What exactly is a nurse case manager (NCM)? In Ohio\u2019s workers\u2019 compensation system, case managers are registered nurses who are supposed to play a supportive role and help coordinate the care that an injured worker receives from the company\u2019s workers\u2019 compensation insurer.<\/p>\n
In theory, that means that they\u2019re supposed to be neutral parties who focus on specific tasks that can speed up your treatment. Those can include:<\/p>\n
\u2014 Coordinating the communication between you, \u00a0your doctors, the insurance company and your employer.<\/p>\n
\u2014 Helping you obtain all the necessary authorizations for treatment.<\/p>\n
\u2014 Explaining to avoid delays in your treatment or care.<\/p>\n
\u2014 Making sure that accurate records are kept about your treatment, surgeries, prescriptions, rehabilitation, overall medical progress and any future prognosis.<\/p>\n
In reality, many NCMs are overly sensitive to the desires of the company\u2019s insurer to get workers off the compensation rolls and either back to work or settled out. They aret not supposed to function like an insurance adjuster or investigator and dig around in your life. However, NCMs rely on insurers for their livelihood, which may factor into how they actually treat you. Keep the following things in mind:<\/p>\n
\u2014 Your NCM should not speak to your physician about you unless you or your attorney are present. If that happens, let your attorney know immediately.<\/p>\n
\u2014 You have the right to be examined by your physician privately and to discuss your treatment options without the NCM present. Don\u2019t agree to waive that right at any time.<\/p>\n
\u2014 Everything you say or do can end up in the NCM\u2019s report to the insurance company. Watch what you say and don\u2019t confide anything to the NCM that you don\u2019t want the insurer to know.<\/p>\n
\u2014 You should receive copies of all your NCM\u2019s correspondence with the insurance company and your treatment providers. If you find out that you aren\u2019t (usually through one of your physicians), let your attorney know.<\/p>\n
The reality is that some NCMs are genuine professionals who are dedicated to making life easier for injured employees. Others forget what their role is really supposed to be.<\/p>\n