Health Care

The Role of Nurse Managers in a Workers’ Compensation Claim

Portrait of successful doctor with stethoscope

The Role of Nurse Managers in a Workers’ Compensation Claim

Cardinal Law Partners August 28, 2020

The last thing you need to worry about after being hurt at work is being tasked with picking up prescription medications, obtaining necessary medical equipment, scheduling and remembering when to make hospital visits, and making/keeping appointments. While you may have a loved one to help out, all of that can still feel like a second full-time job.  

Worker’s compensation insurance carriers sometimes hire nurse case managers to assist injured workers with the aforementioned tasks. In order for a nurse case manager to be as effective as possible, injured individuals must have a complete understanding of both the limits of a nurse case manager’s role as well as the employee’s rights amidst the workers’ compensation process.

What Can Nurse Case Managers Do?

Most nurse case managers are registered nurses. They act as medical case workers and are essentially liaisons to the patient. With the patient’s permission, nurse case workers attend hospital appointments and doctor visits. They communicate with both the authorized physician and the patient about the treatment of the patient.

Responsibilities of a nurse case manager can include the following:

  • Provide information to an insurance adjuster as it relates to treatment authorization and doctor visits.
  • Act as a liaison for all parties involved in the workers’ compensation claim. This may include the insurance company, employer, injured worker, and doctors.
  • Assist the injured individual in getting the medical care that she or he needs.

According to some sources, nurse case managers may also be tasked with ensuring that the insurance carrier is kept up to date by physicians on all matters that are medically relevant. This can pertain to a possible return to work date, future prognosis, treatment, patient prescriptions, and more.

How Workers’ Compensation Claims Are Impacted by the Nurse Case Manager

Nurse case managers are uniquely experienced in situational, vocational, social, and medical issues. They can serve as objective third parties for both patients and physicians.

  • For patients – The nurse case manager is important for providing injured workers with information validation. Additionally, if there are problems related to the injury, nurse case managers can help identify them. They can also make sure that effective medical care progress is made. To alleviate possible problems, nurse managers can take action or raise concerns if they find that appropriate care is not given.
  • For physicians – Case managers are particularly important for physicians because they can facilitate the accurate/necessary communication.

The Insurance Company and the Nurse Case Manager

While nurse case managers can work independently from insurance companies, they are most often connected in some way, shape, or form. The designed role of the nurse case managers is to always advocate for the patient.  Some injured workers have complained that they feel the nurse case manager acts too frequently as a “second insurance adjuster.” Although this is not an official part of the nurse case manager’s job, they do get paid by the insurance company.  If you ever feel that this has been the case, you should immediately contact your workers’ compensation attorney and share this information!

Cardinal Law Partners – Seasoned Workers’ Compensation Attorneys

When appealing or filing a workers’ compensation claim, the best and smartest thing an individual can do is to obtain legal representation. The professionals at Cardinal Law Partners have successfully handled numerous worker’s compensation cases and are more than well-equipped to fight for your rights. Whether your claim has been denied and you want to appeal, or you are filing for the first time, turn to the experts to get the job done right.  

You’ve got rights! We’ll help you defend them. Contact us today for a free consultation.