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Don’t let a nurse case manager ruin a workers’ compensation claim

NewsPersonal Injury   March 18, 2019

Good news! The insurance company handling your workers’ compensation claim has just assigned a nurse case manager (NCM) to your case. The NCM is going to communicate with your medical providers about your medical needs, help arrange for services and, ultimately, facilitate your return to work.

Sounds great, right? Well, don’t you believe it.

Nurse Case Managers are typically registered nurses. Undoubtedly, there are some who have the best interests of their patients at heart. However, they all get paid by the insurance company to do one thing: Minimize the expense of your claim by getting you back to work — whether you’re ready or not.

Theoretically, NCMs are supposed to be independent “third parties” who aren’t supposed to be investigating on the insurance company’s behalf. In practice, however, they often act like a second insurance adjustor — one that will actually follow you into your doctors’ visits, if you let them. Since they rely on the insurance company for their income, whose interests and goals do you think they’re naturally more sensitive toward?

With that in mind, here are some ground rules you need to adhere to if a nurse case manager gets assigned to your case:

  1. Remember that you still have a right to privacy. You retain the right to speak to your physician in private and be examined in private. If the NCM wants to follow you to an appointment, that’s fine, but he or she can’t go in the examination room without your consent.
  2. Anything you communicate to the NCM will go straight back to the insurance company. Watch what you say — especially if it can be taken out of context to make you seem healthier than you really are.
  3. You’re entitled to copies of any communication between the insurance company and your physicians — and that includes anything written by the NCM. If your physician clues you in on a letter you haven’t seen, make sure your attorney knows right away.

If your nurse case manager is actually helping you arrange treatment and improve, that’s fantastic. If you suspect your NCM is working against you, however, don’t let your workers’ comp claim get destroyed without a fight. Our office can help protect you against aggressive insurance tactics, however they may come.