When workers are injured on the job, the first person they will have contact with through the insurance company will likely be a nurse case manager, also sometimes simply called case manager or rehab consultants. These case managers are not doctors and cannot prescribe medication or treatment, they will simply attend all doctor visits with the injured worker and may even discuss the case with the physician.
Workers are first told that nurse case managers are there simply to help with the case and ensure the injured worker is getting the best possible care. However, it can become much more complicated than that if the nurse case manager is only there to work for the insurance company, which many are.
In the best-case scenarios, nurse case managers can help with an injured worker’s recovery and get them back to work as soon as possible. This is what they are legally obligated to do. Nurse case managers should help getting appointments with appropriate doctors and specialists, attend doctor’s visits with the injured worker, provide and arrange for transportation to doctor’s appointments at no charge to the injured worker, and follow up with the insurance company to get approval for referrals to other medical care providers, if needed.
All this assistance is meant to help the injured worker, but not all case managers are interested in the health of the worker. Instead, because they work for the insurance company, they are far more interested in settling the case for the minimum amount of benefits paid to the worker. Too often nurse case managers place more focus on making their employer happy than they are helping those who have been injured on the job.
So how are workers to know if their nurse case manager is there to help them or hurt them? If a nurse case manager is there to genuinely help an injured individual, they will work in the best interest of the injured worker. If they are not, there are several signs those injured may look for. They may push a doctor to give consent for the worker to go back to work before they are ready. They may also question the legitimacy of a doctor’s diagnosis or recommendation. Often nurse case managers will also take a doctor’s words out of context within their own reports or press a patient to admit they are not that injured, even if they are.
These tactics can be very intimidating and workers may feel as though it is easier to just go along with them, even if it means they receive fewer benefits than what they are entitled to. However, injured workers have many rights during the workers’ compensation process.
The first is that injured workers have the right to be examined in private by their doctor, without the nurse case manager being present. This allows for private conversations between the doctor and the worker, which can give the patient a full understanding of their injuries, how long recovery will take, and when they can go back to work without the presence of the nurse case manager giving their own input. It can also make workers feel more comfortable about fully discussing their injuries when no one else is part of the conversation.
The nurse case manager, however, never has a right to discuss the case with a doctor without the patient being present. Injured workers should be a part of the conversation at all times. This is the only way they can speak up if something was missed, or if their own words are being taken out of context.
When injured workers feel as though their rights have been violated or that a nurse case manager is not working in their best interests, they need to speak to an attorney experienced with workers’ compensation cases immediately. An attorney can hold nurse case managers, and anyone else that works for the insurance company, responsible for fulfilling their legal obligations. They can also ensure that an injured worker’s rights are upheld at all times.
Anyone who was injured on the job and now faces the tedious task of dealing with a workers’ compensation insurance company needs to speak to a workers’ compensation attorney as soon as possible. It is the only way for them to receive the full amount of benefits they are entitled to and to ensure they are being treated fairly at all times.