Often an injured worker first finds out that there has been a nurse case manager assigned to their case is when they meet the nurse case manager at the treating physician’s office for the first time. Insurance companies will generally spring the nurse case manager on the injured worker so the injured worker does not have sufficient time to react and/or research their rights regarding have a nurse case manager present when they see their treating physician. Most injured workers do not even know what a nurse case manager is or why they are assigned to their case.
First, please be aware that there is no statutory requirement that the injured worker must allow a nurse case manager to be assigned to their case and/or that the injured worker discuss his treatment plan with the nurse case manager. That being said, if an injured worker objects to the nurse case manager, the workers compensation claims adjuster feels justified, all be it not legally justified, in cutting off their TTD benefits, creating a financial hardship on the injured worker and his family, of not having any money coming in.
To avoid the disruption in TTD benefits, injured workers usually allow the nurse case manager on their file provided the nurse case manager abides by the following guidelines:
- The nurse case manager is never present in the doctor’s office when the doctor is providing therapeutic treatment to the patient/injured worker
- The nurse case manager should never be allowed to speak with or to the doctor without the presence of the injured worker
- The nurse case manager must provide copies of any and all written reports made to the insurance company to the Petitioner or the Petitioner’s Attorney, if he or she is represented.
Generally the nurse case managers will agree to and abide by the above ground rules as they are fair and reasonable. If the nurse case manager violates these rules, the injured worker may cancel the authority given to the nurse case manager to be the nurse case manager on their case, even if she has been to several doctor’s appointments already.
Nurse case managers sometimes wish to discuss the injured workers case with the treating physician, without the injured worker being present, so the nurse case manager can lobby the doctor for a return to work earlier than the treating physician originally planned or ordered, to save money for the insurance company. The nurse case manager is paid by the workers compensation insurance company and thus their duty and obligation is to the insurance company even though they claim they are trying to obtain quality medical care for the injured worker. It is not unheard of that nurse case managers will attempt to plant a seed in the treating physician’s mind that the injured worker is faking their injury or malingering to receive a higher settlement when their case resolves. To ensure that the nurse case manager is prevented from attempting such unscrupulous activities, setting the above stated ground rule that a nurse case manager may only speak with the treating physician in the presence of the injured worker solves that problem.
Workers compensation insurance companies in an attempt to save money will assign telephonic nurse case managers, rather than nurses that actually attend the doctor’s appointment. Usually when the insurance company attempts to use telephonic nurse case managers, those nurse case managers do not provide written reports and as such cannot abide by rule number 3, thus it is prudent not to allow telephonic nurse case managers on your file.
Injured workers who do not have an experienced workers compensation attorney representing them, may not have been told or know that they have the absolute right to refuse a nurse case manager on their file. They may not know that the nurse case manager is paid by the workers compensation insurance company to save money for the insurance company and the nurse case manager reports directly to the insurance company. The injured worker may not know they have a right to receive copies of all reports provided by the nurse case manager including the reports that were made prior to demanding copies of those reports.
Furthermore, the injured worker may not realize that the money paid to the nurse case manager does not get included in the workers compensation insurance company’s Section 5b Subrogation Lien for a third party case.