My long-time trusted colleague Michele Lewane of the Injured Workers Law Firm focuses exclusively on workers' compensation and this is what she has to say about her client's experiences with nurse case managers:"Here is a case in point that happened to more than one of my clients: They leave an appointment with the nurse case manager still there with the doctor, and get a call the next day from their employer saying they are fired because they didn't show up for work and that the doctor had released them to full duty. The nurse case manager got the doctor to "adjust" the work restrictions, gave it to the employer, and "forgot" to inform the injured worker. Don't forget, the nurse case manager is working for the insurance company."
What is a Nurse Case Manager?
A nurse case manager is a registered nurse that may be assigned to your workers' compensation case by the insurance company. His or her role is to monitor your care and report the information back to the insurance adjuster. Because the nurse case manager is hired by the insurance carrier, not the hospital, often times he or she is not looking out for your best interest. They are looking out for the best interest of the employer or carrier.
Why Shouldn't I Trust My Nurse Case Manager?
While there are good nurse case managers out there who truly are patient advocates and are about your well-being, there is a significant portion of nurse case managers whose alliance lies with the carrier or employer.
Nurse case managers often will try to convince the doctor that you are ready to return to full duty or light duty before you are ready. They also will attempt to convince your doctor that the recommended treatment is not a necessity. They do this because the longer you are out of employment and the more treatment you require, the more the carrier or employer will have to pay.
Because biased nurse case managers exist, you should always exude caution during your interactions with him or her.
3 Tips on How to Interact with Your Nurse Case Manager
1) Request a private examination by your doctor.
You have the legal right to a private examination with your doctor without your nurse case manager being present. The reason nurse case managers wish to remain in the room is so that they can potentially learn previous medical issues that you disclose to your doctor. By asking them to leave the room you can discuss freely with your doctor. This is not unusual or something to be nervous about, just ask your doctor for privacy and they should comply. After the examination, your doctor will disclose appropriate information to your nurse case manager with you present.
2) Try to avoid alone time between your doctor and nurse case manager
Referring back to what Michele was discussing, the nurse case manager may try and convince your doctor to reduce your treatment or encourage your return to work after you have already left. If possible, stay in the room during all conversations with your doctor and nurse case manager and leave the doctor's office at the same time as him or her. If your nurse case manager asks to speak with your doctor privately, ask to be a part of the conversation.
3) Keep your attorney in the loop.
Your attorney has dealt with numerous nurse case managers and know the signs of a good nurse case manager and a biased one. If you are unsure about the conversations happened between you and your nurse case manager or the doctor and your nurse case manager, inform your attorney about what is happening. Even if you do not believe the interactions have been important or unusual, tell your attorney anyway because he or she will know what is appropriate conversations and interactions.