During the course of a workers’ compensation claim, the insurance carrier may elect to hire a nurse case manager to help facilitate medical care. My clients often ask about the purpose of the nurse case manager. The following provides some helpful information about the role of the nurse case manager and your rights as the injured worker:

First of all, keep in mind that the nurse case manager is hired by the insurance carrier. Thus, while you may be led to believe that he/she will advocate on your behalf, the fact that he/she is paid by the insurance carrier creates a bias. The nurse case manager may suggest that her intention is to ensure you get all appropriate medical care. However, as to the insurance carrier, the goal is to get you back to work as soon as possible.

Second, you are not required to speak with the nurse case manager assigned to your case, nor do you have to allow him or her to have access to your doctor. My client’s find that sometimes the nurse case manager just shows up to a scheduled medical appointment and casually follows into the exam room. Just because you have a workers’ compensation claim does not mean that you have foregone all privacy rights. However, you do need to be vocal and make sure your preferences are known. I recommend that you inform your doctor that you do not want him/her to speak to the nurse case manager outside of your presence or allow the nurse case manager into the exam room.

Keep in mind that the insurance carrier (and therefore the nurse case manager) will receive copies of any and all medical reports or treatment notes generated by your physician. In fact, doctors are required to submit regular reports to the insurance carrier in order to receive payment for the services provided. Therefore, the insurance carrier and the nurse case manager should automatically receive all of the information that they may need regarding your treatment and disability status.

If one of my clients is assigned a nurse case manager, I generally draft a letter to the adjuster, the nurse case manager and all relevant providers to ensure that my client’s privacy rights are being respected. Beyond that, I request that the nurse case manager direct all inquiries to my office, so that my client is not forced to have any direct contact. Nurse case managers cannot contact you directly once you have legal representation.

Do not allow a nurse case manager to jeopardize your right to workers’ compensation benefits. If you have been contacted by a nurse case manager or you have received notice that one has been assigned to your case, it is important that you speak to an attorney that specializes in workers’ compensation law. Call Gross Law Office to schedule a free consultation.

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