What Is a Nurse Case Manager? Do I Have To Let A Nurse Case Manager Work On My Case?

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November 27  

Who Are Nurse Case Managers?

I had a client call me and say that she got hurt at work and somebody contacted her. A nurse contacted her and said that she had been assigned to work with my client on her medical care. She wanted to know who this nurse case manager was and does she have to work with her. A nurse case manager is when the workers comp insurance company wants to assign a nurse to sort of keep an eye on you and sort of monitor your medical care. That's the official reason.

A nurse case manager can only be on your case if you or your attorney allow the nurse case manager to be on the case. So you don't have to let them be on the case if you don't want to. What I do, a lot of times, is if it's a small case and I know that it's going to be a tiny amount of medical care and the company, the insurance company has otherwise been paying benefits and doing what they were supposed to be doing, I will sometimes allow a nurse case manager to serve on the case. 

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Insurance Companies Do It To Save Money

The problem though is that, the real reason insurance companies put the nurse case manager on these cases is because they're doing it to save money. They want your doctor to give you as little medical care as possible. They want to argue with the doctor, convince the doctor to send you back to work early, cut your treatment short, if the doctor is prescribing an expensive medical procedure or expensive medicine the nurse will come in and argue with the doctor.

A nurse isn't supposed to do that, but in this context they do. So I have a letter that I send and I'll make another article probably today for you, that shows you the letter I send out and I'll gray out the people's names for confidentiality. But if I allow a nurse case manager to serve on a case, I have a bunch of rules for them. If they break any of the rules, they're fired.

Blanket Refusal

A lot of law firms never let a nurse case manager serve. What I find is that, as soon as somebody does that, as soon as with certain insurance companies, if you have a blanket refusal never to allow a nurse case manager on the case. What they do is they'll immediately terminate benefits and then you've got to go to court and fight about everything. They take your refusal to use a nurse case manager as an invitation not to pay anything and then fight over everything. So depending on the stage of the case, the type of injury, who the treating doctor is, I'll make a case-by-case decision on a nurse case manager.

They Are Not Your Medical Team

You have a right not to use one. They have a right to decide that they want to fight your case because you won't allow them to use one. But there's a real danger with nurse case managers, they're not there to help you. The thing to remember is, they're not there to help you, they are not your friends. Even if they act friendly. They're getting paid by the insurance company to keep your case cheap for the insurance company. And that's their primary goal, they're not on your medical team, they're an outsider coming in trying to cut costs for an insurance company, not trying to get you better.

So that's what you need to know. 

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