What to Expect from and How to Deal with a Workers’ Comp Nurse Case Manager
Workers’ compensation cases can feel overwhelming. There are so many steps, and if you’ve never dealt with it before, it can be daunting. You’ve probably heard about workers’ compensation nurse case managers, but what role do they play in the process? The nurse case manager would typically coordinate any medical care needed for an injured worker. The key is recognizing that this position is usually hired by the employer’s workers’ compensation insurance company. What can you expect from a nurse case manager and how should you deal with and manage that relationship?
Where does a Workers’ Comp Nurse Case Manager Fit in the Workers’ Comp Process?
Typically, the nurse case manager is a registered nurse that would essentially be your medical caseworker. Keep in mind that this position is typically hired by the employer’s insurance company, so while they’re there to assist in the process, it’s important to stay aware of the nature of the relationship. They may not be impartial. Nurse case managers are hired as a way to assist in setting up appointments, handling medical-related conversations with care providers, and ensure the injured person is taking the right steps toward recovery. Ideally, the nurse case manager is advocating for necessary care, but since they are hired through the insurance company, it’s always a good idea to advocate for yourself and your own care.
What is the Nurse Case Manager’s Involvement During Your Claim?
A nurse case manager can help with appointment scheduling and follow-ups directly related to any medical care you’re receiving as a result of your injury. They can also be available to attend medical visits. Is it necessary for the nurse case manager to sit in on your appointment? No, it is not. While it could be helpful when reporting back to the insurance company, you also have the right to private medical care. Ideally, your examination with the physician should be private with just you and the physician or the physician’s staff. After the examination, and after decisions are made, the physician can call the nurse case manager into the room to explain what was decided concerning treatment, referrals, work restrictions, etc. This is best in order to prevent the nurse case manager from improperly influencing these decisions.
Additionally, the nurse case manager can manage the communication with the insurance company when it is related to your recovery. It is important to follow through with your own meetings and connection points with the insurance company just to ensure all details are accurate. There is always the chance of human error or even improper influence or manipulation. So while the nurse case manager should be objective, you need to be diligent on your end to ensure communication is accurate and consistent.
The nurse case manager participating in conversations with your care provider gives insight into your healing process and any ongoing treatments. But again, you should be a part of this conversation so that you can ensure accuracy and help to avoid improper influence.
How Best to Interact with Your Nurse Case Manager
Depending on the injury, you could be spending a lot of time with your nurse case manager. Be sure to set clear boundaries, especially with your conversations, and stick to only work-related topics. Again, they should be objective to the situation, but they’re still there on behalf of the insurance agency. Be sure to protect your privacy and set boundaries from the start.
Part of their job is to document everything, from the appointment to your conversations. You should also keep your own records and documentation and make sure that you are a part of any conversation between the physician, or physician’s staff, and the nurse case manager. This helps hold the nurse case manager and the insurance company accountable, and ensures accuracy across all records related to your case.
Like most situations, consistency is key. Stay consistent and check in regularly with both your nurse case manager and your doctor. While the nurse case manager may be assisting with scheduling and appointments, you’re still the patient, so you should be in the know about your own medical care.
Expectations and Working Through Your Workers’ Comp Case with a Nurse Case Manager
The nurse case manager should be an objective party and assist with scheduling appointments, communication with the insurance company, and maintaining an understanding of your medical care and needs. They are hired by the insurance company, so they may not be impartial. It’s important to be diligent and stay up-to-date on everything related to your own case.
Finding a trusted workers’ compensation lawyer plays a huge role in your recovery and getting what you deserve after an accident that caused you injury. The lawyers with Williams & Kamb are more than equipped to help you through your workers’ compensation case and with managing the relationship with your nurse case manager.
Call our office to schedule an appointment and talk through the best next steps for your case.