How To Control a Nurse Case Manager After A Work Injury

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December 4  

Controlling A Nurse Case Manager

I wrote an article earlier about what a case manager is and whether you have to allow the case manager to be on the case. And I promise to make you an article of when I allow them to serve and what rules do I put on them so that they're not unduly influencing the case.

It's not mandatory that a nurse case manager is on your case. So it's your choice or your lawyers choice. I know some lawyers never allow nurse case managers. In my office I take it on a case by case basis. Because some insurance companies if you allow a nurse if you refuse a nurse case manager they stop paying benefits and they make you fight about everything. Injured workers need their money coming in and they need the medical care they need. We don't want to create a fight if it's not necessary. 

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Rules To Set With Nurse Case Manager

So I allow them in some cases, on a case by case basis. So what I'm showing you here is a letter that I sent some time ago. It's just the first one I pulled up and it's a letter. It basically outlines what restrictions I put on a nurse case manager. So if you're doing this yourself, you're going to want to put this in writing and make them sign it and return it.

So the letter says,

I've received your request to contact our client for medical case management. At present, we have no objection, but here's the rules.
1. No representative is allowed to be present while the petitioner, the injured worker is consulting with her doctor in the exam room.
The nurse case manager cannot go into the examination room while the patient is talking to the doctor, receiving care from the doctor.
2. No representative is allowed to communicate with any treating doctor directly without the injured worker or the attorney present or without our consent.
So in other words, there's not going to be any closed-door secret meetings between the nurse case manager and your doctor. If they want to say something to your doctor, they have to say it in front of me, or in front of you. So we know that they're not unduly trying to dictate the course of treatment or get your doctor to send you back to work prematurely.
3. No representative is allowed to dictate the course of treatment.
A lot of times these nurse case managers will go in when the doctor will order therapy and medication or a surgical procedure. The nurse case manager if she can get away with it, she'll try and convince the doctor to try something else first.
Well the nurse is not your doctor. Your doctor is your doctor. They shouldn't be doing that.
4. Our office receives any and all reports generated by the nurse case managers shortly after the creation.
What a lot of these nurse case managers do is they'll keep notes. They'll sit with the patient in the waiting room and interview the patient. The injured worker thinks it's just a conversation. But what they're doing is they're like writing it down and creating notes. And they're doing that to be like "oh well the patient told me he was able to lift 50 pounds and he said he was playing volleyball".

It Keeps Them From Doing Something They Shouldn't

I mean in any crap like that, I want to see their notes immediately. Because the first time I see something like that, I fire them off the case. This is a sort of a leash you can put on a nurse case manager. It requires you or your lawyer or me in this case, to watch what they're doing and if we get a note that isn't right, we got to fire the nurse case manager immediately.

These are the rules that can kind of keep them from doing things they're not supposed to be doing. And then if you catch them doing something, you can fire them and then you look like the reasonable person to the judge. You can say

"Judge, we allowed the nurse case manager because they requested it and then they broke our rules".

 That's why this letter is so important. That's why I thought I would share with you.

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