Nurse Case Manager In Workers Comp? What Are They Allowed To Do? How To Control Them?
Nurse Case Manager In Workers Comp? What Powers Do They Have? Can They Be Controlled? Can A Nurse Case Manager Tell You When To Go Back To Work Or Cut Off Your Treatment?
The short answer is that a nurse case manager in Workers Comp cannot tell you when to go back to work. They are not allowed to direct your treatment or turn your doctor against you.
Whenever an insurance company hires a case manager in a Workers Comp case, who is also a nurse with some medical training, to ‘help’ in one of my clients’ cases, I know what is really going on. The Company or the insurance company is trying to beat your case. They are trying to say you are trying to make the injury bigger than it is, and they are trying to get you to go back to work whether you are ready or not.
Nurse case managers are employees of the Company/insurance company, and their job is to keep costs down. If they do not keep costs down, they are not used by the insurance company anymore.
A Natural Conflict
This creates a conflict between the injured worker and the nurse case manager. The injured person is worried about getting paid, getting benefits started, making sure they get the medical care they need, and getting rest so they can recover from their work related injury.
All of these things cost the Workers Comp insurance company money. So, they hire a nurse case manager to limit treatment, limited time off work, figure out a way to deny claims, and generally get the client back to work as fast as humanly possible. This is not always a good idea, but the dollar is what they care about.
They try to meet with your doctor and influence the doctor. Some get aggressive with the doctor and try to tell the doctor what to do. they might say things like “Well, okay, then he is ready to go back to work right now, correct?” or “She doesn’t require any more case, so why don’t we just release her for full duty work?”
It is a rotten thing to do.
Getting Nurse Case Managers in Workers Comp under control and setting ground rules for their behavior right out of the gate is the name of the game.
I send nurse case managers a letter telling them the “rules” for they being involved in the case. In other words, I tell them what they CAN and what they CANNOT do. If they do not follow my rules, then I force them out of the case.
Yes, I can fire a nurse case manager in Workers Comp off your case. But this usually makes your case 'disputed' which slows it down and can result in your benefits being cut off or interrupted. SO I only do it if the nurse has been warned and will not follow my rules.
I don’t let them bully my client. I don’t let them attend an appointment in the meeting room. I tell my client to answer direct questions but keep the communication short and direct. No long conversations if you have a mean nurse case manager. I remind the nurse case manager that she isn’t allowed to direct treatment or tell my client what treatment to have or what doctor to go to or anything like that.
I hate to say it, because sometimes, a nurse can be a really nice person and can really be helpful. I have met a lot of great, caring nurses over the years.
But honestly?
Usually you can just think of them as insurance company spies who are trying to get you back to work for the benefit of the company; to cut your treatment as short as possible; and to write down anything you do or say that they think will help the Company beat you in your Workers’ Compensation case.
Specifically, a nurse case manager cannot send you back to work or cut off your treatment. Only a doctor can do that, so you do not really want a nurse case manager to be too “buddy buddy” with your doctor. But they CAN and DO influence doctors and insurance company claims reps.
That’s why if I sense that I have a pro-insurance, an anti-working person case manager in one of my clients’ Workers’ Comp case if push comes to shove, I’ll kick them off the case and tell the insurance company exactly why. Better to fight over discharging a nurse than to allow one to stay on a case and let them ruin a case with lies and a rotten attitude.
Consider a Free Consult with a Workers Comp Lawyer
A good lawyer can rein in a nurse case manager that is out of control. They should not be directing treatment or act like they control the medical treatment. They shouldn’t stomp around and treat you like you are a liar or a fraud.
If you have been hurt and are dealing with a difficult Nurse Case Manager, consider giving me a call so we can develop a plan to help protect your rights.
