured worker’s medical history and current prescriptions, which can benefit a patient’s recovery from their medical treatment. Doctors are then alerted about any past medical issues, possibilities of medications interacting negatively, allergies to medicines, or the like.

Be aware when nurse case managers start asking questions such as:

• What are you doing in your free time?
• Are you going on vacation?
• If you went on vacation, where did you go?
• Do you like your job?
• Have you been in trouble with the law before?
• Do you have any hobbies?

There’s a point when these types of questions become less medical in nature and more involved in work capacity. The nurse case manager is trying to see if the current medical issues are not related to work injuries or accidents that can form the insurance company’s foundation of their case.

Please pay attention when a nurse case manager asks questions about the injured worker’s family or personal life. The responses given could be used against them by the insurance company. Injured workers need to understand that the nurse creates reports. What an injured worker says to a nurse case manager could go into the report and then be passed to all the parties involved, even those whose interests don’t align with the injured workers.

Before answering all the questions from a nurse case manager, it’s best to think for a moment and be sure that the information you’re providing will help the nurse case manager do their job. Otherwise, you’re helping the insurance adjuster do their job. For more information on Reports Created By Nurse Case Managers, a free initial consultation is your next best step.